Presentation prepared for IFA 11TH GLOBAL CONFERENCE ON AGEING

28 May – 1 June 2012, Prague, Czech Republic

Support for caregivers in Slovenia: Interplay of transition and ageing

Valentina Hlebec (valentina.hlebec@fdv.uni-lj.si)

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 – 82.3

SURS – Statistrical Portait of Slovenia in EU 2010; SURS – Slovenia in Figures 2010: 15-20.

2. Origins of Slovenian welfare system and care system

The Slovenian welfare system today is the outcome of a series of gradual changes in the

last 20 years.

Its origins can be traced to the 1950s and the development of the Yugoslav welfare

system (see Kolarič, 1990 and 1992; Kolarič et al., 2009), based on the compulsory

payment of contributions by employees and enterprises to cover risks of income loss

(including old age) and all contributions for education, childcare, care for older people

etc.

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 years

is in the area of home care.

Family members (partner and children) have legal obligation to provide (also

financially) for dependent partner or parent.

3. Who are the pensioners

Sources: The Pension and Disability Insurance Institute of Slovenia, 2004 2010, 2011

Average age of new pension beneficiaries (without survivors and widower’s pensioners) under

general and special regulations, by years, situation in December

50

52

54

56

58

60

62

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

men

women

total

Net pensions and income support for pensioners Average net pensions with income support for pensioners in €, and recipients of income support for pensioners 12/2010 Number Mean Number Mean Old-age pension 376.665 625 14.014 88 Disability pension 90.641 500 14.702 81 Survivor's pension 92.927 430 18.019 107 Total 560.233 577 46.735 93

Source: The Pension and Disability Insurance Institute of Slovenia, 2011

http://www.zpiz.si/wps/wcm/connect/zpiz+internet/zpiz/prvastran/ozavarovanju/statisticnipodatki/statisticni+pregled+2010-12

http://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 family

members to take care of a close family member. They are eligible for wage

compensation (80%) for 7 days, exceptionally for 14 days, but only for people who are

living in the same household.

2. Family attendant

The 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 the

right 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 of

payment for lost income in the case of part-time work and full pension and disability

insurance 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 assistance

Currently is financed as a project. 70% of organizations used disability status as criteria

for eligibility. Different services were performed.

Financial means are not ensured, most programmes were financed trough Employment

office (80%), some receive support of the municipalities or Ministry for Labour, Family

and 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.

Source: Nagode, Jakob Krejan, Smolej (2010): IZVAJANJE POMOČI NA DOMU. Analiza stanja v letu 2010. Končno poročilo (Home

care. Analysis of 2010 data. Final report). Social Protection Institute of RS.

0

10

20

30

40

50

2007 (Jan-Jun)

2008 (Jan-Jun)

2009 (1. 12. 2009)

2010 (1. 12. 2010)

Providers of help at home regarding the status, in n

Center for Social Services

Home for the elderly and special institutions

Special institutions for help at home (MB, LJ …)

Concessionaires

Source: Nagode, Jakob Krejan, Smolej (2010): IZVAJANJE POMOČI NA DOMU. Analiza stanja v letu 2010. Končno poročilo (Home

care. Analysis of 2010 data. Final report). Social Protection Institute of RS.

13,4

12,8

11,8

12,7

12,4

37,3

38,5

34,8

33,9

31,8

49,3

48,7

53,4

53,4

55,9

0 20 40 60 80 100

2006

2007

2008

2009

2010

The age of users, in percent

64 years old or younger

65 to 79 years old

80 years old or older

Source: Nagode, Jakob Krejan, Smolej (2010): IZVAJANJE POMOČI NA DOMU. Analiza stanja v letu 2010. Končno poročilo (Home

care. Analysis of 2010 data. Final report). Social Protection Institute of RS.

46

48

42,5

45

43

44,8

9

8,9

12,7

0 20 40 60 80 100

2008

2009

2010

The structure of help at home by content, in percent

help in the household

help with basic daily tasks

help in maintaining social contacts

© Home medical care

The community nursing and home care is carried out in two areas:

o home care and

o programmed heath education in a larger community.

The needs tested service (as much as needed), provided 24/7.

Organized as independent organizational unit within primary health care and

provided by nurses.

In 2009 there were 1.154.737 preventive and curative visits, 20% were community

nursing and 80% home care related visits.

Source: Statistical yearbook of health care (2000-2009)

6,2

0,8

9,8

7,7

0,5

39,4

0,2

11,3

1,7

5,7

0,2

11,0

1,8

0,2

0,6

3,0

0 5 10 15 20 25 30 35 40

Other

Physiotherapy

Art.blood pressure measurment

Collection of lab. samples

Urinary chatheterisation

Wound dressing

Aplication of parenteral fluids

Aplication of injection

Care of stoma

Other procedures

Enema

Health education

Decubitus prevention

Care of dying person

Bathing

Basic care

CATEGORIES OF HEALTH SERVICES DURING HOME VISITS, 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 allowance

The assistance and attendance allowance is a monthly cash benefit based on criteria

defined by Pension and disability act (criteria: ability to satisfy basic (and most of) life

needs, pensioners, blind or weak sighted or immobile). Act does not define the

monitoring of use of the benefit although it assumes the benefit will be used for

acquiring 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 the

base 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 assistance

Social Security Act defines social help in cash as financial means for meeting minimal

living needs for survival (minimal wage). The amount of financial social assistance = the

sum of minimal incomes to which individual eligible person or family members are

entitled – actual incomes of all the family members. In December 2006 the share of the

older 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