1. 1 Integrated solutions to the provision of social and health care services in modern welfare system Monika Haukanõmm Strasbourg 29-10-2008

2. 2 BACKGROUND INFORMATION The Republic of Estonia Capital: Tallinn Currency: Estonian kroon (EEK) The size of population: 01.01.2008 – 1,341,000 Population density: (people per square kilometre) 30 Administrative division – countiest15 - local goverments 227 - cities and towns 33 - rural municipalities - 197 Member of the European Union since 2004

3. 3 Population and ageing The population of Estonia has been characterised by a tendency of decrease since 1990s 1995 - 1 448 075 2006 – 1 334 684 From 1995 to 2006 the percentage of people over 65 has grown from 13 percent to 17 percent (2020 – 25%) 1995 – 208 521 2006 – 240 711

4. 4 Population and ageing Percentage of people over 65 years old in the population: 1990 – 11.5 % 2006 – 16.7 % 2050 – 27.0 % Relationship between employed persons and pensioners 1992 – 2 employed persons per each pensioners 2006 – 1.8 employed persons per each pensioner 2050 – 1.27 employed persons per each pensioner

5. 5 Ageing persons with disabilities The number of disabled people is rising year by year 2008 - over 115 thousand disabled people in Estonia, which is 8.6 % of the population Over 60 % of them (69 thousand) are of retirement age, that is at least 63 years old

6. 6 Who are regarded as disabled persons in Estonia? A person is disabled when he/she has loss of or an abnormality in an anatomical, physiological or mental structure or function, which in conjunction with different attitudinal and environmental obstacles prevents taking part in social life on a equal basis with others.

7. 7 Long-Term Care – the Demographic Challenge of the 21st Century. Social welfare principle State shall secure social security for its citizens, which offers confidence in the future and the opportunity to live all one’s life in accordance with human dignity. The measures of social security are divided into social security and welfare. The principle objective of the policy for the elderly is to promote the internationally accepted principle of “Society for All” that is based on the consideration that society comprises people of different age groups who must have the possibility to participate in social life, irrespective of age and disability.

8. 8 According to the laws, regulation of the social welfare of the elderly is the obligation of the local governments and the persons him/herself. The following services to the elderly are financed from the state budget: the welfare services to adults with special mental needs (incl. dementia) services for the older people with disabilities - rehabilitation services, partial compensation for prostheses and medical devices), expenditure relating to state social benefits

9. 9 Financing the long term care in institution Main principle: social service is paid by the person using it and his/her family members. If their financial opportunities are insufficient, they can apply for support from the local government Health services are not available in long term care institution People going to service are in serious conditions and poor heath – in 2006 average staying in long term care institution was 8,3 months

10. 10 The main problems in long term care services for the disableb elderly Availability is insufficient and it varies among service providers The quality varies among service providers Services provided at home are underdeveloped Welfare and healthcare services are strictly separated and randomly integrated

11. 11 Welfare and healthcare services The National Health System: domestic nursing care primary care services specialized care geriatric assessment services (RAI) nursing care The Social Welfare System: institutional care day care domestic care other supporting services.

12. 12 Estonia is moving towards providing more and more services to people at home. The biggest problem is the integration of health and welfare services so that people could move from one service to the other smoothly and without problems.

13. 13 Integrating Long-Term Care Assistance and Nursing Care The objective is to offer solutions for better organisation of care assistance and nursing care in the welfare and health systems, and for smoother co-operation between them – integration.

14. 14 Principles on the personal level: providing assistance is guided by the needs and wishes of each person involvement support will be given to the coping of the person in familiar surroundings (home) as long as possible similarity to home

15. 15 Principles on the social level increasing the efficiency of care including reducing and purposeful use of expensive care services (institutional care) developing open care services; clearer distribution of responsibility for provision of assistance Universal design (the services have to be accessible, available, usable and understandable for everyone

16. 16 Provided Services Integrated care is a well planned and organised set of services and care processes, which is directed at persons with multiple problems or at solving the problems and needs of a group of persons with similar needs/problems. Integrated care includes both health and welfare services.

17. 17 Provided Services The main services are: housing service maintenance treatment service nursing care service different combinations of the aforementioned By capacity the listed services are divided into daytime services and 24-hour services.

18. 18 Daytime Services care assistance in a domestic environment domestic nursing services day centre services 24-hour services or institutional nursing care and care assistance services

19. 19 24-hour services or institutional nursing care and care assistance services Short-term nursing care nursing care for a dying person (hospice) –long-term nursing care – long-term 24-hour care assistance housing service with care assistance

20. 20 Financing of the Integrated Services: The person him/herself and the Local Government finance: 24-hour care assistance The Local Government finances: domestic care assistance day centre services The Estonian Health Insurance Fund (EHIF) finances: independent in-patient nursing care hospice service domestic nursing service

21. 21 Combining work and family-life arises will the caregivers will remain outside the labour market or will it be made possible to combine the obligation to care with employment this requires the employers to create flexible working conditions the issue of care is gender sensitive, because care is mostly deemed to be a domain for women burden of care can expose the family to the risk of poverty as a result of care, the other members of the family may become isolated

22. 22 Thank You!