LTCcovid Country Profile – Printable Version
1.00. Brief overview of the Long-Term Care system
Informal care constitutes a major part of care provided to older and dependent people. It is estimated that roughly 52% to 75% of care is provided by relatives, at home. The introduction of care allowance in 2007 has been the most significant change in the social services system since the 1990s, and the allowance has been used to compensate informal carers. Formal LTC is based on a two-tiered system of regulation, funding, and services provision—separate for the health sector and for the social services sector and some private provision of LTC services have been developing, including a rise of unregistered LTC services (Sowa-Kofta et al., 2017).
References:
Sowa-Kofta, A., Wija, P. (2017). Czech Republic: Emerging policy developments in long-term care. CEQUA country report.
Update for: Czech Republic Last updated: February 3rd, 2022
1.01. Population size and ageing context
In 2020, there were 10,101,777 inhabitants in the Czech Republic. The total increase this year was 7.8 thousand inhabitants, the lowest in the last decade, while the decrease was 19.1 thousand, which was the largest in the last 100 years.
The population in the three main age groups in 2020 developed in the same direction as in previous years. The child population (0–14 years) grew by 9.5 thousand persons to 1.72 million year-on-year and thus represented 16.1% of the total population. The number of older people (aged 65 and above), which has been growing since the mid-1980s, has grown by a further 26.7 thousand to 2.16 million, and for the first time in its history its share in the population has exceeded 20% of the total residents. The increase in the share of people aged 65+ in the population of the Czech Republic was due to strong vintages – people born in the second half of the 1940s, and a long-term increase in life expectancy. However, for both children and seniors, the growth rate in 2020 was the lowest in the last ten years. The number of people of working age (15–64 years) has a declining trend in the last twelve years, in 2020 it decreased by 28.4 thousand to 6.82 million people, which was 63.8% of the total population.
From 2011 to the end of 2020, the average age of the Czech population increased by less than two years to 42.6 years. The index of economic dependence, which indicates the number of persons in the non-productive age (0–19 years and 65+ years) per 100 persons in the economically productive age (20–64 years), increased from 55 to 69 in the given period.
In 2020, mortality was fundamentally affected by the epidemic situation associated with the occurrence of covid-19. During the year, almost 129.3 thousand people died, which was 15.1% more than in 2019, while in previous years the annual declines were below 3.5%. The greatest impact of the epidemic in 2020 was observed in the age groups 75-79 and 80-84, where the number of deaths increased by more than one-fifth year-on-year – in each group by more than 3,000, and in the highest group 100+ there was an increase of two-fifths .
In 2020, diseases of the circulatory system caused the deaths of 36.5% of all men who died and 43.1% of women who died, their lower proportion being affected by the fact that a large proportion of the total number of deaths were attributed to covid-19. The second place in men and women has long been occupied by neoplasms, whose share in the total number of deaths has been relatively stable in the last decade at around 28% for men and 23% for women. In third place was placed in 2020 by a group called “Codes for special purposes”, which was filled in the Czech Republic only by covid-19. A total of 10,539 people died of the disease (8.2% of all deaths), of which 5,938 were men (8.9% of all men who died) and 4,601 women (7.3% of women who died). The fourth most common cause of death (with a share of 7.0% in men and 5.8% in women) in 2020 was respiratory diseases. Fifth, endocrine, nutritional and metabolic diseases, which make up more than four-fifths of diabetes mellitus, ranked fifth overall. Other causes include external causes – injuries, traffic accidents, diseases of the digestive and nervous systems (Source: https://www.czso.cz/csu/czso/aktualni-populacni-vyvoj-v-kostce).
Update for: Czech Republic Last updated: February 3rd, 2022 Contributors: Martina Paulíková |
1.02. Long-Term Care system governance
Since the 1990s, experts in the Czech Republic have been working to address supply issues in long-term care because it stands between the social and health departments (Holmerová, 2018). A large number of working groups were set up to try to resolve this issue ( Holmerová, 2015).
The last group dealing with long-term care operated in the years 2018–2021. It included representatives – ministers of both ministries – the Ministry of Labour and Social Affairs of the Czech Republic and the Ministry of Health of the Czech Republic. After less than a year, the group ceased operations. Ministries have continue to prepare their own proposals and solutions that have never been published. The COVID-19 pandemic has hindered proposals for solutions or changes (Horecky et al., 2021).
In practice, post-acute care (“follow-up”) and long-term care are not always well distinguished. The term “long-term care” appears only in the Law on Health Care and in the Bulletin 12/2019, of the Ministry of Health of the Czech Republic published Methodological Recommendation for Follow-up and Long-Term Health Care, in which it defined as follow-up care – care for patients in need of treatment and long-term care – care for patients whose health cannot be improved and would worsen without nursing care (MZCR, 2019).
Long-term care usually follows acute or follow-up care. Long-term care can be provided in the patient’s own home-home environment, in a social care facility (residential homes and homes with special regime), in a medical facility where long-term inpatient care is involved, or in the form of palliative care (MZCR, 2019).
Long-term care is not enshrined in legislation (with the one above mentioned exception). There is growing awareness that the long-term care system in the Czech Republic needs to be reformed. It is important that both health and social groups seek solutions, and they must find a system that is financially sustainable in the long-term and for all the payers involved, be it the state, local governments, health insurance companies, long-term care clients and their families. The disparity between long-term care needs and the insufficient capacities, quality and satisfaction with care has been attributed to the existing public policy and administration (Horecky et al., 2021).
Proposals for reforms to improve the system include the introduction of four basic principles (Horecky et al., 2021):
- Long-term care must be accessible, individualised and able to respond flexibly to changes in the health and needs of each person.
- Long-term care must be efficient in the use of financial resources and personnel, and ensure that the recipient always receives the support and care they need, taking into account their abilities and skills.
- Long-term care must be sustainable in the long run with a vision of development and future demand for LTC.
- It is important to strengthen community services – whether field or outpatient, whose proper functioning and support for people with impaired self-sufficiency in the home environment can fundamentally affect the demand for more expensive inpatient care.
References:
HOLMEROVÁ, I. (2018) Case management v pé?i o lidi žijící s demencí: koordinace pé?e zam??ená na ?lov?ka. Praha: Fakulta humanitních studií Univerzity Karlovy, 2018. ISBN 978-80-7571-031-4.
HOLMEROVÁ, I. (2014) Dlouhodobá pé?e: geriatrické aspekty a kvalita pé?e. Praha: Grada Publishing, [2014]. ISBN 978-80-247-5439-0.
Horecky J, Potucek M, Cabrnoch M and Kalvach Z (2021) REFORMA DLOUHODOBE? PE?C?E PRO C?ESKOU REPUBLIKU. Asociace poskytovatelu? socia?lni?ch sluz?eb C?R. https://www.apsscr.cz/files/files/A4_STUDIE%20LCT%202021_FINAL.pdf
Ministerstva Zdravotnictví, MZCR (2019) Vestnik. https://www.mzcr.cz/wp-content/uploads/wepub/18287/39699/Vestnik%20MZ_12-2019.pdf
Update for: Czech Republic Last updated: February 6th, 2022 Contributors: Martina Paulíková |
1.03. Long-term care financing arrangements and coverage
Public LTC expenditure in the Czech Republic was estimated to represent 1.3% of Gross Domestic Product (European Commission, 2018). Some LTC services such as home care are covered by the health insurance system (if indicated by a general practitioner). Institutional care costs are mostly paid by out-of-pocket payments (European Commission, 2019).
References:
European Commission (2018), ‘The 2018 Ageing Report. Economic & Budgetary Projections for the 28 EU Member States (2016-2070)’. Luxembourg: Publications Office of the European Union
European Commission (2019), Czech Republic Health Care & Long-Term Care Systems. An excerpt from the Joint Report on Health Care and Long-Term Care Systems & Fiscal Sustainability
Sowa-Kofta, A., Wija, P. (2017). Czech Republic: Emerging policy developments in long-term care. CEQUA country report
Update for: Czech Republic Last updated: February 15th, 2022
1.05. Quality and regulation in Long-term care
The tools introduced by the legal framework to ensure the quality of formal services in social care sector are the provider’s registration (each provider must be registered to provide services, registration can be withdrawn if quality standards are not met), inspections, and qualifications and training requirements for social workers. Quality standards focus on institutional processes and on personnel capacities (European Commission, 2021).
References:
European Commission (2021) 2021 Long-Term Care Report Trends, challenges and opportunities in an ageing society. Luxembourg: Publications Office of the European Union
Update for: Czech Republic Last updated: February 4th, 2022
1.11. Role of unpaid carers and policies to support them
Unpaid carers represented 4.6 % of the population in 2020: 6.2 % among women and 2.9 % among men. One third of unpaid carers provide care for more than 20 hours per week. Around two-thirds of unpaid carers in social services are female aged between 35-65 years old (EC, 2021). Unpaid care plays an important role in the sustainability of LTC as other options are often not available. There is a growing emphasis to support carers, particularly through improving the availability of respite services and counselling although availability of support is very limited. A care allowance for dependent people who receive unpaid care is also aimed at supporting unpaid carers (Sowa-Kofta et al., 2017; EC, 2021).
References:
European Commission, EC (2021) 2021 Long-term care report. Trends, challenges and opportunities in an ageing society. Country profiles Vol. 2. Joint Report prepared by the Social Protection Committee (SPC) and the European Commission (DG EMPL)
Sowa-Kofta, A., Wija, P. (2017). Czech Republic: Emerging policy developments in long-term care. CEQUA country report.
Update for: Czech Republic Last updated: February 16th, 2022
2.01. Impact of the COVID-19 pandemic on the country (total population)
As of December 2, 2021, there have been 2,193,289 confirmed cases of COVID-19 in The Czech Republic, and 33,317 deaths, according to the European Centre for Disease Prevention and Control, corresponding to 311 attributed deaths per 100,000 population.
Update for: Czech Republic Last updated: December 5th, 2021 Contributors: Disha Patel |
2.05. Impacts of the pandemic on the health and wellbeing of people who use Long-Term Care
A mixed methods study aimed to assess, quantitatively, the mental health of both staff and residents in long-term care facilities (LTCFs), and used qualitative methods to obtain insights into the challenges experiences in dealing with COVID-19 in care homes in the Czech Republic.
Data collection took place in April and May 2020, with a team of evaluators visiting 27 LTCFs, including children’s homes, and interviews were carried out with 378 residents, 443 members of staff and 49 managers. The study found that nearly half of residents met diagnostic criteria for anxiety or poor well-being and nearly 60% for depression. The highest rates of poor well-being were among residents in psychiatric facilities. The data from nursing homes was found to be unreliable due to high levels of cognitive impairment. There was no comparison to rates of poor mental health from before the pandemic, but the study found that COVID-related health worries were associated with poor mental health outcomes (Guerrero et al., 2021).
References:
Guerrero Z, Aliev AA, Kondrátová L, Jozefiaková B, Nesázalová N, Sa?áková JG, Winkler P. Mental Health and Quality & Safety of Care in Czech Residential Institutions during the COVID-19 Pandemic: A Mixed-Methods Study. Psychiatr Q. 2021 Dec;92(4):1393-1411. doi: 10.1007/s11126-021-09912-z.
Update for: Czech Republic Last updated: January 12th, 2022
2.09. Impact of the pandemic on workforce shortages in the Long-Term Care sector
An OECD paper as well as other sources indicated that Czech Republic faced staff shortages during the pandemic, the country attempted to address those by providing financial help to LTC facilities to recruit unemployed or former LTC workers, as well as providing financial help to LTC facilities to recruit LTC students.
Update for: Czech Republic Last updated: January 26th, 2022
3.07.03. Visiting and unpaid carer policies in care homes
In July 2021, visits in care homes are allowed, with guidance stating that visitors are obliged to pass an antigen test, unless they have been vaccinated, have recovered from Covid-19 in the last 90 days before the visit, or have had a negative PCR test in the last two days (source: https://covid.gov.cz/opatreni/zdravotnicka-socialni-zarizeni/omezeni-navstev-v-zarizenich-socialni-pece). Regarding outings for residents, recently the Deputy Ombudsman (“Public Defender of Rights”) asked the Minister of Health “to immediately lift the restrictions on the outing of clients of homes for the elderly and homes with special regimes. An extraordinary measure of the Ministry allows them to leave the facility only if they undergo two antigenic tests and subsequent isolation for several days. It is not possible to accept restrictions on these people in their fundamental rights” (source: https://www.ceskenoviny.cz/zpravy/simunkova-zada-zruseni-omezeni-vychazek-klientu-domovu-pro-seniory/2031948). Further conditions attached to outings for residents are specified in the same ‘extraordinary measure’.
Update for: Czech Republic Last updated: November 30th, 2021
3.11. Vaccination policies for people using and providing Long-Term Care
Covid-19 vaccination is not compulsory for anyone. However, care home workers were among the first groups, together with health care workers, who were offered vaccination. The Czech Association of Social Services Providers published several surveys on progress in vaccination in social services –the findings have been published online (in Czech only).
There has been no specific vaccination campaign at national level targeting long-term care staff, nevertheless they are prioritized group, and were among the first groups who got vaccinated. There has been a more general campaign to promote vaccination among vulnerable groups and prioritized group of workers.
Update for: Czech Republic Last updated: November 30th, 2021
4.02. Reforms to the Long-term care financing system
In 2019 the personal care allowance for the most dependent groups of beneficiaries (apart from people in residential care) has been increased by 45 % (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu).
Update for: Czech Republic Last updated: September 8th, 2021
4.05. Reforms to address Long-Term Care workforce recruitment, training, pay and conditions
An EU report (2021) noted that the Czech government has continually and significantly increased the wages of employees in LTC sector since 2014 which is likely to have made the profession more attractive.
Update for: Czech Republic Last updated: September 13th, 2021
4.06. Reforms to improve support for unpaid carers
In 2018 the Czech Republic, introduced a ‘long-term care-giver’s allowance’ for employed or self-employed carers who can be compensated for the loss of income from work due to taking care of a family member discharged from hospital and requiring at least 30 days of further care up to a maximum of 90 days (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu).
Update for: Czech Republic Last updated: November 23rd, 2021