Structural characteristics of the LTC system, impact of the pandemic, measures adopted and new reforms
This country profile contains the Australian section of LTCcovid International Living Report on COVID-19 Long-Term Care. The report brings together information on the experience of the long-term care sector (focussing on people who use and provide care) during the COVID-19 pandemic in Austria, as well as description of the system and of new reforms. The LTCcovid Living report is updated and expanded over time, as experts on long-term care add new contributions. This profile also provides links to research projects on COVID-19 and long-term care, to key reports, and lists key experts on the impacts of COVID-19 on the long-term care sector in Austria.
Experts on COVID-19 and long-term care in Austria that have contributed to this report:
Living report: COVID-19 and the Long-Term Care system in Austria
PART 1 – Long-Term Care System characteristics and preparedness
- 1.00. Brief overview of the Long-Term Care systemAustria is a federal state and was one of the ‘early movers’ when it came to acknowledge long-term care (LTC) as a social risk that calls for solidarity and societal support for people in need of long-term care. With the introduction of the LTC allowance scheme in 1993, Austria followed its tradition as a continental, conservative welfare regime in which cash benefits dominate over the provision of social services. At the same time, the country deviated from this pathway as funding of the LTC allowances (attendance allowance) has been stipulated through general taxes rather than as a fifth pillar of the social insurance system. With this original reform, competences between the federal state and the nine provinces were reshuffled in that the federal government became responsible for financing all cash benefits, including support for informal carers, while the provincial governments remained in charge to procure community care services and residential facilities. Indeed, home care services are almost entirely provided by private non-profit organisations (based on a long-standing tradition), while about 50% of residential facilities are managed by public entities, 25% by non-profit organisations, while the share of private for-profit providers has been increasing and is currently also at about 25%. To date, there are about 75,000 places in care homes, about 7,000 places in alternative housing and short-term facilities, while about 150,000 persons are using one or the other home care service throughout the year (Statistics Austria, 2021). As there are about 470,000 beneficiaries of the LTC allowance, it becomes evident that the large majority of people in need of care is being cared for at home with support by an informal carer, mainly by wives, daughters and step-daughters. In total, it has been estimated that there are about 801,000 Austrians involved in caring for a loved one at home, while 146,000 are supporting a family member who is living in a care home, i.e. more than 10% of the population (Nagl-Cupal et al., 2018). A survey found that many Austrians experienced barriers to accessing care services, with availability of services being a major factor, as well as cost. Compared to other countries in the European Union, Austrians reported more concerns about the availability of residential care. This lack of availability of services translate in over-reliance on informal support and low confidence on the ability of the system to address future care needs (Ilinca et al., 2022) Against this backdrop, a specific feature of the Austrian LTC system has developed over the past 25 years in terms of a partial replacement (or supplementation) of family care by live-in personal carers, mainly from neighbouring Eastern European countries. Although live-in migrant care is a widespread phenomenon across Europe, the so-called ‘24-hour care’ model in Austria has a special status with dedicated legal regulations and funding since 2007 (Schmidt et al., 2016). ‘Personal carers’ are registered as self-employed at the Austrian Chamber of Commerce, although most of them are also dependent on specialised brokering agencies in their home country or in Austria (Aulenbacher et al., 2020). Due to the geographic situation as well as to unemployment and wage differentials in neighbouring countries, the share of older people in need of care relying on migrant live-in carers has increased significantly over the past 15 years. To date, more than 66,000 personal carers accompany about 33,000 Austrians in need of care in their own households (ca. 7% of total beneficiaries of the LTC allowance). This phenomenon contributes to additional complexity in the already fragmented structural framework of LTC in Austria. The lack of coordination among different LTC settings, and in particular between these and the acute health sector, has been a constant criticism over the past decades, and related caveats became even more evident since the onset of the SARS-CoV-2 pandemic and related measures such as travel restrictions and the closing of borders (Leichsenring et al., 2021). Current initiatives are striving to address shortcomings in information, communication and coordination by means of a pilot project to establish 150 community nurses at municipal level. However, the imminent shortage of workforce in the LTC sector and related challenges of sustainable funding are calling for urgent and more far-reaching reforms. There are currently about 60,000 professionals working in the various settings of LTC. It has been forecasted that a minimum of 30,000 additional professionals would be necessary until 2030 to replace retiring staff and to satisfy the growing demand of formal care (Rappold & Juraszovich, 2019).
ReferencesAulenbacher, B., Leiblfinger, M. & Prieler, V. (2020). “Jetzt kümmern sich zwei slowakische Frauen abwechselnd um meinen Vater …” Institutionelle Logiken und soziale Ungleichheiten in der agenturvermittelten 24h-Betreuung. In: Seeliger, M., Gruhlich, J. (Hg.). Intersektionalität, Arbeit und Organisation. Weinheim and Basel: Beltz Juventa. Ilinca S., Simmons C., Leichsenring K., Kadi S., Ondas K. & the InCARE team (2022) Attitudes, experiences, and expectations on long-term care in Austria. InCARE Factsheet No.1. Leichsenring, K., Schmidt, A.E., Staflinger, H. (2021). Fractures in the Austrian model of long-term care: What are the lessons from the first wave of the COVID-19 pandemic? Journal of Long-Term Care, 2021, 33-42. DOI: https://doi.org/10.31389/jltc.54 Nagl-Cupal, M., Kolland, F., Zartler, U., Mayer, H., Bittner, M., Koller, M., Parisot, V., Stöhr, D., Bundesministerium für Arbeit, Soziales, Gesundheit und Konsumentenschutz (Hg.) (2018). Angehörigenpflege in Österreich. Einsicht in die Situation pflegender Angehöriger und in die Entwicklung informeller Pflegenetzwerke. Wien: Universität Wien/BMASGK. Rappold, E. & Juraszovich, B. (2019). Pflegepersonal-Bedarfsprognose für Österreich. Wien: Bundesministerium für Arbeit, Soziales, Gesundheit und Konsumentenschutz. Schmidt, A.E., Winkelmann, J., Leichsenring, K. & Rodrigues, R. (2016). Lessons for regulating informal markets and implications for quality assurance – the case of migrant care workers in Austria. Ageing & Society, 36(4), 741-763. Statistics Austria (2021) Betreuungs- und Pflegedienste, available at http://www.statistik.at/web_de/statistiken/menschen_und_gesellschaft/soziales/sozialleistungen_auf_landesebene/betreuungs_und_pflegedienste/index.html
- 1.01. Population size and ageing context
In 2016 Austria had a population of 8.6 million, of whom 0.81 million required help from others to carry out activities of daily life (European Commission, 2019). Furthermore, 18.2% of the Austrian population (1.5 million people) are aged 65 years and older, with demographic ageing being observed particularly in rural areas. Approximately 20% of Austrians with LTC needs live in one of the 930 care homes. These homes, on average, can house about 80 people (Leichsenring et al. 2021).
European Commission (2019) Joint Report on Health Care and Long-Term Care Systems & Fiscal Sustainability, Retrieved from: Country Documents 2019 Update (europa.eu)
Leichsenring, K., Schmidt, A.E., Staflinger, H. (2021). Fractures in the Austrian model of long-term care: What are the lessons from the first wave of the COVID-19 pandemic? Journal of Long-Term Care, 2021, 33-42. DOI: https://doi.org/10.31389/jltc.54
- 1.02. Long-Term Care system governance
Governance of LTC system in Austria is relatively fragmented, in that the responsibility is divided amongst the federal government and the federal states in several ways. The federal government is in charge of the care allowance benefit, while the regional governments are responsible for the provision of care services (Fink, 2018). These responsibilities by the federal states include providing LTC services (i.e. in-kind benefits), planning the number of beds/spots for care, and regulating tariffs and subsidies. In terms of home care services, the federal states are responsible for regulating the framework conditions as it relates to funding, collective bargaining agreements for services and out-of-pocket payments by users. Although the federal states are responsible by law for the provision of long-term care services for older adults in Austria, in practice, the responsibility for carrying out these services is shared with several entities, such as the municipalities, non-profit organisations and private operators (Rechnungshof Österreich, 2020).
Fink, M. (2018). ESPN Thematic Report on Challenges in long-term care. Austria 2018, Brussels, https://ec.europa.eu/social/BlobServlet?docId=19837&langId=en
Rechnungshof Österreich, 2020 Bericht des Rechnungshofes: Pflege in Österreich. Wien: RH Österreich
- 1.03. Long-term care financing arrangements and coverage
In 2016 public spending on LTC represented 1.9% of Gross Domestic Product (European Commission, 2018). Long-term care is financed in Austria through a combination of public-sector taxed- based support and out-of-pocket payments by care users. The responsibility for long-term care financing is divided amongst the federal government and the federal states. The federal government is responsible for funding the long-term care allowance (Pflegegeld) and various measures for supporting informal carers, while the federal states cover benefits in-kind (i.e. care services) and are responsible for financing social assistance when a care user cannot cover their costs of care. Although the federal states are in charge of in-kind services and social assistance, as the federal government is responsible for collecting taxes, the federal government provides transfers to the federal states to cover these costs through the general fiscal equalisation scheme and the long-term care funds (Pflegefonds) (Fink, 2018). Since 2011, there is a LTC fund (“Pflegefonds”) for the federal government to redistribute to the states and municipalities to help cover home care and nursing home services, as well as palliative and hospice care (Bachner et al., 2018).
The long-term care allowance (Pflegegeld) is a key aspect of the Austrian long-term care system, with over 467,000 beneficiaries in 2020 amounting to €2.71 billion (source: http://www.statistik.at/web_de/statistiken/menschen_und_gesellschaft/soziales/sozialleistungen_auf_bundesebene/bundespflegegeld/index.html). The care allowance is intended to be a contribution towards the cost of care to cover care-related expenses, whether it be formal care services, either privately or publicly provided, or to cover informal care (i.e. routed wage) provided by relatives. Care allowance beneficiaries may use the allowance however they see fit, with no oversight/control on how the allowance is used. The allowance consists of seven levels, characterized by the number of hours needed per month for home help and personal and nursing-related care tasks. To receive the care allowance, the recipient must fulfill several requirements: 1) be in need of support and help for more than 6 months because of a physiological, cognitive or mental health impairment or an impairment of the senses and 2) need support for at least 65 hours per month. To obtain the care allowance, the recipient must first submit a claim to the pension insurance institution before being visited by a certified doctor or nurse who assess their needs regarding (instrumental) activities of daily living. The federal government also finances support for informal carers, through a number of avenues. In 2016, support for informal care amounted to €72.8 million, primarily covering the social insurance of informal carers (€49.2 million), followed by for respite care (€11 million), for care leave (€10.7 million) and finally for quality assurance (€1.9 million) (Schrank, 2017).
In 2019, gross expenditure on LTC services amounted to €4.2 billion, primarily covered by the federal states and municipalities (59%), followed by out-of-pocket pockets by care users and their families (36%) and the rest (5%) from other sources (i.e. contributions by health insurances). Approximately 84% of this went towards (semi-)residential care facilities, and the rest towards mobile care services (16%) (source: http://www.statistik.at/web_de/statistiken/menschen_und_gesellschaft/soziales/sozialleistungen_auf_landesebene/betreuungs_und_pflegedienste/index.html).
Bachner, F. et al. (2018), ‘Austria. Health System Review’ Health Systems in Transition, Vol. 20, No.3. European Health Observatory. Accessed at: HiT-20-3-2018-eng.pdf (who.int)
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
Fink, M. (2018). ‘ESPN Thematic Report on Challenges in long-term care. Austria’. Brussels, https://ec.europa.eu/social/BlobServlet?docId=19837&langId=en
Schrank, S. (2017), ‘Reforms in long-term care: The Austrian long-term care system : Current challenges and reforms’. Accessed at: European Centre for Social Welfare Policy and Research
- 1.04. Approach to care provision, including sector of ownership
While by law the federal states are responsible for the provision of long-term care services for older adults in Austria, in practice, the responsibility for carrying out these services is shared with several entities, such as the municipalities, non-profit organisations and private operators (Rechnungshof Österreich, 2020). The share of publicly- and privately-provided care providers varies immensely between the federal states and between the home and residential care sector.
In residential care, approximately 50% of care providers are public, 25% are non-profit, and the remaining 25% are for profit (Molinuevo & Anderson, 2017; Rodrigues & Nies, 2013). Approximately 900 nursing homes were in operation in 2017, providing 78,000 beds. Around 400 of these nursing homes were run publicly, with the remainder run by mostly non-profit (religious) organisations, such as Volkshilfe, Sameriterbund and Caritas.
In the home care sector, 91% of providers are non-profit, 8% are public and 1% are for-profit (Rodrigues & Nies, 2013). Mobile services are primarily provided by non-profit (often faith-based) organisations, while day centres (not connected to inpatient facilities) are mostly run by private providers (Grossmann & Schuster, 2017).
Grossmann, B. & Schuster, P. (2017). Langzeitpflege In Österreich: Determinanter Der Staatlichen Kostenentwicklung. Studie Im Auftrag Des Fiskalrats. Wien: Fiskalrat. Retrieved from https://www.oesterreich.gv.at/themen/soziales/soziale_dienste/1/Seite.1210130.html
Molinuevo, D. & Anderson, R. (2017). Care homes for older Europeans: Public, for-profit and non-profit providers. Luxembourg: Publications Office of the European Union. Retrieved from Eurofound website https://www.eurofound.europa.eu/publications/report/2017/care-homes-for-older-europeans-public-for-profit-and-non-profit-providers
Rechnungshof Österreich (2020). Bericht des Rechnungshofes: Pflege in Österreich. Wien: RH Österreich
Rodrigues, R., & Nies, H. (2013). Making Sense of Differences – The Mixed Economy of Funding and Delivering Long-term Care. In Leichsenring, K., Billings, J., & Nies, H. (eds), Long-term care in Europe: Improving policy and practice. Basingstoke: Palgrave Macmillan.
- 1.05. Quality and regulation in Long-term care
As of 2021 there is no clearly defined and integrated quality framework, covering the different sectors of LTC. The ‘15a agreement’ on LTC between the Federal Republic and the federal provinces defines general quality criteria and leaves considerable room for interpretation. On the subnational level, the federal provinces enacted more detailed regulation to promote the quality of LTC services. These regulations address the structural and procedural aspects of LTC quality, and usually do not give much emphasis to outcome-related aspects (European Commission, 2021).
European Commission (2021) 2021 Long-Term Care Report Trends, challenges and opportunities in an ageing society. Luxembourg: Publications Office of the European Union
- 1.08. Care home infrastructure
In 2015, about 850 nursing homes or residential care facilities provided 75 632 inpatient care places while 12 019 persons lived in alternative housing forms. Since 2000, the number of places in nursing homes or residential care facilities increased by more than 30%, as a result of population ageing and increasing demand for long-term care (BMGF, 2017k). Also, the number of hospitals and beds in rehabilitative care increased by around 40% between 2007 and 2016. In 2020 about 90,000 people are cared for in about 870 care homes (about 50% public, 25% private for-profit, 25% non-profit) (Schmidt et al. 2020).
Schmidt, A. at al (2020), ‘The impact of COVID-19 on users and providers of Long-Term Care services in Austria’ Accessed at: Austria report ltccovid.org
- 1.09. Community-based care infrastructure
There is a wide range of community-based services available across Austria, both provided in the home of care-users and in community centers, although the availability and type of services available vary drastically across and within federal states. A range of long-term care mobile services are available for supporting personal care (i.e. personal hygiene, eating, etc.) and household maintenance in the home of the care user, carried out and coordinated at the regional and municipality level, including: food delivery (i.e. meals on wheels), driving services, mobile therapeutic services, cleaning services, repair services, and laundry services. Social services also exist, such as peer-to-peer advice provided by those with disabilities and visiting services for older people who are lonely (sources: https://www.oesterreich.gv.at/themen/soziales/soziale_dienste/1/Seite.1210130.html and https://www.oesterreich.gv.at/themen/soziales/soziale_dienste/1/Seite.1210140.html).
Day care centres, which are available from Monday to Friday, are another community-based care option for older people. These centers offer a wide range of services, including social contact, skills training, professional care, therapies, and general support (source: https://www.gesundheit.gv.at/leben/altern/wohnen-im-alter/altersgerecht-wohnen).
24-hour care, in which care is provided around the clock by a live-in carer (typically of migrant origin), is also a large part of the community-based care in Austria and provides a relatively cheaper option for individuals with extensive care needs to stay in their home (Aulenbacher et al., 2020).
Aulenbacher, B, Leiblfinger, M, Prieler, V (2020) ‘The promise of decent care and the problem of poor working conditions: Double movements around live-in care in Austria.’ Socialpolicy.ch – Journal of the Division of Sociology, Social Policy, Social Work 2: 2.5.
- 1.10. Workforce conditions: pay, employment conditions, qualification levels, shortages
In Austria more than 66,000 personal carers (mostly migrants from neighbouring countries) provide live-in care to around 33,000. About 47,100 staff provide care to care home residents and 18,300 provide home-based care. The share of social care staff who are migrants from neighbouring (Eastern European) countries has increased in recent years. These workers are registered as self-employed, but in practice they are dependent on brokering agencies in their home countries and have precarious working conditions as well as few entitlements to social protection and labour rights. The majority of these workers are women and work in alternate rotas of two weeks or a month (Leichsenring et al. 2021; Leiblfinger, M. at al. 2020).
Leichsenring, K., Schmidt, A., Staflinger, H. (2021) ‘Fractures in the Austrian Model of Long-Term Care: What are the Lessons from the First Wave of the COVID-19 Pandemic?’ Journal of Long-Term Care, pp. 33–42. DOI: https://doi.org/10.31389/jltc.54
Leiblfinger, M. at al. (2020) ‘Impact of COVID-19 Policy Responses on Live-In Care Workers in Austria, Germany, and Switzerland’ Journal of
Long-Term Care, (2020), pp. 144–150. DOI: https://doi.org/10.31389/jltc.51
- 1.11. Role of unpaid carers and policies to support them
Unpaid carers have been receiving greater recognition and benefits in Austria over the years. For example, since 2009, the federal Government pays old-age for informal carers themselves (prior to 2009, unpaid carers had an option to pay health and pension insurance voluntarily from their own pockets).
Carers are also entitled to an extra allowance to pay for respite care. Since 2014, carers who are in paid employment may take a paid care leave or part-time care leave to care for dependent relatives for up to three months, the compensation amount is income-related (Rodrigues et al. 2017).
Rodrigues, R., Bauer, G., Leichsenring, K. (2017). ‘A decade of piecemeal changes in Austria’. CEQUA LTC Network report
PART 2 – Impacts of the COVID-19 pandemic on people who use and provide Long Term Care
- 2.02. Deaths attributed to COVID-19 among people using long-term care
During the earlier part of the pandemic, Austria was among those countries that had reported fewer deaths in care homes. During the second wave of the COVID-19 pandemic, Austria experienced very high rates of infections, reflected in a steep rise in infections and deaths due to COVID-19 in care homes (Source: https://ltccovid.org/2020/11/27/the-second-wave-has-hit-austria-harder-also-in-care-homes/). Through the spring and summer months infection rates fell but as of November 2021, infection growth rates are increasing again.
As of November 1st 2021, there are 69,730 residents in care homes (including all ages) Of this population, 3,953 have died. Compared to the 11,369 total deaths linked to COVID-19 in Austria on the same date, deaths of care home residents would represent 35% of all deaths.
According to data from September 17, 2020, only 0.4% of care home residents had died after the first wave. By November 2021, this number has risen to 5.7%. This is based on there being 69,730 residents in care homes in Austria (BM für Arbeit, Soziales, Gesundheit und Konsumentenschutz (2019) Pflegevorsorgebericht 2018. Vienna, BMASGK).
- 2.05. Impacts of the pandemic on the health and wellbeing of people who use Long-Term Care
A qualitative study by Pfabigan et al., (2022) indicated that older people with light and moderate care needs living alone in Austria had to adjust their activities of daily living as well as other activities such as practising faith or pastimes. However, it was in particular their autonomy that had to be negotiated e.g. those who used to do shopping on their own were no longer able to do so, and had to rely on others such as neighbours. Overall the study found that the management of everyday life and support was challenging for this group of people.
Pfabigan, J., Wosko, P., Pichler, B., Reitinger, E. and Pleschberger, S. (2022) Under reconstruction: the impact of COVID-19 policies on the lives and support networks of older people living alone, 6(1-2): 211–228, International Journal of Care and Caring, DOI: 10.1332/239788221X16308602886127
- 2.07. Impacts of the pandemic on unpaid carers
A survey in Austria ‘among 100 low-income informal carers’ found that reduced availability of home care and community services as well as reduced support from other family members led to an increase in the amount of care provided by unpaid carers, and among 16% of surveyed participants reported ‘a reduction of paid work’.
- 2.09. Impact of the pandemic on workforce shortages in the Long-Term Care sector
According to a recent report by The Federation of European Social Employers, Austria has experienced an increase of between 1 – 10% in staff shortages since 2021. The sub-sector most critically affected by staff shortages across the countries surveyed for this report were services for older persons. The job position most affected was nursing, but care assistants and homecare / social care workers also face real shortages. The most common reasons given for staff leaving the social care sector for another include low wages, and mental and physical exhaustion relating to the pandemic.
PART 3 – Measures adopted to minimise the impact of the COVID-19 pandemic on people who use and provide Long-Term Care
- 3.02.01. National or equivalent Covid-19 Long-Term Care taskforce
Several task forces were put in place ‘at federal and regional government level’. They only contained two representatives from the LTC sector (Source: https://journal.ilpnetwork.org/articles/10.31389/jltc.54/).
- 3.02.02. Measures to improve coordination between Health and Social Care in response to the pandemic
A published paper highlights the fragmented nature of the health and social care system, which leads professionals in both sectors to largely ‘work in ‘silos’’. The paper notes that there is very little exchange between LTC staff working in residential and domiciliary care. It further observes that this lack of exchange between health and LTC services, but also between different LTC services, leads to a situation where some health and LTC workers had to reduce their activities, while others experienced excess demand.
- 3.02.03. Measures to support, facilitate and compensate for disruptions to access to care
The closing of borders during the first wave of the COVID-19 pandemic posed challenges for the Austrian ’24-hour care model’ staffed with migrant care workers who tend to work extended shifts (fortnightly or monthly shifts). Migrant care workers in Austria were unable to return to their home countries and replacement staff were unable to travel into the country. In response to the impact of COVID-19 on the LTC sector, the federal government provided an ‘extraordinary crisis budget of €100 million’. Two provinces (Burgenland and Lower Austria) invested in chartered flights to bring several hundred migrant carers from Romania, Bulgaria, and Croatia into the country. Later on, corridor trains between Romania and Austria were established. Regional governments as well as the Federal Ministry provided a ‘premium of €500’ for migrant carers continuing to provide care in Austria. A hotline was established to support the coordination of care workers across the country.
In care homes, external staff (including occupational therapists/physiotherapists) were ‘extremely restricted’. It is reported that ‘18% of care homes and 15% of people living at home discontinued therapies’ (Source: https://journal.ilpnetwork.org/articles/10.31389/jltc.54/).
- 3.04. Financial measures to support users and providers of Long-Term Care
In Austria, some of the €100 million allocated to support the LTC sector were earmarked for expanding residential care bed capacity for people who could not be cared for sufficiently in their own home because of the complexities of delivering home care during the pandemic (Source: https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf). People with care needs can receive cash-for-care allowances following a needs assessment (Source: https://journal.ilpnetwork.org/articles/10.31389/jltc.54/).
- 3.06. Support for care sector staff and measures to ensure workforce availability
Austria implemented measures that required its hospitals to offer support to care homes in the form of personnel, expertise, and equipment (source: https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf).
In Austria almost 33,000 people with LTC needs receive support from 66,000 ‘personal’ migrant live-in carers. Closed borders at the beginning of the pandemic posed challenges. Two provinces charted flights to bring live-in carers from Eastern European countries back to Austria. Carers were quarantined for two weeks (without income and having to contribute to accommodation). Carers who decided to stay were offered a €500 bonus. A hotline helped to coordinate 24-hour care. Considerable efforts were made to maintain the live-in model. Care workers experienced challenges with complex paperwork (source: https://journal.ilpnetwork.org/articles/10.31389/jltc.54/).
A panel survey of over 20,000 Austrian employees conducted in May 2020 found that 46% of care professionals reported their job to be ‘mentally stressful’, while this was only the case for 11% in other jobs. In addition, only 38% of carer workers think they will reach pension age in their sector (versus 61% of other professions). During the pandemic, one third of care workers reported ‘stress due to time pressure and changing labour processes’ (source: https://ltccovid.org/2020/11/27/the-second-wave-has-hit-austria-harder-also-in-care-homes/).
- 3.07. Infection Prevention and Control measures in the Long-Term Care sector: guidance, support and implementation
In Austria responsibility for the development of guidance in LTC settings, their implementation and monitoring has been given to newly established national task forces (https://apps.who.int/iris/bitstream/handle/10665/336303/Eurohealth-26-2-77-82-eng.pdf).
- 3.07.01. Measures in relation to transfers to and from hospital, from community to care homes and between settings
After 7 April 2020, which marked the peak use of capacity in hospitals during the first wave, patients were transferred from hospitals to care homes, ‘often without testing.’
By 16 April 2020, the Austrian government had announced that people discharged from hospital to care homes should be systematically tested (https://journal.ilpnetwork.org/articles/10.31389/jltc.54/).
- 3.07.02. Approach to isolation of people with confirmed or suspected Covid-19 infections in care homes
In care homes, isolation was used frequently, however, this was problematic in situation where more people shared rooms. (https://journal.ilpnetwork.org/articles/10.31389/jltc.54/)
- 3.07.03. Visiting and unpaid carer policies in care homes
Following the first reports of cases and subsequent deaths in care homes in March 2020, some homes put in place visiting restrictions and bans, even before the general lockdown was implemented, but already by April 2020 some care homes worked towards enabling safe visits by creating ‘encounter zones’ that allowed families to meet residents at safe distance (in the garden/ divided by Plexiglas) and adhering to hygiene measures (https://journal.ilpnetwork.org/articles/10.31389/jltc.54/).
In Austria, care home visiting has been possible again since May 2020 under a range of safety measures. Measures (‘visiting zone’, booth divided by plexiglass) varied between regions. The latest COVID-19 related measures issued by the government (8 February 2021) state that residents can be visited up to twice per week by up to two visitors per resident. Visitors must show a negative COVID-19 test and wear a FFP2 mask throughout their visit (https://www.sozialministerium.at/Informationen-zum-Coronavirus/Coronavirus—Aktuelle-Ma%C3%9Fnahmen.html).
It appears that Austrian visiting varied across Austria during the period from October to December 2020, when the country experienced a high number of cases. A paper reports on screening of visitors and restrictions of visits in public areas in Viennese care homes, as well as a ‘Corona traffic lights’ system in Lower Austria than put in place measures depending on local levels of infections (https://journal.ilpnetwork.org/articles/10.31389/jltc.54/).
As of May 10, 2021, new legislation sets out provisions regarding opening from lockdown (https://www.ris.bka.gv.at/Dokumente/BgblAuth/BGBLA_2021_II_214/BGBLA_2021_II_214.html). A maximum of three visitors a day are allowed for nursing home residents. However, these restrictions do not apply for visits in the context of palliative and hospice care, pastoral care, and for accompaniment during critical life events. In addition, a maximum of two persons per resident in need of support may be admitted if they provide regular support and care tasks. Visitors must present proof of low epidemiological risk, such as evidence of a negative result of a SARS-CoV-2 antigen or molecular test, medical conformation of an infection with SARS-CoV-2 survived in the last six months, or proof of vaccination against Covid-19. Visitors must wear a mask of protection class FFP2 without an exhalation valve, unless there is a suitable protective device for spatial separation that ensures the same level of protection. The same rules apply for the admission of external service providers and patient advocates. Residents shall be offered a SARS-CoV-2 antigen or molecular test at least every week, or at least every three days if they have recently left the nursing home. There are no specific provisions in this legislation regarding outings for residents.
- 3.08. Access to testing and contact tracing for people who use and provide Long-Term Care
By 16 April 2020, the Austrian government had announced plans that staff and residents in care homes should be systematically tested. A paper reports some reluctance in the implementation of testing in LTC services, especially in community care. However, it was also reported that residents ‘were scarcely tested’ up to January 2021 and that communication of test results did not always happen in good time (https://journal.ilpnetwork.org/articles/10.31389/jltc.54/).
By November 2020, care home staff had to undergo compulsory testing on a weekly basis, but regulation allowed staff to continue working following a positive test if they do not show symptoms, their Ct value is above 30 and they ware an FFP2 mask (https://ltccovid.org/2020/11/27/the-second-wave-has-hit-austria-harder-also-in-care-homes/).
- 3.11. Vaccination policies for people using and providing Long-Term Care
On 26 December 2020 the Federal Ministry of Social Affairs, Health, Care and consumer protection published their COVID-19 vaccine prioritization recommendations. In the first phase, the highest priority group included residents and staff in care and nursing home, staff in health care sector with high risk of exposure and people aged 80 years and older. The second phase included people with existing illnesses (including dementia) and their closes contacts (especially of those living in residential care settings), domiciliary care workers, people aged 75 to 79 years. Since the end of December, 1,053,599 people have been vaccinated (appx. 275,000 of whom have received both doses). Starting March 2021, those 65 and older are eligible for vaccination, indicating successfully high rates of vaccination amongst the top two priority groups (https://info.gesundheitsministerium.at/en/).
Currently there is only a recommendation to get vaccinated in place for care staff, but no obligation. An obligatory regulation is also not foreseen in the near future. However, there is a law (Epidemiegesetz 1950) that could make this possible.
It is possible, however, when hiring new staff, that employers ask for tighter tests in the hospital or care sector (e.g. for measles, hepatitis, not influenza). Only in one region (Styria) there are some legal possibilities to oblige staff to have specific vaccinations done. In general, across Austria care personnel that are still undergoing training might not be accepted if no tighter tests are provided. Care homes deviate in their views on how to handle the situation (whether or not to make vaccinations obligatory).
Information in German on COVID-19 vaccinations for care personnel: https://www.sozialministerium.at/Themen/Gesundheit/Impfen/Impfempfehlungen-Allgemein/Empfehlung-f%C3%BCr-Gesundheitspersonal.html
- 3.12. Measures to support unpaid carers
Austria has supported carers through telephone hotlines (for psychological counselling, self-help, guidance, resources). An online course for unpaid carers is being provided by the Austrian Red cross. The national dementia strategy and the Austrian carers association provide links to NGO support. (https://ltccovid.org/wp-content/uploads/2020/07/The-COVID-19-Long-Term-Care-situation-in-Austria-13-July-1.pdf). An article by Leichsenring and colleagues published in the Journal of Long-Term Care highlights the limited support available for unpaid carers.
PART 4 – Reforms to strengthen Long-Term Care systems and to improve preparedness for future pandemics and other emergencies
- 4.02. Reforms to the Long-term care financing system
Since 2017 Austrian federal provinces can no longer use assets of people in residential care, (or assets of their relatives, heirs or gift-recipients) to cover the costs of care. In January 2020, a yearly indexation of long-term care cash benefits was established (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu).
- 4.06. Reforms to improve support for unpaid carers
In 2019, Austria introduced a legal entitlement to care leave, which applies in companies with more than five employees; where previously the employer had to agree to it which impacted the uptake (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu).
Printable version of this country profile:
To cite this report (please add the date in which the document was accessed):
Simmonds C., Leichsingering K, Schmidt A. Patel D. COVID-19 and the Long-Term Care system in Austria. In: Comas-Herrera A., Marczak J., Byrd W., Lorenz-Dant K., Pharoah D. (editors) LTCcovid International living report on COVID-19 and Long-Term Care. LTCcovid, Care Policy and Evaluation Centre, London School of Economics and Political Science. https://doi.org/10.21953/lse.mlre15e0u6s6
Ongoing research projects on COVID-19 and Long-Term Care in Austria:
Most recent LTCcovid report for Austria (July 2020):
Acknowledgement and disclaimer:
This report has built on previous LTCcovid country reports and is supported by the Social Care COVID-19 Resilience and Recovery project, which is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333) and by the International Long-Term Care Policy Network and the Care Policy and Evaluation Centre at the London School of Economics and Political Science. The views expressed in this publication are those of the author(s) and not necessarily those of the funders.
Copyright: LTCCovid and Care Policy and Evaluation Centre, LSE