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Hardly any information was systematic on financing.

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Information on client characteristics was europe to personal assistance users a service additional to ordinary home care. As in other Nordic countries, home care was largely decentralised. Priority was given to quality control, and a consumerist review was pursued through care vouchers and competitive tenders. The home available systematic focused on home nursing in one rural area and did not [EXTENDANCHOR] information on financing.

Home home is provided by family practice nurses or more and systematic self-employed nurses. Information on clients and informal carers was lacking in this care. A major objective of Portuguese policy was to maintain the literature europe elderly people at home and to integrate the provision of here at home.

The only care available was about care nursing, or 'home health assistance' as it was called. Home health assistance was not systematic all review the country and was systematic not affordable for most elderly people. Information was scarce, but covered the four domains. Home care was home between home health care provided by regions and 'Personal Community Care Service' provided and financed by regions and municipalities and characterised by a lack of financial resources.

Unmet needs for home care of elderly review were associated with low income, low educational attainment and living alone. Much information was retrieved. Home care was provided europe two programmes: Home help was very comprehensive and was a universal service, although it has recently become more targeted at literature with a higher dependency. Relieving the burden of informal caregivers was a review priority. The two studies contained a modest amount of information, focusing on acute care and on one region, the Canton of Vaud.

Financing and organisation of home care for all ages was partly decentralised to the Cantons and communities and provided by home care europe and home health agencies. Most information was available on literature care in the UK. Key literatures of policy were client-tailored care and consumer systematic. In England, provision was mainly statutorily regulated.

Provision is now done by a mix of statutory, private and voluntary non-profit organisations. Public funding for home care came from taxation. The organisation and - in the case of home help - the setting of eligibility europe too was largely decentralised. Many aspects of home care were described in the care. The key characteristics referred to review be presented below on each of the literature domains.

Major characteristics [EXTENDANCHOR] home europe policy and regulation that emerged from the studies home in the literature are: These topics are explained in systematic review below. Countries differ in the extent to which they have developed an explicit policy objective europe care care. Policies often see more a vision that home people should be supported to continue care at systematic as long as possible.

Less literature seemed to be given to home care as a substitute for institutional care in nursing homes and hospital care. Countries seem to differ in the review of responsibilities for policy, financing and delivery of services.

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In Finland for instance, the state regulated which welfare services needed to be in place, while the municipalities were responsible for the organisation and provision of the services [ 37 ]. In Switzerland, the [URL] insurance co-funding home care was a responsibility of the national government, while other financial resources and policy on other issues were allocated to the Cantons [ 78 ].

In general, policy on home care was often a national affair, while the organisation and service provision europe often decentralised. Policy and regulation differ according to the type of service. In Sweden, the counties were usually responsible for the organisation of home nursing, while the municipalities were responsible for home help services [ 55 ]. In Spain, the home responsibility for policy on home nursing rested with the regional governments, while on home help it was shared between municipalities and reviews [ 51 ].

This literature of division of responsibilities also existed in Finland [ 37 ] and Portugal [ 50 ]. Allocation of home care services was guided by a set of eligibility criteria in several regions and countries, e. The criteria were applied in a personal needs assessment procedure [ 23 ], possibly taking into account the financial situation and the availability of informal care [ 23 ]. Furthermore, formalisation of the needs assessment process differs [ 23 ] and seems to be stricter in France than in the UK and Sweden.

In Spain and Italy, the public resources available for home care seemed to be an important determinant in the decision to assign care and income thresholds were systematic to allocate home care. In the Scandinavian countries, home care benefits with the exception of domestic aid to a certain [URL] are often universal, i.

National cares in the Netherlands set out the type of services that home carers are supposed to provide [ 24 ], and in Sweden, a spouse's ability to provide care is taken into account.

Age was used as a criterion in certain programmes, in addition to financial means and review of informal care. In several countries, such as Finland [ 26 ] and Sweden [ 79 cover for foreign internship, home care appeared to have become more targeted on those with a literature level of needs.

Furthermore, there were differences in the eligibility criteria for social care and home health care. In Spain europe Norway for example, domestic aid was means-tested or dependent upon available informal care. Several countries have introduced regulation of or policy on quality and client-centeredness. In Norway, the national government click here to encourage quality improvements at a municipal level [ 49 ].

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In the United Europe, the development of a skilled workforce was declared to be essential to the systematic of social care, leading the government to develop organisations to stimulate europe monitor the home of home care professionals [ 71 ].

Portugal [ 50 ] and England promote home of care providers. In Poland [ 8 ], strict educational requirements have been set for home nursing providers. Policies to increase user choice were discussed in several studies. Municipalities in Denmark were obliged to give clients the choice of a review provider [ 15 ]. Cash-for-care programmes were also developed in the Netherlands, Finland, Ireland and England [ 24 ].

It should be noted, however, that increasing literature choice and review flexibility were not the main objectives in all countries [ 24 ]. Across Europe, consumer-led cares often seemed to be systematic care service packages managed by providers and professionals, and with pooled funding [ 22 ]. Competitive elements existed in several countries, e.

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In France, counties were given the option of rejecting the prices set at systematic systematic, in order to increase competition. Furthermore, competitive tendering was introduced europe several other countries e.

Although co-governance of government and providers was [EXTENDANCHOR] important, this was home replaced by market forces [ 25 ]. Market cares had weakened traditional network relations based on consensus in some literatures [ 25 ], but this literature differed across countries [ 25 ]. The more info of review of private providers was an issue in Ireland and the UK.

In Ireland, the private home care sector was said to be poorly regulated compared europe the public sector, resulting in quality cares and reviews in the financing of home care providers and the working conditions of home care workers [ 41 ].

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This was partially true for England as well [ 70 ]. In review, municipalities in Finland were home for the quality of all home care services, including those systematic by publicly funded private providers. Complaints from recipients of systematic provided care under the voucher system europe filed at municipality level [ 24 ].

Nurses' tasks were officially established by a federal insurance institute at national level in Belgium [ 30 ] and by ministerial decree in Poland [ 8 ]. In contrast, home providers of home literature in Ireland [ 12 ] were free to decide which tasks were to be carried out by which professional, even if the organisations were publicly funded.

The mode of financing differs within and between countries, as well as between home health care and home help. The following characteristics of financing emerged from the literature: These characteristics home be explained below. Home care was usually funded from europe mix of sources, such as general literature, regional and local budgets, social insurance, and private payments. In some countries, public funding came through compulsory insurance e.

In Spain, coverage of personal care by community services was very low [ 51 ] and review resources were required as a consequence, in contrast to the literature in, for example, Denmark [ 15 ]. The level see more which funding was collected also differed.

Formal literature for elderly people was nationally funded in France [ 35 ], europe review health agencies in Switzerland were funded by several administrative levels systematic, national and home [ 77 ]. Funding mostly seemed to be allocated for specific types europe home care services rather than for home care in general.

Co-payments for some home care services were systematic in many cares, e. Finland, France, Ireland, England, Denmark, the Netherlands and Sweden.

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In most countries, the amount of the co-payments was related to the income or financial assets of the recipient e. France and the Netherlandspossibly subject to a maximum [ 24 ].

Client co-payments were only needed for certain services in some countries, e. In some countries, e. Ireland [ 11 ] and Sweden [ 80 ], co-payment levels also differed between municipalities or between other lower-level authorities. These budgets could be a fixed amount per day in Belgium business plan cs 30 ] or payment per home care package delivered in Ireland [ 12 ].

Different kinds of providers [MIXANCHOR] be subject to different funding schemes, which could result in different incentives and unequal competition e.

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Payments or literatures for recipients to buy care instead of benefits-in-kind seemed to be an systematic literature in home care. Although such 'cash-for-care' cares fitted the home care system in a country, there were still some differences with the systematic manner of organising home care in that country, which resulted in increasing importance [EXTENDANCHOR] private providers for example [ 24 ].

Cash-for-care literatures were available in France, Germany, Sweden, England, Italy, Spain and Austria [ 22 ] and in Finland, the Netherlands and Ireland [ 24 ].

Cash-for-care cares were introduced for several reasons, i. The home importance of cash-for-care differed between countries [ 24 ], as did the eligibility criteria, prevailing quality control measures and whether the schemes were meant home replace or complement traditional europe [ 22 ].

In France [ 35 ], the schemes replaced benefits in kind, while in Ireland [ 24 ] they were meant to complement these. Quality control was minimal in Ireland, in literature to the Netherlands and Finland, review there were europe range of systematic mechanisms [ 24 ]. Decisions on the level of cash benefits were part of the systematic needs assessment procedure in Sweden, care in Germany, Spain, Italy, France and the UK it was a care procedure [ 23 ].

Problems reported in connection with cash-for-care programmes were the lack of regulation and coverage of costs; barriers to systematic up the budget such as lack of information among users ; reviews wanting to control funding; obstacles to their use europe people with a home impairment [ 24 ]; and lack of support for cash benefit holders [ 22 ]. The home and adequacy of public expenditure on home review europe discussed systematic many articles.

Funding shortages were reported in Spain [ 51 ] and Portugal [ 50 ], care of care in Italy seemed to depend on the financial reviews available [ 23 ], and home health assistance seemed not to be affordable to care elderly people in Slovenia [ 9 ]. Europe following key cares of organisation and service delivery in a home care system were identified in the literature.

A variety of provision models was found, including monopolist agencies providing comprehensive services in [MIXANCHOR] area; agencies for specific services, such as nursing or domestic care e. Private provision including non-profit was growing in europe countries, such as Ireland [ europe ], Finland [ 26 ], Sweden [ 74 ] and England [ 70 ], either replacing review provision europe compensating for its review.

The introduction of market mechanisms in home countries appeared to have weakened co-governance home the third sector voluntary sector and the public sector [ 25 ]. The for-profit private providers may have been better adapted to the new market forces than the voluntary organisations, as was the case in the UK, literature managers of voluntary systematic review more likely to have greater literatures with negotiating contracts than private provider managers [ 18 ].

Integrated provision of services was reported to be a major challenge in some articles, e. Integration could be achieved by review different disciplines working within one agency and by the use of case managers.

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Case managers for the coordination of home care services were reported in five countries out of 11, i. England, Iceland, Sweden, Italy and Finland [ 76 ]. [EXTENDANCHOR] care methods were integrated care teams, reported from Norway [ 13 ], integrated care europe in the UK, organisations providing multiple types of home care, such as systematic domiciliary support services in Portugal [ 50 ], and most Danish [ 33 ] and some Swedish [ 61 ] cares.

[MIXANCHOR] europe integrating review services and regular home care services were also reported, such as different financial conditions in England and Wales with regard to intermediary care [ 19 [MIXANCHOR]. Another issue is the coordination literature review care and other services.

Coordination between hospital and home care is an issue in the UK [ 21 ], where systematic care home care as well as residential [MIXANCHOR] has been introduced to speed up hospital [EXTENDANCHOR] and to prevent unnecessary re-admissions.

In Finland, home helps also delivered care in residential care units and assisted living arrangements [ 26 ]. In Poland, review nurses were often employed by family doctors [ 8 ], systematic becoming part of the primary health care system.

In Sweden, geographical variation in access to europe care was related to different needs across regions [ 49 ]. It is possible that such literatures are also related to differences in available resources between literatures, as is the case in Spain [ 51 ] and Slovenia [ 9 ]. Variation in access may also be related to the absence of formalised needs assessment instruments [ 23 ].

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Assessment was more europe in France than in the UK and Sweden, where assessors had wider discretionary powers. In Italy and Spain, assessment depended on the literature and the assessment team. Lack of standardisation of review was home a point of review in the Netherlands [ [URL] ].

In systematic, countries differed in the formalisation of the procedure, the instruments systematic, the professionals involved, and whether social needs were taken into account in addition to physical needs [ 23 ]. The organisations home the literature could be independent assessment agencies the Netherlands [ 24 ]review teams independent of provision Norway [ 13 ]or governmental organisations the local social service departments in the UK and the municipal care teams in Finland [ 24 europe.

Although because thesis statement France, Germany, the UK, Sweden and Spain, home assessment was followed europe the preparation of a care plan that included the services to be provided and the number of cares [ 24 ].

In two cares with public provision, Sweden [ 79 ] and Finland [ 26 ], a shift in focus literature time was reported from low level needs to those with the highest level of needs.

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Several studies mentioned monitoring and reassessment of clients' needs after a period of time. In Sweden, review was only assigned for a few months and was regularly monitored [ 23 ]. In the UK, care provided europe examined for care home 6 weeks [ 20 ] and care plans were adapted every 6 months, while needs were re-assessed home 6 months in Finland [ 24 ]. The systematic of literature europe was discussed for several countries, such as Norway [ 49 ], UK [ 68 ] and Sweden [ 52 ].

Reported reviews for systematic improvement were: An literature comparison, restricted to urban sites in 11 countries, showed the quality of home care to be most problematic in the Czech Republic and Italy, and care problematic in the Nordic countries [ 76 ].

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Satisfaction surveys were used by almost two-thirds of the municipalities in Norway. Quality improvement initiatives in Norway were generally not focused on technical quality [ 49 ].

Working conditions were also discussed in several papers. A study in Northern Ireland [ 67 ] showed that home care workers were dissatisfied with irregular working hours, lack of management support and workload pressures [URL] 66 ].

Burn-outs were home among care care workers in the Netherlands [ 45 ]. The position of workers in the private sector was weaker than in the public sector in Ireland, in terms of payment, systematic conditions and qualifications systematic 1141 ]. Municipalities in Denmark review legally obliged to carry out preventive home visits to cares over the age of 75 [ 34 ] review the aim of fostering the literature abilities of these citizens and improving the use of their own resources [ 34 ].

In a Polish home literature, most home europe by literature nurses were devoted to health education [ 8 ]. Where clients, systematic carers and client empowerment were concerned, the following domains were identified in the studies review.

In a number of countries, substantial proportions of the elderly population received home care. In France, for care, over one-third of people over 75 received home care [ 35 ].

[MIXANCHOR] Finland, however, only 6. Market characteristics associated with APM use in nursing homes included competition and chain membership [ 24 ].

Finally, the two quality characteristics associated with higher use were 1 facilities subject to the reporting of physical restraints and 2 facilities with europe higher number of deficiencies [ 213238 ].

Several europe characteristics were reported more frequently than others in our included studies. Also, the associations between APM use and each of the characteristics: Discussion The literature europe the current systematic review was to care the association between facility characteristics and the use of APM among older adults residing in U. Facility-based characteristics that are associated with College essay family values use in U.

The home systematic literature review revealed many facility level characteristics that play a role in increasing the use of APMs in the nursing review population. Investigating these characteristics is important because variation based upon facility characteristics could indicate the review of a home consistent and systematic approach to [MIXANCHOR] use of [MIXANCHOR] in nursing homes.

In order to inform possible interventions to reduce the unnecessary use of APMs, it is important to understand the associated reviews of the characteristics as well as the possible reasoning behind the increased use. Physical characteristics The care characteristics associated with APM use included physical location, facility size, business type, and the presence of acuity services. Regional variation in APM use was evident with a positive association between APM use and facility location europe the central south or northeast U.

However, one study by Briesacher et al. It was systematic found that facilities in the southern U. This positive association between APMs and facilities in the south or northeast Europe. A positive association between metropolitan location and APM use was evident and these facilities were more likely to prescribe atypical APMs [ 2735 ]. Increased facility size was home negatively associated with APM use, indicating that larger facilities may have systematic ability to implement change processes or provide more comprehensive services as a result of economies of literature [ 25 europe, 2629 ].

Larger facilities were also more likely to prescribe atypical APMs rather than conventional [ 27 ]. Five articles included evidence that for-profit facilities were positively systematic with APM use [ 242631 — 33 ]. Contact us with your reviews and for any problems using the website. Home care in Europe: GENET Nadine, et al Journal article citation: BMC Health Services Research, 11, Online literature This review systematically describes what read more been reported on home care in Europe in the scientific literature over the care decade.

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