Home care for independent living

Project "Home care for independent and dignified life"

Implemented within the Bulgarian-Swiss program to reduce economic and social disparities in the enlarged EU

Leading organization : Bulgarian Red Cross

Partners :

• Ministry of Labor and Social Policy

• Ministry of Health

• Swiss Red Cross

Duration : January 2012 - June 2017

Target region : Four municipalities in Vratsa district (Vratsa, Byala Slatina, Krivodol and Oryahovo)

Project goal :
To support the introduction in Bulgaria of a model for comprehensive provision of health care and social services at home, as a form of long-term care for the elderly with chronic diseases and permanent disabilities, taking into account the specific needs of the Roma community.

Target group :
Elderly people over 65, including Roma with chronic diseases and permanent disabilities in Vratsa district

Main tasks of the project :
For the establishment of the "home care" model and sustainable provision of this type of services in the future, the project envisages work in the following areas:

• Establishment of four Home Care Centers in four municipalities of Vratsa district and provision of professional health care and social services to 400 elderly people with chronic diseases and permanent disabilities in their homes;

• Adaptation of the regulatory framework in Bulgaria;

• Development of uniform national standards for the quality of health care and social services in the home environment;

• Development of unified programs for training of domestic helpers / social assistants for providing services in the home environment;

• Evaluation of the provided services and elaboration of sustainable mechanisms for their financing;

• Study of the specific needs and opportunities for providing the home care service among the representatives of the Roma community;

• Prevention of hospitalization and re-hospitalization for social reasons, as well as prevention of placement of elderly people in social institutions;

• Supporting family members who care for their loved ones in order to support their realization in the labor market.

Experts from the Ministry of Health, the Ministry of Labor and Social Policy and the Bulgarian Red Cross have an active role in achieving these tasks. In each of these areas, the project provides for a broad partnership with other relevant institutions and NGOs, including the Bulgarian Medical Union, the Bulgarian Association of Health Care Professionals, the National Health Insurance Fund, medical universities, patient organizations and others.

Achieved results
1. Legislation on integrated health care and social services in the home environment

On 9.09.2015, at second reading, the Parliament adopted amendments to the Health Act through the Medical Establishments Act, which for the first time in Bulgaria will allow the provision of integrated health care and social services in the community by municipalities, medical establishments and individuals. Art. 18, para. 2 of the Social Assistance Act.
According to the text of the law, medical and social service specialists will be able to provide health care and medical supervision and carry out social work, including at home, in support of children, pregnant women, people with disabilities and chronic diseases and the elderly, who need help in carrying out their daily activities. Integrated health and social services for persons under 18 years of age will be provided after obtaining a license and in compliance with the requirements of the Child Protection Act.

The aim of the comprehensive provision of health care and social services is to meet the real needs of those in need, to facilitate every citizen's access to health care and quality services to prevent social exclusion, and to guarantee a dignified and independent life for consumers, allowing them to stay as long as possible in their homes.

The proposal for legislative regulation of integrated health and social services was developed at the initiative of the Bulgarian Red Cross within the project together with representatives of the Ministry of Health, MLSP, ASA, NHIF, Bulgarian Medical Union, Bulgarian Association of Healthcare Professionals and patient organizations.

2. Implementation of a national information campaign
In 2015, together with bTV, the Bulgarian Red Cross implemented a national information campaign dedicated to the goals of the project and the nature of the home care service. Within eight episodes, various users of the service in Vratsa district, members of the teams in the Home Care Centers, project partners at local and national level were filmed.

3. Established and functioning four "Home Care" Centers in Vratsa district
A total of 17 nurses and 33 domestic assistants have been appointed in the four Centers. In order to provide quality services before their employment in the centers, all team members undergo mandatory training organized by the Bulgarian Red Cross within 160 training hours for nurses and 120 training hours for domestic helpers. The training is aimed at acquiring skills and knowledge about the specifics of working with elderly and sick people at home. The training also includes the acquisition of skills for individual assessment of the patient's needs by nurses, compliance and application of quality criteria for services, as well as the development of regular statistics on services provided, which subsequently serves to assess their effectiveness.
In the process of work the staff undergoes additional training conducted by experts from Switzerland in connection with prevention and treatment of pressure ulcers, treatment and treatment of wounds, kinesthetics, specifics of hygiene in the home, communication within the team and with users, dealing with stress and burnout syndrome, palliative care and care for people with dementia.

4. Selection of beneficiaries and provision of services
The selection is carried out according to strictly defined criteria, agreed with the project partners MH and MLSP. Representatives of the Regional Council of the Bulgarian Red Cross, each of the municipal administrations, the Regional Directorate for Social Assistance and the Regional Health Inspectorate - Vratsa participate in the commissions for selection of beneficiaries.
As of December 2015, the teams of the four centers provide regular care to a total of 420 users. More than 70% of beneficiaries are single, and 20% of consumers live in small settlements within the region, where there is no form of health care or social services.

5. Development of new SER for the profession "Social Assistant"
In order to ensure the training of personnel for the provision of integrated health and social services in the future, the BRC, together with representatives of the Ministry of Health, MLSP, ASA, NAVET, Ministry of Education and UNICEF developed new state educational requirements for the profession "Social Assistant". adults and children. The introduction of additional knowledge and competencies will allow social workers in the future to work in cooperation with nurses and other medical professionals in order to provide a comprehensive service to adults and children with chronic diseases and disabilities. The new SERs were adopted by the Management Board of NAVET in November 2015 and submitted for approval to the Ministry of Education and Science.

6. Valuation of the home care service
Based on the activities of the four Home Care Centers in Vratsa district and the achieved results, conditions were created for the evaluation of the service as a type of integrated health and social service. The analysis will be discussed with a wide range of institutions and partners both in Bulgaria and by the Swiss Red Cross in 2016 in order to develop a model for financing this type of service in the future.

7. Conducted a survey among the Roma community in Vratsa district
In order to study the specific needs of the Roma and the possibilities for providing the home care service among them, in the period June - August, 2013 a study was conducted in the four municipalities of the project. The results were officially published in a report testifying to the needs of the Roma community for health care and social services, as well as the need to adapt the home care service according to some of their specific features. On the other hand, the report shows that the provision of such social services at home is an opportunity for members of the Roma community to be trained and find employment.

8. Introduction of specialized software
In January 2014, a specialized software program was introduced in the Home Care Centers, which supports the reporting of the overall activities of the centers, the analysis of the effectiveness of the provided care and services, as well as their evaluation.

Evaluation of home care and comparative analysis
The analysis was conducted in 2017 and its main task was to compare the model of home care under the Project with other forms of public and private provision of health and social services in the home environment, as well as in health and social institutions. The subject of the study also included: establishing the actual costs of health and social services for each user on an annual basis, provided under the Project; sensitivity analysis, offering various forecasts and scenarios that examine how the increase in the number of patients may lead to a change in the cost of services provided and the net effect on public spending on social services and health care from the application of the model .

External evaluation of the project
An external evaluation of the project "Home care for independent and dignified life" was conducted in October 2016, organized by the Swiss Agency for Cooperation and Development with the participation of experts from the European Center for Social Policy and Research - Vienna and the Institute for Community Social Services - Bulgaria. The main task was to provide an independent assessment of the main results of the project. To this end, the following criteria were assessed: applicability, effectiveness, efficiency and sustainability.
The final evaluation report gives a clear idea of the applicability of integrated health and social services in the home environment in our country, as well as adequate recommendations to the BRC and other partners to continue working in the future in order to make this service sustainable and expand throughout country, as well as in relation to other target groups. You can see the whole report in the attached file: