RightTimePlaceCare is a European project with eight countries. It aims to develop recommendations on best practice strategies for dementia care throughout Europe, focusing on the period of transition from home care to institutional long-term care. These strategies should provide best available health and social outcomes for people with dementia and their informal caregivers at affordable cost-benefit ratios.
Given the seriousness of the impact of dementia and the increasing age of the world's population political and research action is urgently required focusing on treatments, care services and support arrangements needed by people with dementia and their informal caregivers. As the number of people living alone is increasing in the past decade and ‘living alone’ is an important predictor for institutionalisation, the increase of people with dementia needing professional long-term care and/or institutionalisation will be probably even more substantial than anticipated in view of the increased percentage of persons 65 years of age and over.
This trend will be even more amplified as the future demands on qualified employees will only be met if the female workforce will be even more activated – and at the same time the major portion of family caregivers are females. Due to demographic trends the care situation will change dramatically in the European countries. Nursing care in institutional long-term care facilities will increase as the care-giving potential within the family declines.
Most countries have policies trying to reduce institutionalisation by developing better home-based and community services. It would be dangerous for policy makers to assume that a shifting balance between institutional and community care will necessarily save money. One consequence of this shifting balance is that older people tend to get admitted to care homes when already quite dependent and in later stages of dementia. This can leave families carrying a heavy burden, if they do not receive the required support at home. Institutionalisation increases the expenditures but might also negatively influence health outcomes.
Different health and social care systems diagnose and identify dementia in different ways, identify and assess needs in sometimes distinct ways and at different levels, spend a different amount of resources to meet those needs, present a variety of ways to deliver treatment and support, either through formal services or by relying on families and other carers, and have different financing mechanisms. In general, the extent and quality of long-term dementia care provided in European countries are widely unknown. The policies, funding and access to care for persons with dementia show a wide variance.
RightTimePlaceCare takes these demands as starting point and tries to explore the conditions and predictors of transition from long-term formal professional home care to institutional long-term nursing care facilities as well as the needs to increase the quality of intersectoral information delivery, communication and collaboration. It intends to deliver best practice strategies for need-tailored dementia care throughout the dementia care sectors, particularly with regard to the transitional process, and aims to preserve best available health outcomes for both people with dementia and their informal caregivers at affordable cost-benefit ratios. RightTimePlaceCare comprises six Work Packages (WP).
The main goal of RightTimePlaceCare is to create a benefit for people suffering from dementia in the European countries - and their informal caregivers, i.e. to improve the outcome quality of dementia care. In a first step the project analysed the status quo of dementia care in selected European countries. Special attention was paid to the transitional period between home and nursing home care as well as to the intersectoral information delivery and its potential for improvement (WP 2; lead: Sweden).
To find out which factors influence the institutionalisation of people with dementia clinical data were collected both in long-term formal professional home care and institutional long-term nursing care facilities (WP 3; lead: The Netherlands).
Cost parameters were collected alongside the clinical assessment (WP 4; lead Germany).
In a second step, RightTimePlaceCare will now try to define best practice strategies in the organisation and performance of dementia care, taking into consideration the country’s specific necessities in care (WP 5; lead: Estonia & Spain).
Best practice strategies have to refer to the needs of the various stakeholders in dementia care. Most important stakeholders are the people with dementia and their informal caregivers who both have to manage the illness and at least part of the financial burden - if dementia care is financed by out of pocket payments. The second group of stakeholders are the third-party payers who have to bear the remaining financial burden.
The third group are professional caregivers involved in integrated dementia care (i.e. physicians, nurses and social workers) who have to cope with the burden of providing care to people with dementia.
Finally, the needs of the political decision makers who are responsible for setting up the legal framework of the healthcare sector have to be considered. In order to get information on the financial impact of the defined best practice strategies, a cost-benefit analysis will be performed, and the outcome quality will be compared to the costs per capita based on purchasing power parities.
The impact of RightTimePlaceCare will not result in a reduction of the number of people living with dementia in the European countries. To ensure the impact of the project and its findings on the quality of dementia care, best practice strategies are to be applied by the countries.