Signe Riisalo: What does long-term care reform change for people?

Minister of Social Protection Signe Riisalo on
Minister of Social Protection Signe Riisalo on "Otse uudistemajast." Source: Ken Mürk/ERR

Given that the long-term care reform has been in the works since 2017, it is understandable that those whose lives have finally been made easier by the reform may have missed the most critical information, Minister of Social Protection Signe Riisalo (Reform) writes in a commentary.

When I assumed office in the winter of 2021, I took over the task of reforming long-term care, the results of this work we are finally seeing today, a year and a half later.

Beginning 1 July 2023, people in Estonia will have better access to general care services and substantial funds will be invested in the development of home care services.

In a nutshell, the state budget negotiations secured €40 million for long-term care reform and €57 million for the revenue base of local governments for the coming year. Beginning in 2025, the local government service revenue base will see an annual increase of around three million euros.

Therefore, the local government will cover costs of the caregiver, which is about half of the entire cost of the service. The individual will only be responsible for his or her board and lodging expenses and other personal necessities.

Given that the reform has been in the works since 2017, it is understandable that those whose lives are finally made easier by the changes may miss the most important information in the overload of news, so let me summarize below the most important aspects of the reform.

What will the long-term care reform change for people in Estonia?

Previously, a person was covered 100 percent for the nursing home costs. The fee will now be split between the local authority and the individual requiring the service, depending on the extent of the person's care needs.

The client's contribution will be reduced almost by half and covered by the average pension, which is expected to be about €700 in 2023.

Will your pension allow you to afford a nursing home in the future?

A place in a nursing home will cost around €700 per month, which is the average pension in 2023.

People who require the long-term service will bear less responsibility for financing it, and fewer people will rely on the support of loved ones. Moreover, local governments will provide assistance to people with low incomes, whose breadwinners are unable to contribute to their care needs.

This means that about 75 percent of people in need will be able to afford a place in a nursing home on their pension. The remaining 25 percent may require additional assistance from caregivers and local governments to pay for the service, as is now the case.

Will the planned changes have an effect on service quality?

Yes, more specific requirements for service content and caregiver-to-recipient ratio will be defined, which will improve the overall quality of the service.

One caregiver is currently assigned to every 18 recipients. Depending on the level of need, the reform aims to assign a qualified care worker to a maximum of 9-12 clients.

We have also accounted for an increase in staff salaries in the resources allocated to local governments, which allows for a gross increase up to €1,330.

Will the reform also increase the availability of home services?

Local authorities will receive €16.9 million next year, €8.9 million in 2024 and €8.5 million in 2025 in order to implement the reform and improve access to services that support individuals living at home.

Because of the increased resources made available by the reform, municipalities will be able to determine whether a 24-hour general care service or home services are better suited based on the condition of the person requiring long-term care.

The primary goal of all assistance is to enable a person to return to his or her normal life at home. Arranging for nursing home care should only be done as a last resort.

The cost of care has been the most pressing concern for many people thus far. The amendment's focus on the financing of the care component. The care worker's salary, which is the most expensive component of the care home fee, will be now paid by the public sector.

Unused funds from the 24-hour general care service are set aside for the organization of home care, day care and other services for adults in need of long-term care and their relatives, in order to prevent worsening care needs and alleviate the burden on family members. Family members who provide care should have the opportunity to work professionally alongside living with the loved one, who they care for.

Does the state still provide assistance to people in nursing homes?

Yes, the proposed state budget includes an additional €4.3 million for general and special care institutions to compensate for increased energy, gas and district heating costs incurred during the current heating season (October 2022 to March 2023).

To make all of this feasible, we submitted a draft bill proposal in April to reform the way nursing facility costs are financed, and we also gained consent for an amendment that exempts grandchildren from their grandparents' maintenance requirements.

Although we have made significant progress toward finding solutions, we still have a long way to go.


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Editor: Kristina Kersa

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