-
01 March 2024 | Country Update
Strategic planning of care for the ageing population
5.8. Long term care
LTC for the elderly, disabled and those suffering from chronic diseases, along with vulnerable populations, is fragmented between Czechia’s health care system (for example, aftercare in hospitals, LTC homes for the severely ill) and social care system (for example, residential homes or day care centres), but is not considered a separate branch of either system. Though overlapping, both systems vary in terms of organization, funding and staffing. Within the social care system, different organizational responsibilities rest with the state, the regions and municipalities; regional and municipal authorities are the main owners of residential social care institutions as well as outpatient or community-based services and MPSV is the main supervisor. In the health system, LTC is organized around nursing care and falls under the supervision of MZČR and is only available after a physician’s assessment. Regarding funding from the budget, LTC is primarily SHI-financed and stood at CZK 3288.8 per capita in 2019, up from CZK 2152.8 in 2013 (Eurostat, 2022). In the social care system, LTC financing (which also funds related nursing care) comes first from the state, regional and municipal budgets, though private payments also play a role. A detailed breakdown of different sources of financing in 2018 is depicted in Table5.4.
Table5.4
Act no. 108/2006 Coll. introduced care allowances into the social care system (on top of existing disability and other disability-related social benefits). Care allowances are scaled into four levels according to the recipient’s degree of dependency. Degrees of dependency are determined by the number of basic living needs that cannot be met without everyday help (out of 10 activities). Care allowance applicants must first undergo an examination by the Czech Social Security Administration (including a fitness for employment evaluation). Depending on the assessed ability to perform independently activities of daily living, the patient may then be eligible for a monthly allowance as depicted in Table5.5.
Table5.5
In 2019, personal care allowances amounted to CZK 29.8 billion, up 14.4% (CZK 3.8 billion) from 2018. There were 363 600 allowances paid out monthly in 2019, with 8.5% (30 900) for children up to 18 years of age (MPSV, 2020–2022).
There were 67 889 recipients in LTC institutions in 2019, up from 50 380 in 2008. There were 74 208 residential long-term beds in 2019, the highest capacity recorded for Czechia since 2005, though it was only a slight increase from 2008 (68 811; 7.8%) and was far outpaced by the increase in the number of recipients (34.3% increase from 2008 to 2019) (OECD, 2022a).
Apart from residential settings, comprehensive home care from SHI is also available. First introduced in Czechia in the early 1990s, comprehensive home care is an integrated form of care provided to patients within their own social environments. A key component of comprehensive home care is home health care, which is a particular form of outpatient care provided over a defined time frame by nurses with a physician’s direction. SHI-financed services provided by home health care providers must be strictly medical in nature; nonmedical services, such as meal delivery, are not covered, though patients can purchase them using care allowances.
On 24 January 2024, the Ministry of Health in Czechia launched a project to support the planning of the development of integrated health and social care. This three-year project is aimed at reacting to the rising needs of the gradually ageing population and growing number of chronically ill patients. The goal is to map the existing health and social services around Czechia and identify what is missing. The ambition is to determine specific steps to fill these “white spaces” (bílá místa). A preliminary investigation shows that one of the problems might be the lack of rules and conditions for the cooperation and coordination.
Methodological guidelines for the creation of regional health and social plans should be created in cooperation with the Ministry of Labour and Social Affairs and other partners of the project: the representatives of regional administration, health insurance funds, representatives of health and social service providers, and representatives of the clients/patients. The project will take place in all 14 regions and will also include training of officials of the health and social departments of individual regional offices.