Denmark now provides 80% of its aged care services in the home after the Danish Government passed legislation in 1988 to put a brake on the construction of new aged care homes.
The legislation also forced existing homes to convert to single-occupancy rooms, leading to a 30% fall in the number of aged care beds available between 1985 and 1995.
In total the number of aged care places in nursing homes fell from around 49,000 in 1987 to 27,600 in 2001 and 15,400 in 2006.
The change followed a policy push by the Government in the early 1980’s which encouraged local municipalities to provide 24-hour home care services as an alternative to aged care homes.
Policies were also put in place to limit the incentives for people living in institutional care.
Individuals – not providers – pay for their accommodation – while the Government pays for the required health and social services – regardless of whether the care is received in the home or in a facility (separating care from accommodation as proposed by the Royal Commissioners here).
In 1997, another law also mandated that all new housing for older people had to have at least a bedroom, sitting room, kitchen and bathroom.
One community sets the example
The change was further driven by the example of Skaevinge (pictured above), a community and former municipality in eastern Denmark.
35 years ago, in 1984, the community elected to close its one existing nursing home, converting the facility into a community support hub that included a senior centre, day care, rehabilitation, 24-hour home care and assisted living.
Nursing home staff were guaranteed jobs under the transition but had to learn how to let clients take responsibility for tasks they could do themselves while the residents had to relearn how to care for themselves (be reabled).
The community was then divided into three areas with three teams of staff to service each one.
Today, the setup provides residents with a continuum of care. If they become ill and need closer supervision than can be provided at home or have been discharged by hospital, they can stay in the assisted living facility until they are ready to return home.
Other communities have partnered with private operators to open new assisted living units with the local government providing the health and social support services – and it’s a move that has paid off.
Between 1985 and 1995, total long-term care spending on long-term care dropped from 2.4% of GDP to 2.2% – an 8% decline.
Yet the country still provides home care services to a higher proportion of its older people than Australia – over 40% of people aged over 80 compared to 33.6% here.
Food for thought.