• Good morning to you all, and thank you for inviting me, as your guest speaker at the AFPOP meeting of this morning. Today we will speak about healthcare, which in the last years has become a hot item. Throughout Europe we hear complaints about poor assistance, in comparison to what it was before.
• Before starting I would like to ask you if it is all right for me to speak in English today, as I think this is the language most of the people gathered here will understand. Off course in case of any doubts or misunderstanding due to language, I am willing to explain things in another language (German, Portuguese or Dutch). Furthermore I hope you will interrupt me if you have any questions that matter.
• As the coordinator of our fairly young and modest homecare association, it’s quite some honour for me to stand here before you. To be honest, speaking for an audience like this doesn’t belong to my daily routine, but I hope I can provide you with some useful information.
• Well as you probably already heard, my name is Theo Boom. Normally I explain that this means Tree in Dutch, but Theo Tree is such a common name, so I won’t mention it again. My profession is physiotherapist and radio therapeutic technician. I come from The Hague in Holland, where I lived and worked until some five years ago, until I moved to Faro. The reason why I am living here is that I met a Portuguese lady, who is my wife nowadays on a holiday in the Algarve and after some years of travelling between two countries we decided that Portugal was the best place to live for us.
• So as I came to Portugal I started legalising my diplomas, which was quite a bureaucratic event, and shortly after that I started looking for a job. Through the Dutch Consulate in Faro I came in contact with the SZA, the organisation that I work for now. SZA stands for Stichting Zorgverlening Algarve and translated this means: Foundation Homecare Algarve, this is a Dutch organisation that exists now for about six years and one of the reasons why it was raised, was to give continuity to home nursing and caring for Dutch citizens who live abroad and in this particular case in the Algarve.
• First I would like to explain you a little bit about the Dutch healthcare system, to make clear what our organisation has done until so far. After this I will say something about the Portuguese healthcare system and the role we want to play in this.
• In Holland, unlike in many other countries roughly we have divided healthcare in two parts. First we have the regular healthcare like visiting:
  Your family doctor the General Practitioner, a Medical Specialist, a Dentist, the Physiotherapist, Hospital care, etc. And like in most countries the normal healthcare insurance companies, private or mutual (public), depending your income cover this. Under a certain level of income people pay for public mutual healthcare and above this level of income people are obliged to pay for private healthcare. There is however only a small difference in the level of medical assistance.
  Next to this we also have extraordinary healthcare belonging to the AWBZ law (General Law Extraordinary Healthcare). Psychiatrically care, Institutional care and Homecare make part of it. In our country this is a right that everybody has and is part of our social security system just like social benefit, elderly pensions, or benefits for handicapped people. The costs for this care are covered by the social funds.
• So as I told you that Home nursing care in Holland is part of this extraordinary healthcare and as people pay premium for this throughout their life, also the residents in the Algarve, although they moved abroad, felt that they continued to have right to this part of social security where they already had paid for their whole life. This seemed to be truth, so that is how we started working.
• In the meantime we have been providing in this extraordinary healthcare for Dutch citizens in the Algarve. We work with qualified nurses, auxiliary nurses, and helpers for household care, who visit the people at their homes. After filling in a medical form by ones doctor or specialist, indicating the sort and amount of care and a paramedic indication by us, we can start working. As long off course as the patient has AWBZ rights. And this is a point where we had some ups and downs until so far.
• The last decades there has been a growing population of seniors year by year, and also every year more of those elderly people move away from Holland to the south of Europe, where the climate is some more attractive. This seems all very positive for our homecare organisation, but with all these people also a lot of money disappears from Holland as well, and the governmental institutions have tried to provide this.
• Since the first of January 2000 laws changed and Dutch citizens who lived abroad and who had a private health insurance, lost their AWBZ rights in most cases. At the same time they also stopped paying premium for AWBZ care, which made them receive more money at the end of each month but also without homecare.
• A curious fact has always been, that for Dutch people with a mutual or public healthcare insurance never changed anything. They have kept their AWBZ rights all the way through. A rather strange situation, where concerning this extraordinary healthcare public health patients had got better assistance than the private patients.
• You will understand that with losing many clients, the situation became a lot more difficult for our homecare organisation.
• Lots of people where furious about it and started a campaign against the governmental decisions, which in the end had success. In 2001 the situation changed again, and Dutch citizens living abroad and with a private health insurance were allowed to choose for AWBZ care on a voluntary base.
  • I am very curious to hear from people who have other nationalities than Dutch if they know of a similar system that functions in their country, and if there are possibilities for them to get home nursing subsidised abroad.
• As most of our clients for their regular healthcare depend on the Portuguese public health, I got in contact with health institutions a lot. Fast and adequate healthcare aid and personal attention are not easily available for the majority of the population. There exists a health system, where public health is a right for all of the Portuguese people. Part of the premium for social security is used for healthcare, and therefore people get assistance in the various public health institutions:
  The first is the regional health centre. Everybody who is inscribed in the social security centre (segurança social) must be inscribed in this centro de saúde to get assistance and after some time will get a user identification card (cartão de utente). If possible one will get a family doctor appointed, but normally you will end up on a waiting list and get assistance from the doctor available at the moment. Normally you will have to make an appointment to be seen by one of the general practioners, but in more urgent cases you can get assistance at the SAP Serviço de Atendimento Permanent a 24-hour emergency unit integrated in the Centro de saúde. Your family doctor can send you to a Medical Specialist in the hospital and after making an appointment; you get assistance on the Consulta Externa. (External patient consults) Always be prepared for long waiting lists and long waiting time. Only in real urgent cases one can go directly to the emergency of de district hospitals (urgência hospitalar). Furthermore the hospitals offer internal assistance.
• In case of an emergency and calling 112 you will find that the ambulance from the Fire Brigade (Bombeiros), Red Cross (Cruz Vermelha) or INEM (Institute National de Emergência Médica) will most of the time bring you first to the nearest centro de saúde, from there you can be transported to one of the State Hospitals of the region (Barlavento, HDF) or being brought to Lisbon if there is no possible treatment in the Algarve. Regular Ambulance service are obliged to bring you to public healthcare institutions, there are some private ambulance companies who can transport you to one of the private hospitals.
• Also Dutch foreigners with public health insurance who decide moving to Portugal will lose all the healthcare assistance in Holland, that public health in Portugal is able to offer. Therefore Dutch social security pays healthcare premium to the Portuguese social security.
• One is able to get private healthcare insurance, but Portuguese will have to pay for this as an extra next to their public health insurance.
  There are two important private hospitals in the Algarve: Hospital Particular do Algarve in Alvor, and Casa de Saúde Stª Maria in Faro and throughout the Algarve there are a lot of small private consultorios where Medical Specialists can see you. This offers a lot faster medical assistance and good personal care. It’s a misunderstanding though to think that private medical care is always better. In most complicated situations, where very specialised treatment is necessary patients can be transported to Lisbon and in some cases to public hospitals.
• Foreigners in many cases have a private healthcare insurance of their own; there are a lot of different insurances with a lot of different conditions and clients ask me a lot of questions about private healthcare insurance in Portugal. Until so far though I never advised people in these matters because I never wanted to mix different interests. I work for an organisation that provides the health services itself. It would be strange to represent or speak in favour of a company (in this case the health insurance company) that has to pay for a service I myself provide. In this context I never studied the matter thoroughly although I think it would be very helpful to have a good inquiry about it.
  There are still a lot of questions in this area to be answered, and I would like to discuss this matter more deeply with AFPOP representatives, as I feel we could cooperate in this field in order to improve patient’s conditions.
• Having described the Portuguese healthcare I come to another reasons why our home care foundation was raised, and that is to help improving the healthcare situation in Portugal, where home nursing and caring still exists on a very small scale and to my opinion there is a great need for help. Our purpose is to find a way to not only work for the Dutch, which is a limited group, but also start working with the Portuguese and people from other nationalities in the Algarve, to integrate homecare more into this society.
• In order to get here we wanted to legalise our foundation in Portugal. We just started with translating all paperwork and the whole process was again quite a bureaucratic event. One of those things you will never do if you know what it takes before hand. It took a few years but in the end we managed. We were made understood that for us it was best not to try to raise a new foundation in Portugal, as legally this is a different kind of institution as the Dutch foundation form. For us it was better to raise an Association, where the Dutch foundation could make part of. So since last year we are officially called now:
  SZA (Stichting Zorgverlening Algarve) Associação de Apoio Domiciliário e Ocupacional na Área de Saúde. (Association for Homecare and Occupational therapy in the area of Health).
• As we are a young and small Association I feel we are at the beginning of a growing process and still lots of effort has to be made and support has to be given to make a strong organization out of it. Since the beginning of this year we opened an office in Faro, where I regularly work, if I am not out treating or visiting patients. Next to myself another colleague nurse, is helping with coordinating the homecare. You can always visit the office on appointment or call in. Next to our regular services like nursing, physiotherapy and helping aids, where you have to pay for, we can provide information about, or assist you with any medical problem you have in Portugal. This can be: Finding the right doctor, or specialist for your personal needs. Seeking help for you in the right hospital or clinic, booking consults or medical exams for you, asking for medical information in Portuguese, translating medical documents. Assisting you in urgent situations, where if possible we can help you being transferred to a hospital with the best possible care for you.
  If you want to become member of our Association, because you are interested in our work or services, please fill in the application form and send it to us.
• Finally I would like to say something about how we think ahead. The name of our Association is partly looking towards the future, where next to homecare we would like to promote Occupational Day therapy or Institutional care. At this moment in many cases people decide returning to their home country when they reach the point of needing more care than Portugal can provide.
  As we are a small organization we could never afford large investments in order to realize good institutional care, but we are willing to offer our know-how and nursing services. We are in contact with various large Dutch foundations for Elderly Care, in the process of realizing Senior Living Projects in the south of Europe. Individual living units adapted to your own individual handicap with medical care adapted to your own needs, according to good health standards. One project is being planned between Portimão and Lagos. I have had meetings with responsible directors, and our organizations are in the process of how we can cooperate together.
• Thank you for your attention and I am willing to respond any questions.

For further information please contact:

SZA-ADAS
t.a.v. Dhr. Theo Boom
Urb. Vale da Amoreira,
lote 13 1º esquerdo
8000-495 Faro
Tel:+351 (289) 864900
E-Mail: mop55620@mail.telepac.pt