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Local Authority Services for the Elderly

By: Eigil Boll Hansen and Merete Platz
AKF, October 1995

These annotated tables are based on a questionnaire sent to all Danish local authorities at the beginning of 1995. 245 authorities, corresponding to 89%, returned the questionnaire.

The main purpose of the survey is to obtain an up-to-date picture of the housing and other services offered to the elderly by different types of local authorities. The survey included a systematic investigation of whether there are differences between urban and rural councils and whether there are differences between Eastern and Western Denmark.

Local Authority Housing Services
A study from 1990 shows that nursing home places closed down between 1987 and 1990 had not been fully replaced in the local authorities in which the closures had taken place. However, as there were also local authorities that had increased the number of nursing flats, the overall result was that, nationally, just as many flats with a nursing duty centre had been established as the nursing home places lost.

From 1 January 1991 to 1 January 1995 almost 40% of the local authorities did nothing on the nursing home/nursing flat front, neither closing down nursing homes nor building new nursing flats, meaning flats with round-the-clock care by nursing staff and residents' lounge in which the residents can get together. 20% of the local authorities had either replaced the nursing home places closed down or had even increased the number of nursing flats within their area. The last 40% had closed down nursing home places but had not built new nursing flats to replace them.

A comparison of the number of nursing home places lost in the period 1.1.1991 to 1.1.1995 with the number of flats with nursing care and residents' lounge built shows a nationwide reduction of more than 1,000 in the number of nursing flats. That corresponds to a reduction of 0.2% nationwide in nursing flat capacity in relation to the number of people aged 70+. However, in the metropolitan region and the urban authorities, the account almost balances. The same applies in the local authorities in West and North Jutland.

The types of housing now under construction and planned for construction up to 1 January 1997 are far better suited for nursing care and for meeting the needs of frail old people than the existing stock. If the number of permanently staffed housing units under construction and planned is compared with the number of planned closures of nursing home places there will be a surplus of about 1,000 housing units from 1 January 1995 to 1 January 1997. Thus, by the end of 1996, the nursing home places closed down will have been replaced by new housing – assuming that the present plans are implemented. Only time will show whether that is so.

Personnel in the Home Care Service and at Nursing Homes
In all, local authority personnel working in the home care service and at nursing homes corresponds to 110 employees per 1,000 inhabitants aged 70+. Personnel coverage is highest in the urban authorities and lowest in the metropolitan region's authorities. The differences is due to different coverage with home helpers and other care personnel and therapists, whereas there is almost no difference in the coverage with nurses.

The personnel coverage shows that the greater the proportion of elderly in the population, the lower the coverage. This is particularly so in the case of nurses.

A high personnel coverage can mean that the local authority in question has a high level of service, but it can also mean a low utilisation of resources.

The coverage in the evening and at night shows a clear relationship with the degree of urbanisation, which is in turn related to the number of elderly people in the area. Local authorities with many old people (urban authorities) have a relatively low coverage, while local authorities with few old people (small local authorities) have a high coverage.

In most local authorities the number of nurses remained unchanged in 1993 and 1994, whereas in the majority of authorities the number of daytime and evening home helpers and other care personnel and therapists increased.

Recipients of Practical Assistance and Nursing Care
In the average local authority, a number of households, corresponding to about 25% of people aged 67+, receive regular practical assistance or help with personal necessities. On average, fewer elderly people receive practical assistance etc in the metropolitan region's authorities than in the other local authorities. The average percentage increases as we move from Zealand and Bornholm, through East and South Jutland and Funen, to West and North Jutland. In 1993 and 1994 most local authorities experienced a rise in the number of households receiving regular practical assistance etc and a rise in the number of recipients aged 80 and over.

With regard to the type of practical assistance provided, just over half of the local authorities provide help with cleaning once a week, while about one fifth provide this help less frequently. The remainder have different rules. Almost all local authorities normally provide home help with laundry, and more than 75% normally offer home help with shopping. On the other hand, very few authorities normally provide home help with cooking.

In all 15% of people of 67+ were receiving home nursing at the beginning of 1995. The percentage was lowest in the metropolitan region's authorities and highest in the urban authorities and the small authorities. In 3/4 of the local authorities the number of people receiving home nursing rose in 1993 and 1994.

In the average local authority, 75 out of every 1,000 people aged 70+ receive evening home care, and 32 out of every 1,000 aged 70+ receive nighttime home care. The evening care frequency is highest in the urban authorities and the small authorities, and lowest in the metropolitan region. There is no difference in the frequency of nighttime home care.

It has been found that the greater the number of nursing home places a local authority has, the fewer the number of people receiving evening or nighttime care in their own homes. In all, a distinctly larger number of people receive evening and/or nighttime care (at nursing homes and in their own homes) in local authorities with the highest nursing home capacity than in those with the lowest.

Other Care Services
Almost all local authorities offer respite care, and about two thirds offer acute respite or acute nursing in critical situations. Similarly, two thirds of the authorities offer daytime places at nursing homes, while half offer nighttime places at nursing homes, and another half offer rehabilitation places. It is generally the urban authorities that offer most services.

The average capacity with respect to section 74 day centre places (rehabilitation) is 23 for every 1,000 people aged 70+, but some authorities have none and others considerably more than the average. The average capacity is much higher on Zealand and Bornholm than in West and North Jutland.

Most of the urban authorities have section 60 day centres (welfare work), whereas one third of the small authorities have none. Some authorities have activity centres instead, where elderly people organise the activities themselves. Taken overall, the vast majority of local authorities offer one form of centre or another. Lastly, more than 60% of the local authorities have specific employees to set up local activities for elderly residents. This usually means that the authority also has a section 60 day centre or an activity centre. In all, just under 10% of the local authorities have neither an activity/day centre or special local activities for elderly residents.

Almost all local authorities operate a special transport scheme for taking immobile elderly people for treatment or rehabilitation or to a prescribed day centre, and three quarters of local authorities also offer transport to local societies, public day centres or special arrangements for elderly people. In all, 25% of the local authorities offer their immobilized residents a specific number of runs a month for purposes chosen by the elderly people themselves.

The number of elderly people suffering from senile dementia is increasing, and some local authorities offer special services for this group. More than half have a sheltered unit at one or more nursing homes, while less than 15% have other forms of housing – e.g. specially designed housing cooperatives. More than one third use only their normal housing for this purpose, i.e. ordinary nursing home places, ordinary housing for the elderly etc or psychiatric nursing home places.

One quarter of the authorities have special activities for people suffering from dementia and about one sixth or less have a sheltered day centre, a sheltered unit at a day centre and/or personnel providing support in the home. It is naturally the urban authorities that offer most services.