Integrated Long-Term Care in the EU: Challenges and Concepts
One of the major challenges facing the EU and its constituent countries is comprehensive care in long-term care. Comprehensive or integrated care is a balanced agreement of negotiations, regulations, and incentives to guide the various actors in the provision of care, coordination, cooperation, and consensus in a well-organized system of care in which care for the user is sustained, understandable, flexible, and responsive to their needs.
The appropriate level of integration to promote comprehensive care is the full integration of all the resources that each person has in a care setting. In this sense, the Spanish Law Unit has established the cooperation of individual care programs (art. 11). Integration issues such as long-term care, health care resources, and type of housing in a position of greater dependency are other aspects to consider. The ultimate goal of integrated care is to find ways of responding to the increasing demand for services, linking user participation, social ties, a sense of usefulness, and the optimal level of income, and decent housing.
Also, one must consider the full dynamics involved in caring for each dependent. The implications for a Unit will differ depending on whether they undergo a strong network of relationships or are isolated, or have a very severe dependence, where the patient is more vulnerable to detention and the distancing of his own family due to illness and caregiver stress. Currently in the EU, a principal ongoing action in social policy aimed specifically at disability is the European Action Plan for Persons with Disabilities (2004-2010), which establishes the priority of equal opportunities. It revolves around 3 objectives:
- Complete the implementation of the directive on equal treatment in employment and occupation
- Further integrate the disability dimension in EU policies concerned
- Promote accessibility for all.
Key Concepts Associated with the Unit (Law 39/2006, of December 14)
- Unit: A permanent situation of people living with limited personal autonomy, needing help from another person or persons to perform the Activities of Basic Daily Living (ABDL).
- Personal autonomy: The ability to develop ABDL, and control, manage, and take personal decisions about how to live according to rules and preferences (Art. 2).
- The ABDL: The most basic tasks of the person, such as personal care, domestic activities, essential mobility, recognition of persons and objects, guidance, understanding, and performing simple tasks (e.g., hand washing, eating, dressing, etc. (Art. 2).
Dependency and disability are two related concepts but must be treated separately. The former implies that a person needs help from another or others to perform ABDL as the result of illness or disability. The disability implies limitations in physical capacities that sometimes result in difficulties for some activities. However, not all need help from another person to function in daily life. That is to say, disability is related to the physical problem and dependence with the consequences that sometimes can lead to disability.
- Long-term care: Particularly relevant in terms of dependence. The OECD has defined them as a matter of transversal policy which combines many services for people who depend on aid for ABDL for an extended period of time. The dependent elderly are those with a greater numerical weight in demand for long-term care for chronic physical disabilities and mentally. They urge special care and long-term rehabilitation, social assistance, basic medical services, nursing home, shelter, transportation, food or rehabilitation professionals.
- Non-professional care: Relates to the focus on people in a dependent state at his home by members of the family or its environment, not linked to a professionalized care service.