Care services for the elderly and people with disabilities

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MINIsTRY OF S0cIAL AFFAIRs

Anna Zhamakochyan Ministry of Labour and Social Affairs of the RepublicYour ref. 1903.2024 No 16.1-6/1838-1 of Armenia [email protected] Our ref. 18.04.2024 No 1.4-2/744-2 Government Building 3, Republic Square Yerevan 0010 Armenia

Care services for the elderly and people with disabilities

Dear Deputy Minister Zhamakochyan

In response to your letter dated 19.03.2024 regarding care service reforms for the elderly and persons with disabilities, we are kindly willing to share our best practices regarding care service reforms and regulations. Below we will provide you with general information about the management of the care systems and links to the documents in English.

Long-term care, often related to the elderly, is provided under the healthcare and welfare systems. Estonian welfare system is divided between central system (services provided by the state) and local system (services provided by the local governments). According to the Local Government Organisation Act §6(1,2) https://www. riigiteataja .ee/en/eli/50 1 072023003/consolide the welfare of the elderly is the responsibility of the local authorities. State offers and finances special care services for people with mental disorders, rehabilitation services and the provision of assistive devices.

The main legal acts are: 1. Social Welfare Act regulates the organization of social services and the division of

responsibilities: https:Ilwww. riiqiteataja.ee/en/eli/ee/5 1901 2024004/consolide/current 2. General Part of the Social Code Act regulates the organisation of social protection

and the ensuring of social protection by public authority: https://www. riiqiteataja.ee/en/eli/5 1701 2024006/consolide

3. Overview of the organization of social services: https://www.eesti.ee/en/pensions social-services-and-allowances/social-services/overview-of-social-services

The Care Reform in Estonia that entered into force from 1st of July 2023 included changes in the Social Welfare Act § 20- 22. Main changes included: reducing out of pocket payments for general care service (eiderly care home, improving the quality of the general care service and nudging local governments to develop more seriously high-quality home-based care services. With the reform, we also established the decrees of social protection minister where we set more precise requirements for two social services: care service in care homes (Social Welfare Act § 20-22, entered into force in 1st of July of 2023) and home care service (Social Welfare Act § 17-19, enters into force 1 st of January 2025).

The quality principles of the provision of social services are regulated in the Social Welfare Act § 3 (2). Estonian Social lnsurance Board (https://sotsiaalkindlustusamet.ee/en) is responsible for issuing social service activity licenses (care home providers must apply for a licence) and monitoring service quality in care homes and other social services (Social WelfareAct § 157(1)).

The healthcare system provides inpatient- and home nursing care and also nursing care in care homes, the conditions are set in the Health Services Organisation Act

Suur-Ameerika 1 / 10122 Tallinn / ESTONIA / +372 626 9301 [email protected] / www.sm.ee / Reg. no 70001952

https:Ilwww. riigiteataja ee/en/eli/50 1042024001 /consolide § 24-26. To provide nursing services an activity Iicense is needed. More information about nursing care can be found here: https://www.tervisekassa. ee/en/people/health-care-services; https://www.tervisekassa.ee/en/people/health-care-services/nursinq-care

Regarding persons with disabilities, Estonia has ratified the United Nations Convention on the Rights of persons with disabilities in 2012. Disability assessment and related benetitare regulated by the SociaI Benefits for Disabled Persons Act. Disability is assessed and benefits are paid by the Social Insurance Board. More information about the disability assessment: https:/Iwww. sotsiaalkindlustusamet.ee/en/disability-and-welfare-services/determination disabilities; https:I/www. sotsiaalkindiustusamet. ee/enldisability-and-welfare-services/benefits disabled-people.

For people in the working age there is both a disability assessment and a workability assessment. Workability is assessed and related benefits are paid according to the Work Ability Allowance Act. More information about workability assessment: https://wwwtootukassa.ee/en/vahenenud-toovoime/toovoime-hindamine.

For people with disabilities the welfare services are offered according to Social Welfare Act. Additionally the Health Insurance Fund offers different benefits to people with disabilities, for example: free dental care to some eopIe with disability, discounts to pharmaceuticals, medical devices. There aro also different discounts based on disability. For example: Public Transport Act, Museums Act.

1 hope you find this information helpful in preparing for the impiementation of reforms in the field of care services for the eiderly and people with disabilities. Should you need any more information or have specific questions, please let us know.

Yours sincerely,

Hanna Vseviov Vice Chancellor for Social Affairs

Berit Marksoo Berit. [email protected]

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