Le financement des soins infirmiers à domicile en Belgique - KCE

58 Financing of Home Nursing KCE reports 122
An issue closely connected to the financing of the home care sector are labour market
issues. The attractiveness of the nursing profession is high on the policy agenda. At this
stage, it is unclear on how the labour market of nurses and carers will respond to a
growing home nursing sector. In the recent history, many efforts have been paid to
improve the attractiveness of the profession and to seek alternatives for the
organisation of home care. Moreover, wages have raised, labour conditions have
become better, specific measures for reduction of labour time at the end of the career
are very innovative, home nurses are loyal to their job 33 . However, there is a delicate
balance between the degree of autonomy of home nurses and the need to feel
supported in their responsibilities. Workload or time pressure appears as a problem in
home care. Workload is mainly associated with non direct patient related aspects of
care. The study also indicates that home nurses are convinced that society has an
incorrect perception of the home nursing profession compared with the image of
hospital nursing. These observations could be important for the attractiveness of the
profession.
6.2.3 Social Factors
The ageing of society, the shift in health care provision and the increasing number of
chronic patients induce a shift of healthcare needs in the home environment. If the turn
is taken towards more home care provision, it will also be required to consider the
growing number of individuals living alone. Moreover, the financing mechanisms should
be assessed against the background of intended objectives. For chronic patients with a
certain degree of dependency the emphasis could be set on self-care support, increasing
the abilities of patients and their families, teaching and motivation activities rather than
getting support for punctual technical nursing acts. The latter could be more
appropriate for post acute care (e.g. as a result of early discharge or specialised nursing
acts that can be provided in a home care setting). Moreover, an adapted financing
scheme should take into account that people in need of long term home nursing care
integrate more the role of self-care and support by informal caregivers. Integration of
formal professional care delivery and informal care and mutual reinforcement by
professionals and family caregivers are required.
6.2.4 Technological Factors
Technological developments in health care allow to a certain extent “to bring the
hospital home”. Developments in tele-monitoring, patient support tools, independent
living technology are considered as key factors in the future development of home care.
Although home care technology has not pervaded the sector yet and most technology
at home is still implemented on an experimental basis, it can be expected that the
technology will change the provision of nursing, the role of informal or self care and
thus the needs of the patients. One of the future challenges in the reflection on home
nursing and home care will definitely be to assess to what extent these new
technologies will affect on how nursing care and support could be organised and how
these developments should be accounted for in the funding of home nursing.
In Belgium, some initiatives were funded on stimulating the use of technology for
organisational support processes in nursing (2006 programme on software and the
VINCA-project in 2008-2009). It is expected that these technologies will have both an
impact on the development or registration and control of care delivery as well as to
enhance the communication and sharing of information between home nurses and other
professions in primary care and hospitals.