EUROPEAN CONTEXT Chapter 7. Integration <strong>of</strong> <strong>Palliative</strong> <strong>Care</strong> <strong>in</strong> Long-Term <strong>Care</strong> Facilities <strong>in</strong> 18 <strong>Europe</strong>an countries B TechnicaL data ON THE <strong>2019</strong> <strong>EAPC</strong> SURVEY ON PALLIATIVE CARE IN LONG-TERM FACILITIES Population: 54 countries <strong>of</strong> the <strong>Europe</strong> WHO region and Lichtenste<strong>in</strong>. Survey Details Areas explored: 7 ma<strong>in</strong> <strong>in</strong>dicators for long-term care facilities (LTCFs): Existence <strong>of</strong> <strong>of</strong>ficial documents regulat<strong>in</strong>g PC <strong>in</strong>terventions and its provision; tra<strong>in</strong><strong>in</strong>g <strong>in</strong> PC; publications regard<strong>in</strong>g the provision <strong>of</strong> PC; collaboration with PC teams; availability <strong>of</strong> national funds. Questionnaire: on l<strong>in</strong>e survey, 17 questions, answered <strong>in</strong> (average): 27 m<strong>in</strong>utes. Participants: 25 national experts: 6 identified <strong>in</strong> the <strong>EAPC</strong> TaskForce on LTCFs or <strong>EAPC</strong> report, 5 <strong>in</strong> LTCF-related publications, 9 recommended by PC experts and rema<strong>in</strong><strong>in</strong>g 5 are from Universities, PC research centres, or PC services´ contexts. Coverage: 18/54 countries (33%): with two respondents or over <strong>in</strong> 5/18 countries (28%), and one respondent <strong>in</strong> 13/18 countries (72%). Data collection: 12/2018 to 3/<strong>2019</strong> (4 months). Project Management: ATLANTES Research Group, Institute for Culture and Society, University <strong>of</strong> Navarra, Pamplona (Navarra), Spa<strong>in</strong> . Scientific Advice: Kather<strong>in</strong>e Froggatt (UK) and Lieve Van den Block (Belgium). Promotor: <strong>Europe</strong>an Association for <strong>Palliative</strong> <strong>Care</strong> (<strong>EAPC</strong>). Long-term care facilities are collective <strong>in</strong>stitutional sett<strong>in</strong>gs <strong>in</strong> which care is provided to older people on-site 24 hours a day, 7 days a week, <strong>in</strong>clud<strong>in</strong>g facilities with on-site and <strong>of</strong>f-site nurses and medical staff. This term <strong>in</strong>cludes a range <strong>of</strong> facilities <strong>of</strong>fer<strong>in</strong>g different levels <strong>of</strong> social and health care (Froggatt et al, 2017). The first study on how palliative care (PC) is <strong>in</strong>tegrated <strong>in</strong>to Long Term <strong>Care</strong> Facilities (LTCFs) <strong>in</strong> <strong>Europe</strong> was developed <strong>in</strong> 2013 by the <strong>Europe</strong>an Association <strong>of</strong> <strong>Palliative</strong> <strong>Care</strong> (<strong>EAPC</strong>) (1). Thereafter, <strong>in</strong> 2015, the PACE project (Compar<strong>in</strong>g the effectiveness <strong>of</strong> PATIENT CARE for older people <strong>in</strong> LTCFs) provided an overview <strong>of</strong> mapp<strong>in</strong>g PC systems <strong>in</strong> LTCFs <strong>in</strong> <strong>Europe</strong> (2). This chapter <strong>in</strong>tends to evaluate the current state <strong>of</strong> PC <strong>in</strong>tegration <strong>in</strong>to LTCFs <strong>in</strong> the WHO <strong>Europe</strong>an Region build<strong>in</strong>g on previous experiences through the use <strong>of</strong> similar <strong>in</strong>dicators. PC provision <strong>in</strong> LTCFs LTCFs can seek advice from <strong>Palliative</strong> <strong>Care</strong> teams to better address the patient <strong>in</strong> terms <strong>of</strong> pa<strong>in</strong> and symptom management, specific needs and family support. In <strong>Europe</strong>, this collaboration between PC teams and LTCFs staff varies <strong>in</strong> its frequency. Lithuania and Kyrgyzstan report that cooperation “always” exist <strong>in</strong> their practice, at the time that Belgium and Austria also consider that this partnership happens “most <strong>of</strong> the time”. Countries such as the Czech Republic, Israel, Russia, Italy, and Armenia admit a hardly <strong>of</strong>ten to non-existent/never collaboration frequency. A vast majority <strong>of</strong> <strong>Europe</strong>an countries though (9/18) po<strong>in</strong>t out occasional collaborations (Greece, Denmark, Poland, The Netherlands, France, Switzerland, UK, Germany, Spa<strong>in</strong>). Regulation <strong>of</strong> PC provision <strong>in</strong> LTCFs <strong>Palliative</strong> <strong>Care</strong> provision is <strong>of</strong>ten regulated by documents with national validity, usually referr<strong>in</strong>g to structural features that should be available <strong>in</strong> LTCFs such as personnel, beds, materials, etcetera. Ten <strong>Europe</strong>an countries <strong>in</strong>form hav<strong>in</strong>g national strategies, plans or policies, Carla Reigada , Kather<strong>in</strong>e Froggatt, Lieve Van den Block. and eight state hav<strong>in</strong>g standards <strong>of</strong> quality provision <strong>of</strong> PC services. Likewise, 11/18 countries report hav<strong>in</strong>g some sort <strong>of</strong> guidel<strong>in</strong>es or protocols, either as <strong>of</strong>ficial protocols (four countries) or other non-<strong>of</strong>ficial documents actually modulat<strong>in</strong>g palliative care provision <strong>in</strong> long-term care facilities <strong>in</strong> the country. Fund<strong>in</strong>g For PC provision <strong>in</strong> LTCFs Less than half <strong>of</strong> report<strong>in</strong>g countries (7/18) <strong>in</strong>form hav<strong>in</strong>g national fund<strong>in</strong>g available to support the provision <strong>of</strong> <strong>Palliative</strong> <strong>Care</strong> <strong>in</strong> LTCFs. Fund<strong>in</strong>g models vary from grants, prizes and loans, to the reception <strong>of</strong> an annual economic support. Specifically, five countries state gett<strong>in</strong>g an annual national support which occur <strong>in</strong> different ways. Some countries have a contract with the National Health Fund and get a donation for hospices, others report hav<strong>in</strong>g regional economic rates from regional health and social-care funds, or others where PC at LTCFs is entirely public. PC tra<strong>in</strong><strong>in</strong>g <strong>in</strong> LTCFs The estimation <strong>of</strong> LTCFs staff with PC tra<strong>in</strong><strong>in</strong>g is over 90% <strong>in</strong> Lithuania, followed by Kyrgyzstan, Poland, The Netherlands, Belgium, France, Switzerland and the UK (rang<strong>in</strong>g from 40% to 90%). Half <strong>of</strong> the report<strong>in</strong>g countries do not reach a 40% ratio <strong>in</strong> terms <strong>of</strong> staff´s PC tra<strong>in</strong><strong>in</strong>g. Furthermore, 12/18 countries confirm the existence <strong>of</strong> national studies on the provision <strong>of</strong> PC <strong>in</strong> LTCFs and another seven countries declare their participation <strong>in</strong> an <strong>in</strong>ternational project on PC provision <strong>in</strong> LCTFs (Lithuania, Belgium, Poland, The Netherlands, Switzerland, UK, Italy). <strong>EAPC</strong> <strong>Atlas</strong> <strong>of</strong> <strong>Palliative</strong> <strong>Care</strong> <strong>in</strong> <strong>Europe</strong> 73
EUROPEAN CONTEXT Chapter 7. Integration <strong>of</strong> <strong>Palliative</strong> <strong>Care</strong> <strong>in</strong> Long-Term <strong>Care</strong> Facilities <strong>in</strong> 18 <strong>Europe</strong>an countries B Map 7.1. Staff <strong>in</strong> Long Term <strong>Care</strong> Facilities tra<strong>in</strong>ed <strong>in</strong> <strong>Palliative</strong> <strong>Care</strong>. Map 7.2. Official documents regulat<strong>in</strong>g <strong>Palliative</strong> <strong>Care</strong> provision <strong>in</strong> Long Term <strong>Care</strong> Facilities. <strong>EAPC</strong> <strong>Atlas</strong> <strong>of</strong> <strong>Palliative</strong> <strong>Care</strong> <strong>in</strong> <strong>Europe</strong> 74
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Abstract INTRODUCTION B Background
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1. Presentation B
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PRESENTATION Note from the authors
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PRESENTATION Net of collaborators o
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