C.1b. – Vignette sheet – Monsieur I :
Lausanne, CH
ITEMS
C.1.2.0 – Public
authority/authorities
considering the demand
(name; territorial level;
institutional framing)
C.1.2.1. – Case management
(if yes, who)
C.1.2.2. – Assessment of
means: who
C.1.2.3. – Cash allowance
(amount per month; duration)
No. of interviews: 6
Source of information:
Adjointe au Chef du Service des assurances sociales et de l'hébergement (SASH) du
Canton (-> Gelfi ?) Directeur de l’Organisme médico-social vaudois (OMSV) ( ->
Monchan ?); Responsable du Bureau régional d'information et d'orientation (BRIO) (->
Decolony ?), Chef du Bureau prestations complémentaires du Service des assurances
sociales de la Ville de Lausanne (-> Eggstein ?), Directrice de l’Association lausannoise
de l’Organisme médico-social vaudois (-> Mamboury ?) et Responsable d'équipe du
Centre médico-social (CMS) L'Ancien stand à Lausanne (-> Lintaf ?)
C.1.1.
Name: Medico-social Centre of Lausanne (“Centre médico-social de Lausanne (CMS) ”)
Level: local (Municipality of Lausanne)
Frame: The Canton of Vaud has 46 Medico-social Centres (CMS). These centres are gathered in 8 regional associations/fondations.
These 8 regional associations are coordinated by a cantonal public organisation, the Medico-social organisation Of Vaud (“Organisme
Médico-social Vaudois –OMSV”). The territory of Lausanne includes 3 regional associations (Ouest lausannois, Couronne lausannoise
and ALSMAD). Each medico-social region chooses its providers of services but the range of services is defined by the Canton.
The following acts constitute the normative basis of the eldery care, including the home assistance:
- At federal level :
1. for medical care : Sickness Insurance (1996)
2. for financial aid : Old Age Insurance (AHV) -> Attendance Allowance; Supplementary Benefits to Old Age Insurance (1966)
- At cantonal level :
1. for medical care: Public Health Act (Loi sur la santé publique (LSP) (1986), Law for the creation of a medicosocial organisation of Vaud
Loi créant un Organisme médico social vaudois (LOMSV) (1967),
2. for financial aid: Law on assistance to persons resorting to medicosocial action (Loi d’aide aux personnes recourant à l’action médicosociale) (LAPRAMS) (2006) -> part of the subsidies for the CMS
Actors involved and relationship structure: specify also user’s involvment
- Medico-social team of the CMS: chief of the employees in charge of home care and assistance, including nurses, ergotherapists, welfare
officers, auxiliaries of health, auxiliaries of household.
The client directly contacts the CMS. Afterwards the team of CMS visits the client to assess his needs.
Office/professional in charge: please, focus also on the discretionary power of social workers
Mr I. contacts the CMS in order to receive domestic support. The case manager is designated into the CMS team according to the
principal need of the client. Mr I. needs some help for his household. The person who carries out the follow-up of the client are the home
care and assistance employees (“personnel de soin et d’aide au ménage” (PERSAM)”).
Time pattern: frequency of case assessment: The assessment is carried out by a care worker of the CMS when they visit the client. A
data-processing file is set up and a paper version of this file is left at client's home. By this way all persons who take parts of the
intervention can reach and consult it.
Who: The practitioners of the CMS (auxiliary of household, deliverywoman of meal...) assess at home the needs and the resources of the
client.
How: There is no formalised criteria for the need assessment carried out by the CMS. The needs of support are evaluated each 4 years
(each year, if the support exceeds 10 hours per month)
Entitlement (access criteria; appealability): There is no monetary allowance for Mr I. The client must pay the services provided by the
CMS (Eur 15.63 (CHF 25) per hour). If Mr I. has an Supplementary Insurance (optional), a part of the expenses can be dealt with. The
Variations
C.1.3.2 (1)
C.1.3.4 (1)
C.1.3.5 (2)
1
Sickness Insurance pays the expenses only if home care is prescribed by a doctor for medical reasons (medical certificate).
-No Attendance Allowance (“Hilfslosenentschädigung”) : Criterion of medium or grave level of helplessness is not given.
-No Premium Reduction (“Prämienverbilligung”) : Criterion of modest economic conditions is not given.
C.1.3.7 (3)
If Mr. I receives a low old-age pension and if he has a fortune below Eur 15,625 (CHF 25 000), he can make a request for Supplementary
Benefits(“Ergänzungsleistungen (EL) zur AHV”) to the municipal compensation fund. If he cannot obtain Supplementary Benefits, the
CMS can give him an individual benefit in form of a graduated tariff (“aide individuelle”/”tarif dégressif”).
Amount :
All financial benefits are granted according to the resources of the claimant.
- Supplementary Benefits (national legislation): According to the resources of the recipient (fortune, pension of AVS/AI, revenue 2nd pillar,
rent...), he can receive complementary pension. The maximum amount being able to be versed is Eur 1609.38 (CHF 2 575) per month or
Eur 19,312.5 (CHF 30 900) per year.
In case the domestic support is prescribed by a doctor for medical reasons (medical certificate), Mr. I.’s expenses are refund (maximally
Eur 15,625 (CHF 25,000) per year for a single person).
- Individual benefit (cantonal legislation): a graduated tariff, taking into account the ressources, for the support to household (from Eur 2.5
(CHF 4) to Eur 13.75 (CHF 22) per hour) and for the meal (from Eur 1.88 (CHF 3) to Eur 3.75 (CHF 6) per meal).
Duration:
-Supplementary Benefits: indefinite (as long as needed). The re-examination is carried out at least every 4 years (or before according the
circumstances)
- Individual benefit: indefinite (as long as needed). Re-examined every year for persons aged 65 and once every 2 years for
persons above the age of 65.
C.1.2.4. – In-kind support (if
yes, measures; duration)
Also consider transitional
Steps and path through services and offices:
- Supplementary Benefits: The CMS can help the recipient to make his request but this he has to organise that. The official form of
request is filled by the agents of the municipal compensation fund, and signed by the applicant. The expenses of the household
assistance are only refunded on presentation of the invoice. If a private household assistant intervenes, the recipient must first pay and
then request refunding at the municipal compensation fund. The CMS directly invoices at the Agency when it intervenes (the evaluation
carried out by the CMS of the district confirming the need for home assistance).
- Individual benefit: The employee of the CMS makes a request to the cantonal administration of the taxes in order to recover informations
on the income of the person. The administration returns the data which are used for the calculation of the benefits. The decision is finally
validated by the director of the CMS. It takes approximately one month to grant the individual benefit and it can be retroactive during the
current year.
Entitlement (access criteria; appealability): according to the needs of the client
Measures: Services of the CMS : household assistance, delivery of meals ...
Duration: indefinite.
2
solutions
C.1.2.5. – Criteria and decision
process
Steps and path through services and offices:
Generally, assistants visit the client once every 2 weeks for household assistance, and for the delivery of the meals 6 days per week.
Criteria: please, focus also on the discretionary power of social workers
The main criteria to grant financial support (Supplementary Benefits and individual benefit) are the resources of the recipient.
Furthermore, for the Supplementary Benefits, the person must be an Old Age Pensioner and be living in Lausanne for the last 10 years.
Decider: Each concerned organisation carries out the mean test to provide its own financial assistances.
In Lausanne, that is the social security the municipal compensation fund of Lausanne (City of Lausanne) which makes the decisions of
granting the Supplementary Benefits, and that is the CMS for the individual benefit (graduated tariff).
The medicosocial workers determine their interventions with the client, according to his needs. They in particular take into account the
size of the apartment, the resources of the client and acceptance by him of home assistance.
C.1.2.6. – Co-payment (if yes,
criteria; degree)
C.1.2.7. – Deliverer
C.1.2.8. – Accountability
C.1.2.9. – Private and informal
care (how it is taken into
account; likeliness)
C.1.2.10. – Strengths and
weaknesses of service/policy
organisation
User’s involvement: The client must contact the CMS for the household assistance and the municipal compensation fund for the
financial services. He can choose the organisation which carries out the prestations. Like he does not have many financial resources, he
probably will take a public service (the CMS) or a non profit private organisation.
Criteria: The customer has to pay the entire expenses when his incomes are sufficient, only a part of the expenses when he is entitled to
a graduated tariff. When he has Supplementary Benefits, he doesn't pay the expenses of household assistance, but a part of the meals.
Degree: The Supplementary Benefits refund the expenses until a maximum of Eur 15.63 (25 CHF) per hour. If this amount is exceeded,
particularly in the case where a private assistant intervenes, the insured person must pay the difference.
In the Canton of Vaud, the home assistance is delivered by the Medico-social Centres (CMS). The territory of Lausanne includes 3
regional associations (Ouest lausannois, Couronne lausannoise and ALSMAD).
Some others private organisations, in particular for delivery of meals (DSR for example), or charitable organisations (Pro Senectute,
Croix-Rouge, etc.) can also intervene.
There is no explicit act set out, individual entitlement to domestic support. The Cantonal Health Act only says that Municipalities must
provide domestic support (Health Act § 46).
Mr I. can decide on the use of the financial support paid to him to a limited extent only. Costs incurred due to illness, such as domestic
support prescribed by a physician, are only refunded if he presents a receipt.
If Mr I. does not agree with the decisions regarding his application for financial assistance, he can appeal against the rulings of the Social
Insurance Fund of the Canton of Vaud. If this appeal is rejected, he can file a complaint at the Cantonal insurance court. If the decision is
negative, he has the possibility to take the complaint to the Federal Insurance Court in Lucerne.
How: The entourage is taken into account by the pratictionners for the definition of services but that is not definate.
Likeliness: Combien d’organisation privée intervient pour l’aide au ménage dans la ville de Lausanne?
Strengths: Mr. I. can decid when and what kind of domestic support he wants. There is a good range for domestic support. There are
reduced prices for assistance services at home for people in need.
Weaknesses: -
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C.1.2.11. - Last reform1 (year;
changes in the access
chances)
C.1.2.12. - How relevant is this
case in your country?
C.1.2.13 - Further comments
Year: There is not recent change. In the Canton of Vaud, the structure of home assistance policy was been put in place at the beginning
of 1990.
Access chances: Other relevant changes: The CMS were created between 1988 and 1992 and involved the installation of some multi-disciplinary teams.
The CMS now regroups all actors of home assistance sector previously working in autonomous manner (welfare officers of Ligues de
santé, auxiliaries of health of Croix-Rouge, voluntaries for support to family of Pro Senectute…). They play an important role regarding coordination.
Qualitative interviewees’ evaluation if available, data should be collected
Estimated weight of this case on all cases: statistical data and/or interviewees’ evaluation; national and local level.
The monthly average clients number for household assistance in Lausanne: 1,277 clients. 201,728 delivered meals in 2005 by the
Association of Lausanne (Rapport d’activité 2005).
Should be added in order to frame the case and help interpretation
The home-support services for seniors constitutes a priority of the Canton of Vaud since the beginning of the 90s through the structure of the practioners network,
the installation of the Medico-social Centres and regional associations.
Variations
C.1.2.0
(1) C.1.3.2 The CMS would not intervene at home. Private actors would primarily intervene.
C.1.2.3.
(1) C.1.3.4 The granting of Supplementary Benefits and graduated tariff depend on the resources of the recipient.
(2) C.1.3.5 The granting of Supplementary Benefits depends on the value of the house.
(3) C.1.3.7 There is a waiting period of 10 years before they have access to Supplementary Benefits.
1 If needed, please refer to summary tables and/or WP1 for further details. In case, specify the relevant differences between the legal and the actual frame.
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