Responses to the crisis in long-term care in Latvia Martins Moors Deputy director, Head of Social Administration Riga City Council Welfare Department (member of ESN)

Organization of nursing care home (or LTC) service for older people in Latvia Provision of nursing care home services for older people is considered to be a social service and falls entirely under the responsibility of the municipalities. However, the majority of nursing homes employ some medical personnel, mainly nurses. Provision of medical services to nursing homes’ inhabitants is organized in the same way as the provision of medical care to the general population. Long term care services for persons with severe mental disorders are under the responsibility of the Ministry of Welfare and are financed from the central government’s budget.

Financing of nursing care home (or LTC) service for older people in Latvia Recipients of social care services must cover the cost of services or a part of it – 90% from state pension (and other income) The rest of the cost must be covered by this person’s primary guardian/caretaker (formula according to rules of government) if the guardian/caretaker is not able to do so, by the municipality.

Sources of revenues of nursing homes, 2011 Co-payments from the customers (paid from the old age pension income in case of the retired customers) and municipality funding have constituted the bulk of nursing homes’ revenues Source: Ministry of Welfare (2013)

Actual and forecasted number of nursing homes customers, 2007-2012 While the average monthly old age pension of a retired person increased during the crisis from LVL 141 in 2008 to LVL 178 in 2011, the average monthly salary of the working age population decreased during the same period (CSB, 2013b). As a result, according to the interviews with the management of Stella Maris, relatives of the elderly had an incentive to keep them at homes, rather than in a nursing home, in order to be able to use their old age pensions as extra incomes for the household. This could be one of the reasons why the Ministry of Welfare data show a decrease in the number of nursing homes customers during the crisis and explains the gap between the forecasted and the actual numbers of customers during the crisis. Source: Ministry of Welfare (2013)

Trends in the number of nursing homes employees, 2007-2012 Those in charge of the administration of nursing homes had to cope with diminishing revenues and had to reduce the expenses, including reducing the number of staff and salaries. Source: Ministry of Welfare (2013).

Case study: nursing home Stella Maris Long term care centre owned by the municipality of Riga Stella Maris had long term care In 2007, 107 customers; 53 employees In 2011, 109 customers; 49 employees In 2012, 114 customers; 53 employees

Trends in monthly spending per customer, 2007-2012 (1LVL=1,42€) As the result of the cost-containment measures, spending per customer per month decreased Source: Ministry of Welfare (2013).

Case study: nursing home Stella Maris expenses, 2007-2012 (1LVL=1,42€) As a result, Stella Maris had to look for ways to reduce its expenses.

Actual trends now in Riga Almost half of LTC institution clients are people with dementia (46% in 2014 (Riga)) Increasing number of receivers of alternative care in living area (home care, alarm button, meals on wheels, assistant) from 3941 persons in 2009 to 6410 persons in 2014 Increasing numbers of people with disabilities From 40 063 persons (5,65% from Riga population) in 2009 to 47 588 persons (6,82 from Riga population) in 2014 Lack of LTC providers in Riga and surrounding municipalities

Thank you for attention!