De-institutionalisation in long-term care for older people in Denmark: Case studies on international policy and implementation

For half a century, long-term care in Denmark has been provided according to the
principles of self-directed life in the community. Over the last decades, drivers for
changes in policies have been ageing populations and shortage of staff. The main policy
concern today is therefore how to ensure sufficient and high-quality provision of care.
• Long-term care for elderly in Denmark is the responsibility of the 98
municipalities. They organize, finance and, for the most parts, also deliver
services.
• The free provision of home care is a central service supporting deinstitutionalisation
• Home care includes personal care as well as practical assistance in the home,
mainly cleaning.
• Take-up of home care has in recent years declined, and mainly due to policy
changes and targeting. This puts more pressure on institutional care.
• The de-institutionalization policy has been strengthened with the introduction of
reablement, a goal-oriented, cross-disciplinary intervention aiming to maintain
functional ability.
• Equally supportive is the evidence-based intervention of preventive visits.
• The long-care system is based on professionalized and formal care work.
However, today one in four care workers have no formal care education.
• Working conditions are poor and it is difficult to recruit and retain staff.
• A choice of home care provider has been introduced in order to introduce
elements of consumerism but also to forward the quality of care. Today more
than one in three use a for-profit home care provider.
• The quality of the services is monitored through the development of quality
indicators; most recent indicators focus on outcome quality such as maintenance
of functional ability and whether service provision succeeds in avoiding
hospitalization