Provision of health services to nursing home residents across selected European countries – policy options for Europe.

Background: Many European countries have recognised the challenge of providing high-quality long-term care (LTC). We explored how selected European countries organise and fund primary and specialist healthcare services for nursing home residents requiring 24-hour nursing and social care in view of understanding which approaches might offer better outcomes.

 

Approach: A rapid literature search of the databases MEDLINE, Embase Ovid, Google Scholar and Google was performed, complemented by inputs from national experts and practitioners. The following European countries were included, representing a variety of health systems and models of care provision in nursing homes: England (UK), Germany, the Netherlands, Norway, Poland, Spain and Sweden.

 

Results: The organisation, financing and provision of LTC, as well as of primary and specialised care for nursing home residents, varies substantially between and within European countries, even among those with similar social, cultural, health and funding systems. In most included countries, LTC services are covered and financed similarly to health services, but co-payments often play a substantially larger role in LTC than in healthcare spending. Nursing staff or care assistants provide 24-hour nursing care, while GPs tend to be responsible for providing medical care.

 

However, most GPs working in nursing homes are self-employed and community-based rather than employed by the facility. Nursing homes in all of the selected countries engage allied health professionals, such as physiotherapists, occupational therapists and speech and language therapists. These professionals usually work in private practices and provide nursing home services either on-site or at their own practice. Whether health professionals are directly employed by the nursing home or work on a freelance basis depends on various factors; however, direct employment is rare.

Similarly, specialists are often brought in as consultants, rather than being part of the nursing home’s permanent staff, as they typically work in private practices and may offer nursing home visits. The Netherlands is the only country in our sample where it is common practice for nursing homes to employ specially trained elderly care physicians (ECPs), although some nursing homes in Norway follow the same model. There is some evidence that the ECP model can help to reduce the demand for specialised services, avoid unnecessary hospitalisations and lead to higher patient satisfaction with primary care services.

 

Implications: European countries largely separate health services from LTC, but initial evidence from more integrated models like those in the Netherlands and Norway suggests potential benefits. Decisions on ownership structures and quality assurance, as well as on access to primary care, allied health professionals and specialised care will need to take into account their impact on care integration and facilitating transitions between care settings. Improved coordination between different care providers could reduce avoidable hospitalisations while improving discharge processes. These decisions should be explicit and opened up to public consultation, but have so far been made implicitly and by default.