Residential care

Residential LTC services are provided separately in the health care sector and in the social sector. Consequently, employment principle and information are separated into both sectors.

Below, LTC personnel in residential nursing in the health sector and social assistance homes are presented. The following types of personnel could be distinguished with respect to residential LTC:

• Administrative and technical personnel responsible for managering facilities and their technical preparation (maintenance, cleaning, etc.);

• Professional personnel, including medical personnel and care personnel.

Personnel requirements with respect to these two employment categories are formulated separately in each sector. The two types of personnel do not differ in terms of educational level as education requirements for medical occupations and care occupations are high (Hryniewicka, Herbst 2010).

The analysis below concentrates on professional personnel as this type of personnel is better covered with data. In the social sector, information at the level of administrative and technical personnel is provided and discussed. In the health sector, information at the level

of administrative and technical personnel is not available. It can only be estimated that the proportion of administrative and technical personnel to the professional personnel is similar to the proportion in the social sector.

Statistical information on LTC personnel in the health care sector is provided by the Centre for Information Systems in Healthcare (CSIOZ). These statistics include information on the number of personnel directly involved in the provision of care which is presented below. It also covers information on the work of volunteers. According to the Law on Public Work and Volunteering volunteers are covered with employment rights and are covered with social insurances. However, the number of volunteers involved in long-term residential care provision in the health sector is very unstable. According to the CSIOZ statistics, in the period of 2005-2011, it oscillated around 1.0 thousand volunteers and dropped to less than 40 in 2012 (CSIOZ 2005-2013).

Professional requirements for medical and care services in the health sector residential LTC are strictly defined in the National Health Fund guidelines for residential LTC in the health sector. According to the guidelines, professional personnel must include: physicians, nurses, social workers/social nurses, psychologists, physiotherapists/rehabilitators, educators and, if needed, dieticians.

Based on the information coming from the health sector⁴, specialised LTC personnel in residential nursing care (physicians as well as nurses and other medical workers) has increased significantly in recent years; it almost doubled between 2004 and 2011: from 10.8 thousand workers to 20.2 thousand workers in 2011 (dropping again in 2012, mainly due to a decrease in the number of volunteers). The overall changes in employment levels were related to the growing need for care and the moving of older patients in need from hospitals to the new created LTC facilities due to the health care reform. As a result, the number of places in residential care supervised by the Ministry of Health grew from 17.8 thousand in 2004 to 23 thousand in 2011 (CSIOZ 2005-2012).

4 Data on employment in residential LTC in the health sector has been published since 2004.

Table 2. Occupational structure of LTC professional personnel in residential care

Source: Own calculations based on CSIOZ data 2005-2012.

The largest (and continually expanding) group of LTC professional personnel in residential care in the health sector is made up of nurses, who constitute nearly half of LTC specialised employees. The number of nurses grew by 73% until 2010 and by 90% until 2012. In the last ten years, the educational requirements for nurses have changed. The most sound change was the requirement for nurses to complete higher education. At the same time, new professions have been introduced, including the specialization in nursing the chronically ill and disabled (the so-called LTC nurse). Nurses employed in the LTC sector need to complete qualifying courses in this field. According to the Center of Post-Secondary Education of Nurses and Midwives (CKPPP - Centrum Kształcenia Podyplomowego Pielęgniarek i Położnych), in 2007 there were 453 nurses with a specialization in nursing the chronically ill and disabled (Golinowska, Styczyńska 2012).

The following large groups of LTC professional personnel in the health sector residential care are nursing assistants and physicians. While the number of nursing assistants has been moderately growing, the number of physicians employed in residential nursing care has more

than tripled. Although smaller in absolute terms, other dynamically growing groups of employees are psychologists and medical workers. The profession of medical workers was established by law in 2007 in response to growing needs for care. Professional education in this field includes vocational education or a one year post-secondary school degree. Regulating the education path of this profession has resulted in a dynamic inflow of new personnel in this category.

Figure 2. Medical personnel employed in residential LTC in the health sector

Source: CSIOZ 2001-2012.

In addition to LTC nursing and care in the health sector, care for the elderly, chronically ill and other groups specifies above is provided in the social residential care homes.

Statistical information on employment in residential care in the social sector (mainly social assistance homes) is provided by the Ministry of Labour and Social Affairs. Additionally, fragmentary information about educational attainments can be found in the Ministry of Education database or educational centres of selected occupations (like for example

2,280! 2,596! 2,625! 2553! 2633! 2,975! 2,809! 3,096!

0!

2004! 2005! 2006! 2007! 2008! 2009! 2010! 2011!

Medical!doctors! Nurses! Medical!workers! Nursing!assistant!

At the same time, the total number professional LTC personnel employed in residential care in the social sector grew by 24%. This increase is attributable to the increase in the number of therapeutic personnel as a result introducing three new specialised care occupations: care workers in residential social assistance homes, environmental care workers and assistants to disabled persons. Appropriate qualifications for these professions can be obtained in secondary vocational or post-secondary educational institutions (Golinowska, Styczyńska 2012).

Table 3. Professional LTC personel in residential care in the social sector, end

Source: Data from the Ministry of Labour and Social Policy, Social Assistance and Social Integration Department⁵.

It should be noted, however, that the number of medical personnel has been decreasing.

These changes are a result of changes in employment conditions. Until recently, in social assistance homes, physicians and nurses were employed as full-time permanent staff.

At present, there is no unified way of ensuring nursing and rehabilitative care for residents of social assistance homes. Some physicians and nurses have permanent employment contracts but others have civil service contracts as separate private units (Golinowska, Styczyńska 2012). Qualitative research in social care homes indicates that primary care medical services are often outsourced by the social assistance homes (Golinowska,

5 Data received thanks to the Directors of the Social Assistance Department and of the Division of Statistics, Analysis and Budget of the Social Assistance and Social Integration Department in the Ministry of Labour and Social Policy.

Sowa 2010). At the same time, the involvement of care personnel and volunteers in social assistance homes’ activity increased.

Figure 3. Medical personnel and volunteers employed in social assistance homes, 2004-2011

Source: GUS 2005-2009, 2011.