Le financement des soins infirmiers à domicile en Belgique - KCE

116 Financing of Home Nursing KCE reports 122
• “Specialization and function differentiation are partial solutions for higher
complexity” (participant 2; session 1)
• “We must also consider which tasks might be done by home nurses instead
of doctors?” (participant 4; session 1)
With this regard it was stated that the financing of home nurses and the Integrated
Services for Home Care should be geared to one another.
As a complement a participant from the health authority argued that all healthcare
workers should provide information to a shared electronic patient record. Use of
adequate ICT instruments is a means to reduce the time needed for consultation and
coordination with other health care professionals, especially in primary care.
One self-employed home nurse mentioned that coordination of different professional
disciplines was different from delegation of nursing care to another discipline. For selfemployed
nurses delegation of nursing care might be complex/difficult.
Accreditation
Mainly self-employed nurses requested that NIHDI should install provisions for an
accreditation system and/or social statutory comparable to the medical doctors.
THEME 4: ASSESSMENT AND REGISTRATION INSTRUMENTS
Topic 17: General remarks with regard to administrative tasks
Many participants argued that registration of data on both the patient’s needs and the
nursing care provided is an essential part of actual nurse’s roles in home care. This is an
essential condition to coordinate care, for communication, delegation, needs
assessment, etc. But this obligation should go hand in hand with the development of a
well elaborated data registration model.
• “Data registration is required on every level of care delivery. Therefore an
adequate data management model will be required” (participant 23; session 2)
With regard to the current situation it was criticized that financing does not account
(sufficiently) for the work load of data registration, information collection and keeping a
nursing record up to date. Punctual reflections were made on the current practice of
registering pseudo-codes for lump sum financing: it was accepted as a useful tool but
nurses expressed fear for an administrative overload. Some participants are favourable
of more investments in ICT applications in order to reduce administrative workload.
Topic 18: Patient needs and nursing care
Participants expected in general that financing accounts correctly for the patients’ need
for nursing care. They mentioned several instruments which can be used for
determining the need for nursing care. Some participants stated that a nursing diagnosis
system should be used for evaluating the need for nursing care. It was argued that in
patients receiving highly technical nursing interventions, the ADL evaluation scale (Katz)
does not describe the need for nursing care correctly. It was also mentioned that in
recent years the need for support in activities of daily living (hygienic care, bathing,
clothing, using the toilet, eating, etc. ) has increased because older persons are
increasingly living alone, without supervision and help of family members and relatives.
Several single isolated quotes and questions or propositions were expressed with
regard to the patients’ needs and the required or delivered nursing care. Some
participants requested that a new assessment instrument should take into account the
use of time of home nurses with special attention for rehabilitation nursing/restorative
nursing care (which is more time intensive).
It was mentioned that nurses do not always give feedback about how they are able to
deliver the required nursing care. The patient’s nursing record was considered as a
powerful tool to document nursing care, especially in patients with the lump sum
payments. Mainly nurses argued that it is important that assessment of the need for
nursing care should be done by home nurses.