Strong variation in home care across Europe

Co-funded by the European Commission, NIVEL carried out a mapping study of the home care systems in 31 European countries. It shows that decision makers can learn a lot from each other’s approaches, despite considerable differences between the countries in culture, health systems and available resources.

Across European countries, the importance and function of home care varies, from a safety net for people without family on the one hand, to a free-of-charge entitlement for all citizens including both nursing care and domestic aid, on the other hand. In Bulgaria, for example, home care is not available throughout the country and, where it is available, just for underprivileged people. In Greece, it seems home care has long been affordable only with EU financial support and the question is how it will survive current austerity measures. The countries in North and North-Western Europe, like Sweden, Denmark, Norway and The Netherlands, have well-developed home care sectors but are now facing challenges of financial sustainability.
The EURHOMAP project (Mapping Professional Home Care in Europe) has made an inventory of home care in 31 European countries. It has provided politicians, policy makers, researchers and care providers with information allowing them to compare their home care system with the one in other countries. The information particularly deals with the organisation, financial aspects and the available services and facilities in a country. In some countries, like France, Germany and The Netherlands, eligible users of home care can be provided with a budget for purchasing care themselves.
Usually, the two pillars of home care services, which are personal and nursing care on the one hand and domestic aid on the other hand, are differently organized with different ministries at the top. As personal and nursing care are usually provided as health care services, while domestic aid generally belongs to the domain of social services, the coordination of both is often difficult. The great cultural diversity in Europe is also reflected in home care, where the role of families is strong in some countries and others have extensive professionalized systems in place. However, nowadays all countries share policies aiming to keep elderly people and chronic patients – the heavy users of home care – in their home situation as long as possible and to avoid institutional care.
NIVEL-researcher Wienke Boerma: “In a time of financial crisis the countries in North-Western Europe, with their generous home care systems, are no longer the evident models for countries that are developing home care. Rather, in developing leaner home care systems wealthy countries may learn lessons from countries with more basic home care services.”
For specific information (also country-by-country):

European Commission
Project partners
IRDES - Institute for research and information in health economics (France), Alice Salomon University of Applied Sciences Berlin (Germany), Corvinus University Budapest, Department of Public Policy and Management (Hungary), I.N.R.C.A. - National Institute for the Resta and Care of the Elderly (Italy), AMB - Medical University of Bialystok (Poland), IDIAP Jordi Gol, Institute for Primary Health Care Research (Spain), BTH - Blekinge Institute of Technology, School of Health Science (Sweden) and The University of Sheffield, ScHARR - School of Health and Related Research (UK).