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1
Rundum Zuhause betreut

• Home Care Europe Conference
• Caritas Vienna
• Irene Pichler
• Vienna, 4th of June 2009

2
Points of Departure

• High number (no exact estimates) of illegal
  migrant health care workers in Austria to deliver
  home-care-services for persons in need of care
• Changing patterns of care reduction of
  traditional care of relatives, people wish to
  stay at home as long as possible
• New laws passed in 2007 to legalise
  home-assistance workers
• Hausbetreuungsgesetz (home assistance law)
  entered into force in July 2007
• Changes to the Trade Commerce and Industry
  Regulation Act regulates the self-employment of
  home-assistance workers
• Legalisation of illegal migrant health care
  workers in Austria ? transition to legal service
  of 24/7-home-assistance
• End of the amnesty by the end of June 2008

3
Self employed legal Home-Assistance Workers (HAW)

• Two legal possibilities regular employment and
  self-employment
• Most of the new legal HAW are self-employed
  (employment too complicated)
• Necessary to have a trade licence (unregulated
  trade)
• Two-week rotation (2-3 months for
  Romanians/Bulgarians)
• Origin of neighbourghing and other EU-states
• Qualification requirements Caritas - at least
  the qualification as a home-assistance worker
  (about 200hours) since 2009 there is a new
  requirement for public funding of
  24/7-home-assistence
• Contractuelle Situation 1 -Service-contract
  between the placement agency and the client
• 2 - Home assistance contract between the person
  in need/relatives and HAW that defines the
  precise activities ? monthly payment, social
  insurance and self employed taxation

4
Contractuelle Situation
Caritas
Service-contract
Home-assistance workers
Person in need of care
Home-assistance contract
Placement Agencies
(Partially high recruiting-fees)
5
Services provided by the legal Home-Assistance
Workers

• Services rendered for people in need of care
  include the following home-assistance
  activities (vs. medical care) f. e.
• Support activities in the household (such as
  cooking, making purchases, etc.)
• Support regarding the organisation of daily
  activities
• To assure social interaction for the person in
  need of care
• Preparation for changes in residence
• Organisation of home assistance activities
• Support in feeding, hydration and prescription
  medicine, personal hygiene, support in
  dressing/disrobing etc. ? unless medical reasons
  necessitate a written order (Delegation)
• Includes single medical care activities if
  delegated by physicians or nurses

6
Caritas offer of 24/7-Home-Assistance

• Service has been offered by the Caritas
  non-profit association Rundum Zuhause betreut
  since 2007
• Within the non profit association five Caritas
  dioceses (Caritas of Vienna, St. Pölten, Linz,
  Salzburg und Graz-Seckau) are working together
• This service is offered in five Federal States in
  Austria Vienna, Lower und Upper Austria,
  Salzburg, and Styria
• Cooperation with placement agencies regarding the
  recruitment of HAW (mainly in Slowakia)
• Legalisation Project in 2008 in cooperation
  with other Austrian NGOs on behalf of the
  Austrian Ministry of labour and Social Affairs
  information and consulting regarding legalisation
  

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Key Services rendered by Caritas

• Information and consulting for Austrian families
  regarding the legal service of 24/7-home-assistanc
  e
• Care assessment (requirements, health situation,
  activities)
• Recruitment of legal home-assistance workers,
  check of qualification requirements and knowledge
  of German as well as occupational aptitude /
  motivation
• Legalisation ( business or trade
  registration)
• Quality management check through regular
  quality visits
• Administrative support for families and HAW
  (regarding social insurance, business/trade
  registration, etc.)
• Mediation and support activities in conflict
  situations

8
Caritas Quality Assurance

• 1 Home visit by nursing staff
• Checklist for the home visit Personal data,
  assessment of care needs and existing care
  assistance-network ? decision if this service is
  appropriate
• 2 - Regular quality assurance visits by the
  nursing staff of Mobile Home Care Services
  (Caritas Mobile Dienste)
• Checklist for the quality assurance visit
  assessment of - customer satisfaction, -
  competence of the HAW, - evaluation of changes in
  care needs and the care assistance-network, -
  suggestions for improvement
• If necessary mobile home care services or a
  written order (Delegation) is provided

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Written order Delegation for medical care
activities

• In April 08 a new law was passed dealing with
  Delegation/Subdelegation of medical care,
  diagnostisc and therapeutic activities (GuKG
  3b,15)
• Regulates that single medical care activities
  needs to be delegated by physicians or nurses
• Development of procedures / documentation forms
  by Caritas
• Training of Caritas employee in these procedures
• Information and consulting are given to the
  client during the home visit
• Control during the regular quality assurance
  visits

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Services in Detail Client Perspective

• First home visit to assess needs in care und
  home assistance activities, decides on the
  admission to the 24/7-home assistance service
• Regular quality assurance visits by the nursing
  staff of the Sozialstationen / regional bodies
  of the associated dioceses
• Recruitment of qualified HAW
• Legalization and administrative support
  regarding social insurance, registration of a
  business/trade
• Continuous contact in the case of conflicts

11
Services in Detail from theHAWs Perspective

• Recruitment activities for self-employed HAW
  instead of own acquisition activitites,
  organisational support and strong bond to the
  organisation
• Check of qualification, legal requirements and
  German knowledge
• Legalization - support activities regarding the
  registration of the business /trade, Caritas/NGO
  serves as a clearing house for HAW
• Further administrative support regarding social
  insurance regulations, etc.
• Regular quality assurance visits by the nursing
  staff of the Sozialstationen / regional bodies
  of the associated dioceses Support as well
  suggestions for improvement / competence of the
  HAW
• Contact by native-speaking team members in case
  of conflicts

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Costs of 24/7- Home Assistance

• 1- Service-contract between the placement
  agency and the client
• Amount for placement and home visit 970,- (2
  HAW)
• Monthly charge 155,-
• 2 - Home assistance-contract from 65 to 75 /
  per day plus travel expenses room and board must
  be provided
• Public financing of 24/7-home care 550,-/per
  month ? recoverable after the 3rd level of
  long-term care benefits (federal system)
• Sample calculation 30 days x 65 1950,-
  160,- travel expenses 155,- Caritas ?
  2265,-/per month

13
Results / Status Quo 2009

• High level of interest in the new legal services
  from Austrian families ? less focus on
  legalisation of illegal HAW
• Caritas about 130 active clients in five Federal
  States
• More than 260 HAW in the labour pool
• Regional focus Vienna / Lower Austria
• Countries of origin about 95 Slovakia (Czeck
  Republic, Hungary, Romania)
• Development of wellcome-folders for clients as
  well as bi-lingual folder and introductory
  sessions for HAW

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Experiences / Challenges

• Heavy financial burden for Austrian families
  already at the limit
• Recruitment of qualified home-assistance
  workers with good knowledge of German and social
  competence
• Lack of entrepreneurial competences /
  entrepreneurship of HAW
• Significant administrative, language and social
  barrieres lack of legal information (f. e. on
  HAWactivities) etc.
• Necessity to cooperate with private placement
  agencies
• High expectations of the persons in need
  /relatives
• High potential for conflicts

15
Prospects

• Need to promote entrepreneurial competence
  /improvement of language knowledge /ability
• Need for accompanying/advising structures for
  self employed HAW
• Improvement of support / information / further
  training for HAW (partially excessive demands f.
  e. dementia)
• Differentiation of the service short-term
  24/7-assistance (f. e. relief of the burden on
  the families), service after hospitalisation
• Quality assurance continuous improvement of
  quality / quality assurance of the new legal
  service
• New qualification requirements for public funding
  of 24/7-home-assistance (at least 168 hours
  theory plus first aid training)

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• Thank you !