The need for personal assistance increases with age, so the elderly most gain from services offered at home.
Services for the elderly
The aim is to help an elderly person in need of personal assistance to cope independently, through services provided by family or a social worker, in a familiar environment, i.e. at home, for as long as possible. If the individual’s need for personal assistance can no longer be ensured by providing services which support their life at home, a general care service provided outside of the home (care home) would be an appropriate service for them.
For a detailed overview of the social services provided by local governments, see the website of the Ministry of Social Affairs.
The local government of the elderly person’s place of residence entered in the population register organises the provision of social services, social benefits, emergency social assistance, and other assistance to them, like to all other people. If an elderly person is in need of personal assistance, the local government of their place of residence should be contacted. Ask the social worker of your city or rural municipality government for more information on services and other help.
Applying for services
If there is a need for a service
Contact the local government where the elderly person lives pursuant to the population register, and report their need for assistance.
Agree with the social worker on when and where to conduct an assessment of the need of assistance and how to arrange it (whether the social worker comes to their home, visits the elderly in the hospital, or if it is possible for the elderly person to go to the social worker for assessment).
As a result of the assessment, it becomes clear what kind of help and to what extent the elderly person needs for daily coping.
Ask the social worker what service providers are available in the area, how the elderly person will receive the service, and what steps have to be taken.
If the elderly person or their close family member finds that no local government assistance is needed, you can contact the appropriate service provider and agree upon the terms and conditions for starting the provision of the service.
Elderly persons’ rights when applying for social services
If you disagree with the decision of the local government, you have 30 days to file a complaint with the local government which made the decision.
If the local government refuses to help, leaving the situation to the elderly or their relatives, or the assistance offered does not resolve the situation (e.g. timely or in full), the local government should be asked for a written explanation. If the action of the local government does not satisfy the need of assistance of the elderly, it is possible to inform the Social Insurance Board by e-mail at [email protected]. The role of the Social Insurance Board is to exercise administrative supervision over the quality of local governments’ social services and other assistance.
Functions of local governments in processing applications
The local government must ensure that the necessary services are available and accessible to all those in need.
The decision to provide an appropriate service must be made within 10 working days of receiving a valid application. The decision is based on a prior assessment of the need for assistance. The decision whether or not the suitable service will be provided must be made in writing and be clearly reasoned to the elderly.
Payment for services
There may be charges for providing social services. The local government determines the terms and amount of the charge for the social service it provides. The charging is decided by the body paying for the service or providing the service.
The amount of the fee charged from the elderly person depends on the volume of the social service, the cost of the service, and the financial situation of the person receiving the service and their family.
The amount of the charge for the social service must not be an obstacle to being provided the service.
Nursing care
People with particular healthcare needs can benefit from nursing care services. Nursing care is provided according to the needs of the patient both at hospitals or care facilities and at home. A doctor must decide is a person needs nursing care and a referral is required to receive the service.
The provision of nursing care in a hospital is intended for stable patients who are not in need of continuous medical care, but need care and treatment beyond the possibilities available for home nursing.
A decision to refer a person to a nursing hospital is made by a general practitioner or a medical specialist, either by themselves or together with a nurse. The time spent in the nursing hospital and the services provided depend on the patient’s state of health and need for nursing care.
85% of the fee for insured patients in in-patient nursing care is paid by the Estonian Health Insurance Fund and 15% is paid by the patient. In addition, the hospital has the right to ask for an additional EUR 25 for the first 10 days of hospitalisation.
Home nursing is intended for a patient whose state of health does not require hospitalisation but who still needs expert medical care. This may apply to persons with reduced mobility who are unable to go to a doctor themselves. A home nurse is therefore also an important link between a general practitioner or an attending physician and the person in need of care. A general practitioner or a medical specialist decides on the need to refer a person to a home nursing service. A referral is needed where the doctor indicates the patient’s health problems and the treatment, and the nurse the need for nursing care. Home nursing is free of charge for those with health insurance. It is paid for by the Estonian Health Insurance Fund.
More information on nursing care can be found on the Estonian Health Insurance Fund website.
General care service provided outside the home (care home)
Care homes are intended for those individuals who are permanently or temporarily not able to cope at their own home even with the help of supporting services due to their health condition and/or need for care. Care homes ensure round-the-clock accommodation, catering, security, the required care, instruction, and assistance in daily operations, social counselling, as well as activities which increase the individual’s level of activity. Care homes may be managed by the state or the local government or private care homes.
Care procedures and other activities which support and ensure coping must be provided to care home residents. For this purpose, an individual care plan is drawn up for each care home resident, specifying the specific care procedures and other supporting activities which are required to ensure the safe coping of the individual in the care home. The activities required to preserve the independence and quality of life of the individual are highlighted separately. The elderly person, their family members, and the local government of the place of residence of the elderly person must be involved in drawing up the care plan, if possible. The care plan is reviewed at least once in six months or more frequently, if the condition or the needs of the individual change.
In drawing up the care plan, the need of the individual for healthcare services must also be assessed, in addition to their need for care. Therefore, it is important to involve the family physician, family nurse, or another healthcare worker in drawing up the care plan.
Payment for the care home
The amount payable for the service provided in the care home is divided between the local government of the place of residence of the elderly person and/or the family members who are responsible for the maintenance of the elderly person. When the local government has determined that the need for assistance of the elderly person can only be covered in a care home, it is the obligation of the local government to cover the part of the care costs of the cost of a place in a care home. The care costs include the labour costs of the care workers and assistant care workers employed at the care home, and the costs of their work wear, health checks, and training. The recipient of the service pays the remaining part of the cost of the service, which mainly consists of the costs related to the accommodation and catering and other individual needs. It should be kept in mind that the local government may establish a limit for the care costs. Thus, the amount paid by the local government to cover the care costs may differ by local governments (e.g. 500 euros in some rural municipalities and 600 in others). The limit for the care costs must be sufficient to ensure that an elderly person can live in a care home so that their care costs are covered by the local government. The limit for the care costs is not required to cover the care costs at any care home in Estonia, however. The elderly person must keep this in mind when choosing their care home place and consider their own financial situation and the financial situation of their maintenance providers.
If the income of the elderly person is lower than the average old-age person published by Statistics Estonia in the second quarter of the previous calendar year, the local government will partly help to cover the part payable by the individual. Local governments are not, however, required to cover an unlimited amount – their obligation is to cover the difference between the income of the individual and the average old-age pension.
Further information about funding can be found at www.sm.ee/hooldereform and from the website of the Social Insurance Board.
In order to be allocated a care home place, the local government of the place of residence of the elderly person on the basis of the population register must be contacted, and the local government must determine the need for assistance of the elderly person and the volume thereof and ensure respective assistance.
When choosing the care home, the institution should be visited, if possible, to make sure that the care home chosen meets the expectations and the actual needs of the elderly person.
Further information about applying for a place in a care home can be found on the website of the Ministry of Social Affairs.