Better days ahead for the Czech Republic's home care service for the elderly

Photo: European Commission

Statistics show that twelve percent of Czechs are now over sixty-five years old. Nothing exceptional about this, but the number will rise significantly when a big group of Czechs who are now in their fifties reaches retirement age, putting a bigger strain on the state budget and on relatives.

Photo: European Commission
The state is obliged by law to look after its older citizens and to provide them with affordable care. But the answer is not for every body to be crammed into old people's homes. With a bit of help, most old people can - and want to - stay at home.

Helena Celisova is director of a welfare organisation for the elderly in Prague 13, the newest and smallest in the Czech capital.

"It is better when there are fewer hospices and hospitals. It is easy to place an old parent in a hospice if they are very sick, but an elderly person should stay at home as long as possible. We can meet all his needs in his own environment. He doesn't have to go anywhere, doesn't have to get dressed and after all we all feel most comfortable at home. Home nurses wash, do shopping, tidy the flat or prepare food for everyone who needs it. Moreover clients like to have a closer relationship with home nurses who very often become like part of a family."

This welfare organisation is, like others of its kind, financed from the city's budget. Though the money is only just enough to get by on, any other ways of raising funds, such as sponsorship or grants, are out of the question. But by the end of the year, the parliament is expected to pass a new law that will allow these organisations to find additional sources of cash. This would enable home care services to provide wider and better care to their clients. Also, under current rules, home care social workers are unable to provide basic services like changing bandages and giving injections, simply because they are not covered by health insurance companies.

The welfare organisation in Prague 13 takes care of four hundred clients. About a hundred of them use 'meals on wheels'. Warm food, cooked in a local school is delivered to their door and comes as a blessing to those not able to cook and lacking a relative's helping hand.

"We cook three different meals each day, including one meal for people with special food needs. We make sure that it is suitable for diabetics. All meals are put into special dishes that keep the food warm for longer. Lunch usually arrives at about 11.30. Our crew delivers food to the clients' doors. If our client is not able to heat his food or feed himself we can do it for him. It all depends on what we agree with the client or his or her family."

To start with each client is interviewed by a nurse who finds out about his or her preferences and health needs.

Bela Masova is one of the clients. At 83 she needs daily special care, even with the regular help of her four children. She has been suffering from asthma and can't do any housework or go out. I visited her in her flat.

"I was given a microwave for Christmas so I can heat my meals easily now. I don't cook I only make coffee. Of course I do like that. I am very satisfied. Home nurses do anything I ask for. I don't think I could ask for any more. I don't have to cook, do shopping, clean the flat, they even wash me."

The welfare organisation has been helping Bela Masova for about ten years now adding "meals on wheels" service to a list of tasks last September. Bela has just one criticism.

"The food was great when I signed up for it. I even recommended it to my neighbour I told her, 'Milada, it's not worth cooking! You can get the same food as me for 40 crowns. It will be enough for you and your husband.' So she did follow my advice but after two months the food got worse and she got very dissatisfied. It is not as tasty and not very varied. I have been taking notes of the menu to make sure I remember. In one week we had chicken four times. So I called in to complain and talked to the cook. Although they promised a change, nothing has happened yet. It costs 40 crowns and it is waste of money if food is not tasty."

According to Helena Celisova it is difficult to please everybody and it would be even harder to cook a different meal for every client.

"We do have regular feedback from our clients. They do not beat about the bush and simply say if they do or don't like a meal. Of course it is impossible to please everyone especially the hundred or so people we serve, but if they complain we try to offer them some sort of compensation. Their feelings are important to us."

If the new law is passed it will not just make things easier for welfare organisations. It will also create a more competitive environment, as it will be possible to set up new welfare organisations in competition with existing services. The bill's authors say it will enable clients and their families to make their own choices. Welfare workers do agree but warn that it might be tricky for lonely seniors recognise good and bad services.