RESPITE ROMANIA

Designing Romanias Assisted

Living Infrastructure

ROMANIA
QUICK FACTS

Joined the EU in 2004

8th largest country in EU
Population: 21.8 Million (2013)
PPP GDP = USD $271.4 B (2012)

PPP GDP Per Capita = USD $12 700

Language: Romanian (91%)
Capital: Bucharest

21.8 Million
Total Population

ROMANIA
DEMOGRAPHIC

15% of population > 65 y (2010);

25% of population > 65 y (2035)1

3.27 Million
(15%)

>65 years

10% of patients > 65 y = FRAIL3

More than 3.2 Million Romanian

elders
More than 300 000 Romanians are
frail elders
The fraction of elders is increasing
Frailty Definition2

320,000 (1.5%)

weight loss exhaustion

weakness slowness
low physical activity

Frail + >65 years

Frail Elders need increased supports

Popa D, The Long-Term Care System for the Elderly in Romania, ENEPRI Research Report No 85, Jun
2010, p. 6
1

Fried et al, Frailty in Older Adults, J Gerontol A Biol Sci Med Sci 2001;56(3):M146-56

Collard et al, Prevalence of frailty in community dwelling older persons: A systematic review, J Am Geriatri
Soc; 2012;260(8):1487-1492
3

Post Acute Care Infrastructure:

Supply and Demand
Population: 21.8 M

Population: 31.8 M

Analysis
NO BEDS IN THE SYSTEM
The post-acute care sector is virtually non
existent in Romania
Romania - 2,250 people per bed
Canada - 155 people per bed : 15x more

9 300 Long-Term Care Beds

NO STAFF IN THE SYSTEM

440 Assisted Living Beds1

1 nurse per 252 people (2006)

Canada: 1 nurse per 95 people
EU Average: 1 nurse per 127 people3
14 500 Day Program Slots1

1 physician per 428 people (2008)

Canada: 1 physician per 424 p e op le
EU Average: 1 physician per 294
people
204 000 LTC + Assisted Living Beds2

Popa D, The Long-Term Care System for the Elderly in Romania, ENEPRI Research Report No 85, Jun 2010, p. 6

Residential Care Facilities 2009-2010 Catalogue No 83-237-X, Statistics Canada, Sept 2011.

OECD (2012), Health at a Glance Europe 2012, OECD Publishing http:// dx.doi.org/10.1787/9789264183896-en

Post Acute Care Infrastructure

2

Analysis
1 Insufficient Training
Education for health disciplines
(nursing, rehab, etc.) is being
upgraded to EU Standards

2 Lack of Interprofessional
Collaboration

There is no expectation by the system

for disciplines to collaborate with each
other

3
3 Incomplete Staff Lineup
Most facilities have an incomplete
lineup of staff (e.g. lack of
geriatricians, rehab staff, therapeutic
recreation, etc.)

Analysis

Shifting Family Dynamics

1 WORKING HARDER

More family members working Less

ability to stay at home to manage
elderly loved ones

2 INCREASED PRESSURES

2
G IVE
C AR E

WOR

P ERS

O N AL

Increasingly difficult to balance time

between work, caregiver roles and
personal life
Most families lack professional training
in caregiving

3 CAREGIVER BURNOUT
Hard to sustain the physical and
emotional demands of caregiving
without a break
Worsening isolation of elderly loved
one and family

Our Goals in ROMANIA:

Designing Romanias Assisted Living Infrastructure

Building TOGETHER a STATE of THE ART RESPITE Facility
Building a model which will serve as a template for other RESPITE Facilities
Creating the expertize to enhance the ADL in Romania

Assessing Functional Capacity for ADL (Assisted Daily Living)

Basic ADLs

Instrumental ADLs

Feeding

Bowel Control

Shopping

Transportation

Bathing

Bladder Control

Housekeeping

Medication Use

Grooming

Toileting

Accounting

Laundry

Dressing

Ambulation

Food Preparation

Telephone Use

Transferring

Stair Climbing

Typical Patient Profile

% Patients needing
ADL assistance

Feeding

10%

Transferring

15%

Toileting

33%

Dressing

46%

Bathing

64%

Medication
Reminder

50%

Medication
Dispensing

70%

Proposed types of care

RESIDENTIAL CARE

>30 days

RESPITE CARE

<30 days

DAY PROGRAMS

1 day

1
Provide a home for vulnerable elders in a supervised environment
Provide professional care services for vulnerable elders with stable medical
problems
Patient moves in

2
Patient in for a short break
Gives caregivers a rest - AND/OR
Allows the patient to recover from a medical illness
in a supervised environment

3
A day of supportive activities designed to enhance well being for frail elders Day
care for elders

Service Flows
2

3
Programs

Intake Process

Activities

Day Program

Respite Care
Program

b
Health Care

c
Retirement Living

Day-to-Day Living

Discharge Process

Services Offered
1

5
SOCIAL and RECREATIONAL ACTIVITIES
Group
Individual

COMMUNITY IADL ASSISTANCE

Health Promotion
Exercise

9
Shopping Assistance
Shuttle service to City Centre

6
MEAL SERVICE
3 meals / day
Snacks

UTILITIES MANAGEMENT
Heating
Electrical

Water
Telephone

10
HOUSEKEEPING SERVICE

CHAPLAINCY SERVICE

Dining Room
Setting

3
BASIC ADL ASSISTANCE
Eating
Bathing
Ambulation

LAUNDRY SERVICE

Dressing
Toileting

11
BEAUTY AND BARBER SERVICE

4
HEALTH CARE SERVICES
Medication Assistance
Medical Follow up

BAKERY / FARMERS MARKET

Cable
Internet

Parameters

PECUNIARY

Continent

PROPERTY

Age > 65 years

100-unit Facility

Green Technologies

Medically Stable

10 - 20 Million
?Sale and Leaseback
Arrangement

POLITICAL

PATIENT

Municipal Support

Federal Support

Staffing

Resident Council
Executive
Director

Cooks

Kitchen
Aides

Dishwashers

Business Officer
MD

Maintenance

DDS

SL
P

Pharm

Diet

Security
Volunteers
RN

RecTx

SW

OT/PT

HCA/PSW

Housekeeping

Hairdresser

Laundry Aide

Clergy

SWOT Analysis
STRENGTHS
1

Huge Market

OPPORTUNITIES
3
Political Access

4
Team Expertise

Financial Access

Care Staff Expertise

Care Staff
Availability

First Mover
Advantage

THREATS

WEAKNESSES
1

Become the
Standard

Trainability of Care
Staff
World Financial
Stability

Political Instability/
Corruption

To Do List
1

POLICY & PROCEDURES

Define Expectations

2
Define Performance Assessment Tools

3
Create Educational Resources

MEASURE PERFORMANCE

IMPROVE PERFORMANCE