Abstract
Background: As a consequence of the Aging society, the elderly people have growing need for long-term care and often for special nursing in addition to the health care system. The focus of Hungarian health care system lacks basically the examination of health care provisions carried out in the social care system. The main objective of this study is to assess the health care needs within the residential social care institutions for elderly people and to follow the implemented capacity transfer from hospitals nursing wards to social care residential homes.
Approach: In 2015 March-May time period - with the support of the State Secretary of Social Affairs of the Ministry of Human Capacities (MHC) about 600 elderly people an empirical survey has been carried out using institutional and individual datasheets focused on care problems and health care activities. Data have been analysed by descriptive and regression statistical methods. Qualitative analysis was carried out making 6 + 4 interviews with directors of residential care homes and public administrators before (2015) and after (2024) the implementation capacity transfer from healthcare to social care.
Results: The results showed that the average age of inhabitants of residential social care institutions became increasingly higher (78 years). Among residents gradually growing rate of dementia (21.2%), need for intensive care (at least 12 hours a day), or continuous (24-hour) monitoring and wide range of special nursing activities (in the sample up to 35%) were observed. Based on this health needs assessment (HNA) our research and administrative group had developed an integrated organizational care model that later MHC approved as a comprehensive regulatory background on newly established skilled nursing facilities (by amendments of social care act, and ministerial order on minimum requirements of residential homes). Our research and developing expert work continued with the detailed analysis and obsevation of the current capacity transfers including 2400 beds in 2023-2024 from nursing wards of hospitals to skilled nursing facilities of residential homes summarising the advantages and futher challenges of these organizational changes.
Implications: The Hungarian integrated skilled nursing program was really based on a HNA, which was followed by a comprehensive regulatory background, which can set an example for the integrated care efforts of other countries. However, further human resource development, improvement of the competence level of APNs, and further integration of social and health resources are needed in order to create a better incentive system. In the continuation of this programme the development and sustain the care pathway management is also needed, connecting home, day care and ambulatory care platforms.