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The Flemish model, a multiplicity of Home Care organizations. Sarah Willockx. Belgium: Politics and society structure of state. Federal state Competent for specific matters such as ‘social security’ 3 communities : Flemish, French-speaking, German-speaking community

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belgium politics and society structure of state
Belgium: Politics and societystructure of state
  • Federal state
    • Competent for specific matters such as ‘social security’
  • 3 communities: Flemish, French-speaking, German-speaking community
    • Competent for personal matters such as education and welfare
communities

Flemish or Dutch-speaking community

French-speaking community

German-speaking community

Communities
the social security system
The social security system
  • Totally elaborated system:
    • Elderly pensions
    • Unemployment benefits
    • Family allowances
    • Sickness and disability insurance
  • 2 pillars
    • insurance principle
    • solidarity principle
  • Control and organisation by federal state
slide5

Demographic context

per age group of 5 years and per 1.000 inhabitantsSource: www.statbel.fgov.be

slide6

Home Care services in Belgium

Purpose

  • Door-to-door care for costumer
  • Support proximity aid
  • Promote independency
  • Non-commercial point of view
  • No exclusion based on risk, financial situation, race or conviction
slide7

Job contents

Federal home nursing

  • Nursing tasks
  • Help with:

- everyday personal hygiene

- medical care

  • Specialized tasks by specialized nurses
slide8

Job contents

Non-medical home services

  • Personal hygiene
  • Domestic help
  • Cleaning help
  • General psychosocial and pedagogical support
slide9

Job contents

Logistic services

  • Growing demand for logistic help and additional home help
  • Cleaning help, odd jobs and sitting services + general psychosocial and pedagogical support
  • Wallonia: elaboration in progress
  • Flanders: own rules already applied
slide10

Job contents

Service vouchers

  • Cleaning, ironing and cooking at home of costumer
  • Also ironing, transport or shopping services
  • Employment measure
  • Fight illegal work
  • Support families with two partners out working
  • Accessible for everyone: with or without need of care
slide11

Conditions & accessibility

Home nursing

  • Medical care: doctor’s prescription
  • Personal hygiene: No prescription GP

Katz-scale

slide12

Conditions & accessibility

Non-medical home care services

  • No formal reference
  • Contact by: costumers, proximity caretakers or 3rd persons (GP, social service hospital)
  • Social examination by social worker
slide13

Conditions & accessibility

Logistic services

  • No fixed rules
  • Often same procedure as non-medical home care
slide14

Conditions & accessibility

Service vouchers

  • Target group: able-bodied healthy people
  • Apply at certified organization
  • Exception in Walloon part: also for

non-medical home care services

slide15

Organization & caregivers

Home nursing

  • Qualified nurses: bachelor, master or registered
  • Reference nurse
  • Wage earning or self-employed
slide16

Organization & caregivers

Non-medical home care services

  • Caregiver: certificate regular daytime classes or adult education
  • Wage earners for a certified home care service
slide17

Organization & caregivers

Logistic services

  • Flanders: no specific certificate
  • Wallonia: sitting services require certificate of professional caregiver
slide18

Organization & caregivers

Service vouchers

  • No specific certificate
  • Employed by a certified firm
  • Certified firms: commercial or non-commercial
  • Steady job
slide19

Legal & financial framework

Home nursing

  • Federal matter< social security

Subsidies rating per nursing act

Lump sum: based on degree of need of care

  • Third party system: user pays nothing
  • Share of beneficiary can be charged
slide20

Legal & financial framework

Non-medical home care services

  • Community matter
  • Public and private services
  • Flanders: quota of subsidized hours based on programming figures
  • Wallonia: subsidies per geographic zone & per service
  • Wallonia: limited 200 hours per user / trimester
  • Flanders: no limitation
slide21

Legal & financial framework

Non-medical home care services

  • User contribution per hour depending on income and family situation:

Flanders: 0.5 €  cost price Gravity of need = reduction possible (average 3.5 €)

Wallonia:0.9 €  8 €

(average 2.60 €)

slide22

Legal & financial framework

Logistic services

  • Community matter

How?

  • Flanders: envelop financing on annual basis per full time equivalent
  • Wallonia: no specific financial framework

user pays small contribution based on income and family situation

slide23

Legal & financial framework

Service vouchers

  • Federal matter

How?

  • fixed wage
  • User buys voucher of 7.50€/hour
  • Fiscal advantage of 30% (2.25€/hour)
  • Voucher is worth 20.80€ for the employer
  • Financed by federal government
slide24

Multidisciplinary collaboration & consultative bodies

  • Types of services not unrelated
  • Disciplinary and multidisciplinary consideration
  • Structured formal consideration
slide25

Challenges

  • Ageing and declining population
  • Solidarity principle under pressure?
  • Market developments
  • Job demarcation and competences