Le financement des soins infirmiers à domicile en Belgique - KCE

50 Financing of Home Nursing KCE reports 122
5.2.3.2 Topic 13: Organisational characteristics of providers of nursing care:
As mentioned before, participants accepted that fees should not be differentiated for
self-employed nurses and employee-nurses. Many stakeholders argued that a
compensation, such as the subsidy for specific costs of services for home nursing,
should be given if the collaboration in a service/practice enhances continuity and
coordination of nursing care.
5.2.3.3 Topic 14: Labour market: attractiveness of home nursing as a profession
The attractiveness of the nursing profession in home care was raised as an aspect to
consider when reflecting on financing reforms. Attractiveness of the profession was
associated to the autonomy to organise oneself the work and the work hours and the
opportunities for high professional care delivery that a home nurse experiences. It was
suggested that in recent years self-employed nursing became more attractive (with
exception for Brussels) than for employee-nurses who experience major difficulties to
recruit employee-nurses.
5.2.3.4 Topic 15: The need for (higher) qualifications
Within the framework of financing reforms it was mentioned that financing should take
account for more specialist roles in home nursing. Currently, there are no conditions
for home nurses to carry out the specific technical nursing interventions. Participants
raised questions about the available expertise of home nurses to carry out specific
technical nursing interventions with enough quality. It was also mentioned that training
of home nurses in new nursing care techniques should be financed.
5.2.3.5 Topic 16: Labour differentiation
On the one hand, there will be less GPs in the future, and nurses will have to take over
tasks which are currently carried out by GPs. On the other hand, there are many
nursing interventions which are carried out routinely by home nurses and which might
be rather easily delegated to care assistants. These evolutions will require adaptations in
horizontal and vertical labour differentiation of home nurses. For many participants
there seems to be a contradiction between the Royal Decree nr. 78 which allows
nurses to perform some nursing interventions without a doctor’s prescription and the
financing system of home nursing which requires a doctor’s prescription for most
nursing interventions, except for hygienic nursing care delivery. Mainly self-employed
nurses requested that NIHDI should install provisions for an accreditation system
and/or social statutory comparable to the medical doctors.
Several participants from home nurses agreed that chronic nursing care delivery
including nursing interventions with regard to personal hygiene, should not be
underestimated. These basic nursing tasks are often thought upon as routine nursing
tasks that can be substituted by lower qualified employees, e.g. care assistants or family
aids. However, participants argued that e.g. in frail older people, an adequate
assessment of the patient’s status and situation is required.
In the discussion on the relationship between home nurses and professional carers, two
topics emerged.
First, there was discussion about collaboration/task demarcation between nurses and
other care professions (family aids from social services / services for family support/aid).
A main theme in the discussion was that an adequate differentiation is needed between
health care delivery including hygienic nursing care versus hygienic care by the social
service. According to a participant from health authorities, it is the home nurse’s
professional role and competency to decide between the two systems for delivery of
hygienic care. It is considered inadequate that the patient chooses for nursing care
delivery for economic reasons (no personal contribution). Home nurses are expected
to express leadership and to give feedback and steering/guidance to other disciplines.