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Denmark

2013: National policies covering the care and support of people with dementia and their carers

Background information

Where people with dementia receive care and support

The following table provides estimates of the number of people with dementia living at home, in various types of residential care and in hospitals or psychiatric institutions.

Place of residence

YES or NO

Estimated number/

Additional information

At home (alone)

Yes

Not known

At home (with relatives or close friends)

Yes

 

At home (with other people with dementia)

Yes

 

In general/non-specialised residential homes

Yes*

 

In specialised residential homes for people with dementia

*

 

In general/non-specialised nursing homes

*

 

In specialised nursing homes for people with dementia

*

 

In hospitals, special wards or medical units

No

 

In psychiatric establishments

Yes

 

* In Denmark, no distinction is made between residential homes and nursing homes.

The percentage of residents in nursing homes who have dementia is not known but it is estimated to be around 85%. This figure seems to have been increasing over the years.

The ratio of staff to residents in nursing homes is about 0.75 (i.e. 1:1.3), sometimes slightly higher (e.g. if the percentage of people with dementia in a particular home is higher than usual).

The organisation of care and support for people with dementia

The overall organisation of care and support

Denmark has three levels of government:

1. The parliament and the ministries who make the overall laws.

2. Five regions with responsibility for running the hospitals and for general practitioners, who are private but have an agreement with the regions on how to work. They are paid by the regions.

3. 98 local municipalities which are responsible for homecare, care homes, home nursing and rehabilitation.

If a person needs to go into a care home, they move into their own flat in a complex called a “care centre”. They then have to pay their own rent and also for food, medicine, washing and electricity. If they are in need, they can be reimbursed for some of the rent. The municipalities are responsible for, and pay for, the staff (e.g. nurses, social and health assistants and helpers). The need to go into a care home is assessed by the authorities in the person’s local municipality.

The municipalities offer three different levels of care. People who live at home can receive:

1. Homecare in the form of a fixed number of hours per week/day. For example, this might include help getting washed and dressed, help getting in and out of bed and help with medicine.

2. “24-hour care” in their own home, which means that they can receive help several times during the day and it is also possible to receive visits at night.

3. If this kind of care isn’t sufficient, a person can move into a flat in a “care centre”. The centre offers 24-hour care by trained staff.

Some care centres have a smaller part of the centre with flats for people with severe dementia, but they are becoming fewer as most of those who need a placement in a care centre have dementia.

Care homes (i.e. in the care centres) are the only kind of institutionalised care available unless a person needs psychiatric care, in which case they would have to go to a specialised psychiatric nursing home.

There are very few private care homes.

How specific aspects of care and support are addressed

Provisions relating to the care and support of people with dementia are covered in some national policies.

Standards of care and support

All of the five regions in Denmark have now implemented “a case management protocol” which stipulates which action should be taken, starting from the patient’s first meeting with the doctor up to interaction with the municipalities. This protocol emphasises the importance of a proper diagnosis and stipulates how support should be provided to patients and carers through the disease.

In care homes/residential homes there are rules about what should be included in the patient’s record.

Controlling and monitoring care and support

Every other year, or yearly if necessary, the Danish Health and Medicines Authority inspects the care centre in order to ensure that the rules are followed.

Continuity of care and support

Issues related to the continuity of care and support are addressed in the above-mentioned “case management protocol”.

Interdisciplinary cooperation and coordination

Issues related to Interdisciplinary cooperation and coordination are addressed in the above mentioned “case management protocol”.

Needs assessments (e.g. ensuring that it is timely, fair and appropriate)

In order to obtain home care or a flat in a care centre, a person must apply to the authorities in the municipalities. The application is assessed by a social worker or a “dementia coordinator”. There are general rules about how to obtain financial and other support from the municipalities. If the person does not choose a specific care centre, they should not have to wait more than two months to have a flat in a care centre offered to them.

Staffing levels

There are no specific regulations on staffing levels, except that there has to be enough staff to meet the needs of the people who live in the care centre. Similarly, there are no specifications from the government concerning the kinds of qualifications that staff ought to have. The politicians at the level of the municipalities are responsible for ensuring adequate staffing levels.

Research into care and support

Research into care and support is carried out, mainly in the form of projects. The costs are covered by grants from the government based on individual applications or private funds. A certain amount of money is set aside every year to this kind of research in the national financial budget. It may, for example, be allocated to research into “old age problems” and people with an interest in dementia can apply for it. 

Funding and control bodies

There are minimum standards for how big the flat in a care centre must be. As staff members very often have to help the person with dementia in the bathroom, there are also minimum requirements for the size of the bathroom. Every flat has to be equipped with a kitchen/kitchenette. The municipalities are responsible for this and have to make sure that the flats meet these requirements.

The standard of the flats and of the care provided is controlled by The Danish Health and Medicines Authority.

Complaint procedures

There is a complaints procedure whereby complaints about decisions made by the municipalities can be lodged in the first instance to the municipality itself. If the decision is upheld, the municipality has to send the complaint on to an independent body, which makes the final decision.

Respecting individuality and cultural diversity

People with dementia who have rented a flat in a care centre can decide which furniture and decorations they would like to bring with them. However, there are certain limitations as the flat is also the workplace of the staff and the bed is provided by the care centre, as it has to be a special bed. This specific issue is covered by legislation on the Protection of the Workforce (Arbejdsmiljøloven). Special eating habits are respected. This is covered by the rules of individual care centres. 

Involving people with dementia in decisions about care and support

No one in Denmark can be treated or cared for without informed consent, or through the use of force. If the person with dementia does not have the capacity to make a particular decision, a close relative can decide on his/her behalf. Under certain circumstances, the use of force is possible. It must be absolutely necessary and the prior authorisation from the authorities in the municipality must have been obtained. This does not apply to medical treatment. It is covered by Act No. 81 on Social Services of 4 February 2011,

Training

Which social and healthcare professionals provide care and support

The following social and healthcare professionals are involved in the provision of care and support to people with dementia in residential care or living at home.

Social or healthcare professional

Involved in the provision of care and support to people with dementia in residential care or at home

Nursing staff

Yes (also auxiliary nurses called “social and health assistants”)

Auxiliary staff

Yes (e.g. social and health helpers and people with no training at all, especially during holiday periods, as well as cooks and cleaners etc.)

Allied health professionals

Yes (see below)

Specialists (e.g. psychiatrists, gerontologists, neurologists)*

No

General practitioners*

Yes (in some areas to educate staff)

Other

Yes (dementia coordinators)

* Only if they are linked to the provision and organisation of care and support (i.e. not with regard to their role to provide medical treatment).

Trained nurses have a three-year Bachelor’s degree, usually with a special interest in elderly care, but are not necessarily trained in geriatric nursing. Only 4.7% of staff members in residential care are trained nurses. Nurses with special training in dementia are employed by the municipalities to supervise home care and to help families to cope with care. They also work as consultants in care centres (residential care). These nurses are often called “Dementiacoordinators” (*see more below) as they help people with dementia and their carers to obtain coordinated support.

There are also auxiliary nurses, who are called “social and health assistants”. They must first train to become a “social-and health helper” (see below for details) before they can become a social and health assistant. The additional training to become an assistant consists of 1 year bedside and 8 months’ theoretical education. Around 32% of staff have this education. The education is not a Bachelor’s degree but at the end of the course students obtain an authorisation to work independently. Those who wish to study further can go on to study for a Bachelor’s degree in nursing.

There are different kinds of auxiliary staff who are involved in providing care for people with dementia in residential and home care. “Social and health helpers” have 14 months of education: 6 months at a school and 8 months’ “bedside” learning. These helpers account for about 62% of staff. There are also quite a lot of people with no training at all, especially during vacation periods, as well as kitchen personnel and cleaners etc.

With regard to allied health professionals, some care centres employ physiotherapists, occupational therapists (in charge of activities etc.), social education workers, and dieticians.

Dementia coordinators/consultants have no specific education. Some are nurses by profession whereas others have knowledge about dementia at an administrative level.

As an experiment, general practitioners have been employed in five different municipalities to educate staff and to be GPs for the people living in in the care centre.

The type of training that social and healthcare professionals receive

Training in/knowledge about dementia is not part of the compulsory curriculum for nurses but relevant courses can be selected. For auxiliary staff, there is the training for social and health helpers which from 2013 onwards also includes information about dementia.

How the training of social and healthcare professionals is addressed

The training of social and healthcare professionals is addressed in national policies. From 2013 onwards, the curriculum for social and health helpers must include one week of training about dementia.

Support for informal carers

Respite

The municipalities are obliged to offer possibilities either for the person with dementia to go into a care home for a short period of time or to provide someone to go into the person’s home to look after him or her while the daily carer does other things. However, the amount of respite that the municipalities have to offer is not stipulated. It is assessed individually, based on each person and each situation. It can thus vary from one municipality to another.

Training

According to the “case management protocol”, there is a joint obligation for the memory clinic and the local authorities to offer basic education for carers. Basic education comprises some knowledge about dementia-related diseases such as symptoms of cognitive decline, medical treatment, how to understand the symptoms, legal matters and where to get help. Not all municipalities and localities have memory clinics but they are all connected to one specific memory clinic. The memory clinics are operated by the regions. 

Consultation/involvement in care decisions

Carers are involved in care decisions only if the person with dementia can no longer make informed decisions. In such cases, carers are entitled to make decisions on behalf of the person with dementia. An assessment of capacity must be carried out each time that a decision needs to be made and in case of incapacity, this must be noted in the person’s medical file. However, in cases where the use of force is being considered, a legally-appointed decision maker must be consulted in accordance with Act no. 81 on Social Services.

Counselling/support

All of the 98 municipalities have employed dementia nurses, dementia coordinators or dementia consultants. Whatever they are called, their main task is to educate, counsel and support carers. They also go into care centres to counsel the staff in difficult cases.

Case management (insofar as this relates to care)

Please see above

National Alzheimer Association

The Danish Alzheimer Association (Alzheimerforeningen) provides the following services and support.

Helpline

x

Information activities (newsletters, publications)

x

Website

x

Awareness campaigns

x

Legal advice

 

Care coordination/Case management

 

Home help (cleaning, cooking, shopping)

 

Home care (personal hygiene, medication)

 

Incontinence help

 

Assistive technologies / ICT solutions

 

Tele Alarm

 

Adaptations to the home

 

Meals on wheels

 

Counselling

x

Support groups for people with dementia

x

Alzheimer cafes

x

Respite care at home (Sitting service etc)

 

Holidays for carers

x

Training for carers

x

Support groups for carers

x

Day care

 

Residential/Nursing home care

 

Palliative care

 

Acknowledgements

Anne Arndal, Chairperson, Alzheimerforeningen (Danish Alzheimer Society)

 

 
 

Last Updated: Tuesday 25 February 2014

 

 
  • Acknowledgements

    The above information was published in the 2013 Dementia in Europe Yearbook as part of Alzheimer Europe's 2013 Work Plan which received funding from the European Union in the framework of the Health Programme.
  • European Union
 
 

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