Madise recommends the rate of possible price increases be in-fixed into the contract signed between the Social Insurance Board (SKA) and the service provider. 

SKA says it agrees in essence with Madise's proposals in this area.

A resident of Estonia had requested from the Chancellor of Justice an explanation of how the prices of accommodation and catering services at special welfare institutions, known as the co-payment, is formulated. The questioner said they did not understand why they are requested to pay a different amount to the care home operator in question, AS Hoolekandeteenset Türi Kodu, each and every year, even as the content of the service does not substantively change.

In her public response to the query, Madise recommended that in order to better protect the rights and interests of customers of special care services, a clause hedging against unexpected price increases should be stipulated in the contract between SKA and the service provider.

Madise added that: "An individual should be able to predict when and by how much the price of the service may rise at once. This also ensures that after relocating to a special care home, the patient will not have to forgo their place after some time, simply due to money."

The Chancellor of Justice reminded SKA officials that in some cases, the state has deemed it necessary to regulate any rise in service prices, not only in respect of care homes but with other service providers, such as private education.

"For instance, the Private Schools Act stipulates that tuition fees can be upped by up to 10 percent between one academic year and the next, unless the contract between the private school operator and the student's fee payers stipulates otherwise. The same principle might also be applied to special welfare services. In this case, any price increase would be more foreseeable, and also better comprehended by the recipient of the special welfare service or their carer."

Lagle Kalberg, head of SKA's special care and rehabilitation department, told ERR that the state agency fully agrees with the Chancellor of Justice's opinion that it must be clear to a person who requires special care services, or to their executor, what they are getting in terms of meals, accommodation etc., in return for the fee, what additional services they are liable for, and how this price is calculated each year.

Kalberg said that: "A higher co-payment must be proportionate the value of the additional benefits offered. For example, if an institution puts in place better security requirements, or a more comfortable environment. In any basic contract concluded between SKA and a service provider, it is written in that the service provider can alter the co-payment amount paid by the service recipient, once per year. We are currently renewing contracts."

Kalberg also noted that the Ministry of Social Affairs has plans to revise the sections concerning health protection requirements, i.e. what the specific minimum requirements for accommodation and catering – which the service provider may request for a higher co-payment – consist of.

"For our part, we can state that fortunately no situation has arisen whereby an individual has had to give up any special care service simply because the service provider has changed the amount of the deductible," Kalberg continued.

Special care services are aimed at those people in society who have received a diagnosis of any difference of ability in mental or intellectual aspects and who, due to their mental health condition in particular, require guidance, counseling, auxiliary help and supervision in their everyday life, conducted by a special care activity supervisor, and for whom it is not possible to provide the necessary help via other social care assistance measures.

SKA pays a service provider for services rendered to the individual, on the basis of invoices. In the case of community live-in services and 24-hour special care service, the recipient has to fund food and accommodation themselves, i.e. the service has a co-payment component, whereby the maximum state contribution is established for each fiscal year, within the state budget. If the individual cannot afford to pay that deductible, they or their carer can apply for compensation of that amount, from SKA.

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