Presentation prepared for IFA 11TH GLOBAL CONFERENCE ON AGEING28 May – 1 June 2012, Prague, Czech RepublicSupport for caregivers in Slovenia: Interplay of transition and ageingValentina Hlebec (email@example.com)University of Ljubljana, Faculty of Social Sciences, Slovenia
Overview 1. About Slovenia 2. Origins of Slovenian welfare system and care system 3. Who are the pensioners 4. Services and rights a. (In)Formal home care (Leave of absence for family member, Family attendant, Personal assistant) b. Home social care c. Home medical care d. Cash benefits and allowances (Income support for pensioners, The assistance and attendance allowance, Financial social assistance, Exempts from payments of the services) e. Institutional care 5. Users’ perspective 6. Conclusions
1. About Slovenia Small CEE country with about 2mil inhabitants on 20.000km2 16.4% 65+; Mean age 41.1 (M - 39.7; F - 43.0) Ageing index 118.0 Total fertility rate 1.53 Life expectancy M - 75.8; F – 82.3SURS – Statistrical Portait of Slovenia in EU 2010; SURS – Slovenia in Figures 2010: 15-20.
2. Origins of Slovenian welfare system and care systemThe Slovenian welfare system today is the outcome of a series of gradual changes in thelast 20 years.Its origins can be traced to the 1950s and the development of the Yugoslav welfaresystem (see Kolarič, 1990 and 1992; Kolarič et al., 2009), based on the compulsorypayment of contributions by employees and enterprises to cover risks of income loss(including old age) and all contributions for education, childcare, care for older peopleetc.
Components:- The public sector (a well developed and regionally dispersed network of public (state) institutions with formally organised professional services - homes for the care of older and community nursing),- The informal sector (largely based on strong value orientations, normative expectations and emotional closeness within family and informal networks) was ignored by the state and therefore not supported by policy measures,- The “gray” sector (employees in public institutions and organisations who were offering services for direct (illegal) payment).Major development in the quantity and quality of new services during the last 20 yearsis in the area of home care.Family members (partner and children) have legal obligation to provide (alsofinancially) for dependent partner or parent.
3. Who are the pensioners Average age of new pension beneficiaries (without survivors and widower’s pensioners) under general and special regulations, by years, situation in December 62 60 58 men 56 women total 54 52 50 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Sources: The Pension and Disability Insurance Institute of Slovenia, 2004 2010, 2011
Net pensions and income support for pensionersAverage net pensions with income support for pensioners in €, and recipients of incomesupport for pensioners 12/2010 Number Mean Number MeanOld-age pension 376.665 625 14.014 88Disability pension 90.641 500 14.702 81Survivors pension 92.927 430 18.019 107Total 560.233 577 46.735 93Source: The Pension and Disability Insurance Institute of Slovenia, 2011http://www.zpiz.si/wps/wcm/connect/zpiz+internet/zpiz/prvastran/ozavarovanju/statisticnipodatki/statisticni+pregled+2010-12http://www.zpiz.si/wps/wcm/connect/zpiz+internet/zpiz/prvastran/ozavarovanju/statisticnipodatki/statisticni+pregled+2011-07
(a) (In)Formal Home care (Leave of absence for family member, Family attendant, Personal assistant) 1. Leave of absence for employed family member (informal carer)The Health Care and Health Insurance Act (1992) offers an opportunity for familymembers to take care of a close family member. They are eligible for wagecompensation (80%) for 7 days, exceptionally for 14 days, but only for people who areliving in the same household.
2. Family attendantThe Social Security Act (2004; MDDSZ, 2006a; Amendment to the Social Security Act,1992) defines a possibility for a family member to become a family attendant with theright to partial payment for lost income at the minimum wage level (521 EUR in 2006;1.349 cases, 981 family attendants were family members) or to a proportional part ofpayment for lost income in the case of part-time work and full pension and disabilityinsurance contributions covered.The tasks of the family attendants are: - personal care, health care, social care, homemaking. - Evaluation for eligibility is done by the local Centre for social work and Disability Commission at Pension and Disability Insurance Fund. - Centre for social work is responsible for monitoring the care provided and has to prepare annual reports. Social inspection also inspects the work of family attendants. - Family attendants are financed through municipality budget.(The Social Security Act (2004; MDDSZ, 2006a; Amendment to the Social Security Act, 1992), Hlebec 2010, Prevodnik Rupel, Ogorevc,2010: 7-8, 14).
3. Programme of personal assistanceCurrently is financed as a project. 70% of organizations used disability status as criteriafor eligibility. Different services were performed.Financial means are not ensured, most programmes were financed trough Employmentoffice (80%), some receive support of the municipalities or Ministry for Labour, Familyand Social Affairs.In the first six months of 2007 there were 705 users of these programs (29% aged 65+).(Prevodnik Rupel, Ogorevc, 2010: 8, 16).
(b) Home social care A new service, developed in first half of 1990s. It is a social assistance service intended to improve the quality of life of older people living at home who are unable to care for themselves due to old age or illness and whose family cannot provide them with sufficient care. It was developed to cut the number of waiting applicants for old people’s homes and to improve the quality of life of those living at home. Home social care encompasses Homemaking , Help with basic daily tasks with personal hygiene, Maintaining social contacts An individual is eligible for up to 4 hours of care per day or a maximum of 20 hours per week in residential municipality. Evaluation for eligibility is done by local centre for social work.
The financial burden of the service is carried by the municipality which by law is obliged to cover at least 50% of the cost of the service. The state reduces the price of the service by contributing to the labour costs of the service provider. Users pay the remaining costs of the service (which may be up to 50% of the total costs). In 2010 65% of the costs were covered by municipalities, 22% by users and 13% by central state budget (active employment policy). The active employment policy project ended in November 2011. The number of users is increasing from 2875 in 2003 to 6575 in 2010. Average price paid by user varies considerably across municipalities (was 4.42 EUR on average in 2010). In 2008 the difference in price between private (4.99EUR) and public (4.15EUR) providers was considerable.
Providers of help at home regarding the status, in n 50 40 Center for Social Services 30 Home for the elderly and special institutions 20 10 Special institutions for help at home (MB, LJ …) 0 2007 2008 2009 2010 Concessionaires (Jan-Jun) (Jan-Jun) (1. 12. 2009) (1. 12. 2010)Source: Nagode, Jakob Krejan, Smolej (2010): IZVAJANJE POMOČI NA DOMU. Analiza stanja v letu 2010. Končno poročilo (Homecare. Analysis of 2010 data. Final report). Social Protection Institute of RS.
The age of users, in percent 2010 12,4 31,8 55,9 2009 12,7 33,9 53,4 64 years old or younger 2008 11,8 34,8 53,4 65 to 79 years old 80 years old or older 2007 12,8 38,5 48,7 2006 13,4 37,3 49,3 0 20 40 60 80 100Source: Nagode, Jakob Krejan, Smolej (2010): IZVAJANJE POMOČI NA DOMU. Analiza stanja v letu 2010. Končno poročilo (Homecare. Analysis of 2010 data. Final report). Social Protection Institute of RS.
The structure of help at home by content, in percent 2010 42,5 44,8 12,7 help in the household 2009 48 43 8,9 help with basic daily tasks help in maintaining social contacts 2008 46 45 9 0 20 40 60 80 100Source: Nagode, Jakob Krejan, Smolej (2010): IZVAJANJE POMOČI NA DOMU. Analiza stanja v letu 2010. Končno poročilo (Homecare. Analysis of 2010 data. Final report). Social Protection Institute of RS.
CATEGORIES OF HEALTH SERVICES DURING HOME VISITS, 2009 (%) Basic care 3,0 Bathing 0,6 Care of dying person 0,2 Decubitus prevention 1,8 Health education 11,0 Enema 0,2 Other procedures 5,7 Care of stoma 1,7 Aplication of injection 11,3 Aplication of parenteral fluids 0,2 Wound dressing 39,4 Urinary chatheterisation 0,5 Collection of lab. samples 7,7 Art.blood pressure measurment 9,8 Physiotherapy 0,8 Other 6,2 0 5 10 15 20 25 30 35 40Source: Statistical yearbook of health care (2000-2009)
(d) Cash benefits and allowances (Income support for pensioners, The assistance and attendance allowance, Financial social assistance, Exempts from payments of the services) 1. The assistance and attendance allowanceThe assistance and attendance allowance is a monthly cash benefit based on criteriadefined by Pension and disability act (criteria: ability to satisfy basic (and most of) lifeneeds, pensioners, blind or weak sighted or immobile). Act does not define themonitoring of use of the benefit although it assumes the benefit will be used foracquiring help in ADL.Evaluation for eligibility is done by the Pension and Disability Fund physician.
The amounts (February 2009) of Attendance and Allowance Supplement depend on thebase on which it is calculated: - It is equal to the base for the most severe cases (24-hour supervision of relatives and compulsory help of a professional) - 398 EUR (422 cases). - It equals to 70% of the base for blind and immobile for fulfilling all basic life needs – 279 EUR (11.318 cases). - It amounts to 50% of the base for fulfilling all basic life needs for persons who need help in most of their basic needs or are sight impaired – 139 EUR (17.378 cases).Among 29.800 recipients in February 2009, 657 recipients received other amounts(Prevodnik Rupel, Ogorevc, 2010: 4-6, 14).
2. Financial social assistanceSocial Security Act defines social help in cash as financial means for meeting minimalliving needs for survival (minimal wage). The amount of financial social assistance = thesum of minimal incomes to which individual eligible person or family members areentitled – actual incomes of all the family members. In December 2006 the share of theolder people (65+) among recipients of financial social assistance was 2.8% (1.548)recipients.Evaluation for eligibility is done by the local centre for social work.The Social Security Act (2004; MDDSZ, 2006a; Amendment to the Social Security Act,1992), Prevodnik Rupel, Ogorevc, 2010: 11).
3. Exempts from payment of the services- The border of social security is set as an amount of money that has to remain in the hands of the user of the service after the payment of the services (all kinds of long term care services). The ability to pay is the maximum amount up to which the user is able to pay.- Family members (partner and children) have legal obligation to financially provide for dependent partner or parent.- For owners of the real estate properties the issuing of the written order on exemption from payment contains the inhibition on alienation or burdening of this real estate to the credit of the municipality which finances the institutional care of the user.- In the case of home care services, the inhibition on alienation or burdening is not done for permanent residence of the user.- The exempts from payment are evaluated by local Centre for Social Work. The difference is paid by municipality. (Prevodnik Rupel, Ogorevc, 2010: 13).
4. Users’ perspective- Many services and rights- Information not available in one place- Different entry points- Long procedures- Some services universal and financed by state budget while others available only for additional payment (mostly newly developed services)- Large regional differences- Large differences across municipalities- Freedom of choice?
5. Conclusions- The system of LTC is evolving (however, currently very fragmented and perhaps not so efficient)- Poor access to services owing to fragmentation of services, different entry points and long procedures- Lack of data – only official reports available as secondary data (Statistical yearbooks and reports at Institute for Social Protection)- Lack of data base with data about different services at one place- Lack of harmonization (services organized at different level and therefore data collected at different level – unit of observation?)- No systematic data about users and about users perspectives (satisfaction with services, subjective assessments of needs)- No systematic and official standards of quality of services