Assessment of opinions on financial sustainability in nursing homes and elderly care and rehabilitation centers

As societies evolve, birth rates change inversely with their lifespan. This situation has brought about an increase in the elderly population in the world with the development of health facilities. In the globalizing new world order, the aging of the population has become an issue that needs to be examined not only in developed countries but also in developing countries. Aging phenomenon, process, and results; It is effective on all layers of the society, from health to social security, from financing to education, from job opportunities to social-cultural activities and family life. The financing models and sustainability of services provided to the elderly have become the most important and priority issue of all societies and all sectors related to the issue in the last century. Some countries in the world have taken different financial sustainability measures (such as elderly care insurance) due to the importance of this issue. Because of the above-mentioned importance and priority, the subject of this research is the analysis of the financing structure in nursing homes, elderly care and rehabilitation centers in Turkey and the examination of their long term sustanaibility. It is aimed to resolve possible problems and accordingly, by discussing with experts and stakeholders. In the research, in-depth interviews were conducted using qualitative research methods and techniques to learn the views of 17 participants selected by the purposeful sampling method. 15 of the participants selected with purposeful sampling are from Turkey and 2 of them are from foreign countries. Two meetings were held in Germany in german language in order to see the big picture in the world, both because they emphasized that they took the German model as an example in the construction of care in Turkey in the meetings between the Ministry of Family and Social Services (ASHB) and the Social Security Institution (SGK). In line with the information given by the participants, the interviews were examined with the content analysis method, and open codes were reached. Open codes laid the groundwork for the formation of categories and themes.The information obtained was gathered under three themes. While the themes of "Current situation" and "Obstacles and Risks" explained the current situation in Turkey, the theme of "Modelling of the Care Assurance System" explained the situation that should exist. The current situation theme has been examined under the sub-headings of public expenditures, private expenditures, lack of fair care assurance system, false perception of nursing home, administrative separation, and social state understanding. Barriers and risks theme can be defined with demographic change, burden of care, wrong construction and legislation. The sub-headings in the modeling of the maintenance assurance system are; design of care level criteria, presentation of service models, multi-leg financial distribution, actors and effects of the model. As a result of the research, all of the stakeholders stated that financial sustainability in the field of elderly care services in Turkey is not possible in the long term. In order to ensure financial sustainability, it is necessary to plan the care services. The first step to be taken in this regard is to determine the care levels of the elderly according to the activities of daily living (ADL), which is applied in the world but has not yet been implemented in our country. Where and by whom the elderly, determined according to the care level criteria, will be cared for is the second critical point required in financial sustainability. According to the care level criteria, it is necessary to care for the elderly, whose place of care is determined, with a multi-pronged financial distribution, which basically includes long-term care insurance, supported by taxes, out-of-pocket payments, complementary and private insurances. The presence of actors including the state, private institutions, families, local governments, universities and non-governmental organizations (NGOs) is important in the new model to be established. With the system designed in line with the steps described above, financial sustainability will be ensured, and all elderly people who need an accessible, fair and quality care system that is distributed fairly to the entire population will benefit from it.