Underfunded and with ever higher costs, the network of nursing homes is in danger of collapsing. The point, the new model and the proposals of the National Union of Charities and Assistance to the IX Commission of the Lombardy Regional Council
Healthcare residences (also known as Rsa) are called upon to respond to increasingly complex needs and to guarantee increasingly intensive levels of assistance, with a “severe misalignment” between the public resources dedicated to the system and the costs sustained by the structures. In a context of suffering of the social and health services system, the RSA are also considered one of the most structured services offered for the elderly: indispensable when the needs of the elderly and their families can no longer find answers in situations of less assistance intensity and are “certainly, today more than in the past, an underfunded sector” (the 48 euro average daily contribution should guarantee coverage of health care costs: presence of medical and nursing staff, medicines, aids, elements characterized by important increases which are not matched by adequate public refinancing).
An underfunded sector, to the point that “all the monitoring carried out in this period among our associates have highlighted the concern for the stability of the entire system”. These are some of the notes presented today to the IX Standing Commission (social sustainability, home and family) of the Lombardy Regional Council by theNational Union of Charities and Assistance Bodies – Uneba, representing more than 70% of the entities managing social and health services for the elderly in residential, semi-residential and day care. Uneba has not only presented a snapshot of the sector. But he made specific requests to the Lombardy Region, five to be precise: programming, revaluation of tariffs, enhancement of the proximity skills of the RSA, experimentation with new models of integration between hospital and territory and open RSA. Uneba’s reiterated request? «Being an active part of the planning process and willingness to co-build and experiment with new models of taking charge that are based on decades of experience and strong professionalism».
Programming
Programming, Uneba argues, would allow “a temporal perspective that allows services to be organized by making the necessary investments, and this path must consider the social and health care sector not as a provider of services but as an actor with whom to co-plan and co-build that dimension of the welcoming territory, that is, capable of taking care of fragile people and their families”.
Rates
The remodulation of tariffs “following a re-evaluation and stratification of the need accepted and consistent with the guaranteed standard of care” has the objective of reducing the distance between costs and the financing system of our structures, enhancing the quality of care.
Proximity
For Uneba, know-how needs to be valorised in terms of proximity». The RSAs should be considered “as actors sitting at the co-planning table, able to make experiences and services available to the system”.
New models of integration
The fourth point passes through the “experimentation of new models of integration between hospital and territory”, recognizing the role of “multiservices played by many of our RSA for some time now”.
The RSA is open
Finally, Uneba brought to the attention of the Region the issue of systemising the open Rsa measure which, as a provider of home care services, “must be recognized as equal in dignity to the C-Dom and a remuneration system consistent with the services provided” .
The system is at risk
In a context of financial crisis, “consequent to a system of rules no longer consistent with needs, the application of which continuously widens the gap between costs and revenues”, the system, Uneba points out, is “at risk of stability. The current levels of remuneration of the services, despite the adjustment interventions of the last few years, are in fact significantly lower than the management costs of the same».
A new model
To respond to these critical issues, Uneba underlines the need for an overall reorganization of the system, “overcoming the performance logic and starting from the role that the RSA can and must play” and calls for a reform based on four key words: quality of life, proximity , multiservices, refinancing.
Life quality. It means “attention that moves from the themes of the fragility of the person to the person in his entirety, in the complexity of his personal and family history, in the expectations and expectations above all centered on his paths of social and emotional relationships”.
Proximityunderstood “as an element of a psychological nature, of closeness understood not only in its physical dimension, but also as an attitude of the service system in the ability to listen, to understand the needs expressed and not only, to which to match the interventions”.
Multiservices. For Uniba “the RSA can and must take an active role not only in planning but also in the provision of specialist services, focused and calibrated on chronicity and great fragility”.
Refinancing. the social health sector, underlines the National Union of Charity and Assistance Bodies, “needs greater financial resources and the overcoming of the season of management trials, financial resources commensurate with the work performed and the complexity of the needs received”.
Opening photo credits Pixabay