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National Audit Office: Home help system should be rationalized

Social workers deployed by local government provide home help such as shopping, washing, and, as here, helping with home heating.
Social workers deployed by local government provide home help such as shopping, washing, and, as here, helping with home heating. Source: National Audit Office (Riigikontroll)

While there is no serious issue with the availability of home help in Estonia to those who need it, funds allocated nursing care reform are insufficient to develop that service, the National Audit Office (Riigikontroll) finds.

While the Estonian state says it wishes to improve the availability of domestic services, provided themselves by the 79 local authorities in Estonia, the National Audit Office report did not find evidence that people are even now failing to receive the necessary assistance from those local governments.

Definition of domestic service

Domestic service or home help is defined by legislation and by the audit office as one of 13 social services organized by any of Estonia's 79 local government jurisdictions, and provided by social workers on the ground.

The home help target group consists of those who are unable to cope with everyday tasks at home by themselves, which, under the relevant legislation, must include help with heating, cooking, cleaning the home, washing clothes, purchasing food and household items, and running other errands outside the home.

A wide availability of domestic service helps to postpone the need for visiting nursing home service, which is several times more expensive than domestic service, the office says.

The number of people receiving domestic service has risen by 41 percent over the last 10 years; double the rate of growth of the number of elderly people in society, but at the same time slower than the growth rate of clients residing in general care homes.

The state has reportedly started to funnel more public funds into the area in order to improve the availability of domestic service, ie. to curb the numbers needing to have places in care homes.

€13 million allocated to domestic services in 2023, double 2022's figure

Out of the €39.2-million budget earmarked for nursing care reform, about €13 million has been allocated in 2023 for the development of services which support living at home, the audit office says.

This is approximately twice as much as local governments spent on domestic service in 2022.

In 2024, the plan is to allocate €56.7 million to local governments to finance long-term care services, including domestic service. EU funds will also be directed into this area.

Audit office examines issue from local government perspective

The National Audit Office has analyzed the problem of availability of domestic service from the point of view of the organization of work of local governments.

Thinking primarily about the increasing costs, the focus was, among other things, on looking for areas where, by improving the activities of local governments, the provision of domestic service could be increased at the expense of available resources.

According to local governments in Estonia, however, the funds for the nursing care reform are not enough in 2023 to even finance nursery service, let alone the development of domestic service.

The National Audit Office has analyzed the organization of domestic service and the provision of the service in ten local governments in 2022, among them the four largest local government areas in terms of population, and says it did not detect a serious problem with the availability of domestic service, as defined in the Social Welfare Act, in those local governments which were audited.

In the cases analyzed, domestic service was provided when the need for it was identified, while the public were not left without assistance when they approached local authorities in this area.

The same conclusion can be drawn about local governments in general based on the supervision carried out by the Social Insurance Board (SKA) in recent years, the audit office says.

National Audit Office: Why does actual provision of domestic help lag so far behind ministry's assessment of needs?

The National Audit Office finds that the Ministry of Social Affairs should, however, provide explanation as to the vast gulf between the current provision of domestic service and needs-assessed by the ministry. 

Whereas in 2022, approximately 8,500 people received domestic service, the Ministry of Social Affairs has inferred from the studies commissioned that the actual need comes approximately to 20,000 places for these service.

This has been repeatedly pointed out when preparing for kindergarten care reform and in other policy initiatives in the area, the office says.

Local governments can do more

The National Audit Office has noted in its previous audits that local governments can do more preventive work in the social field and find their own way to help those in need.

Such a major difference between the reported demand for the service and the provision of that service as of today, however, cannot be explained by possible shortcomings in preventive work, the office says.

While the state has begun to funnel additional funds into the area of domestic services; the Ministry of Social Affairs should clarify the problem to be resolved and its causes in more detail.

Inadequate analysis conducted

The National Audit Office notes that although the requirements for the content of domestic service were specified by the regulation of the Minister of Social Protection in the summer of 2023, the effects of the regulation on the costs incurred by local governments have not been properly analyzed.

Were the responsibilities of local governments to increase, it seems a big ask to hope that something would change significantly in the practice of domestic service, the audit office goes on.

The organization of the provision of domestic service can be improved in several ways, the National Audit Office says, finding that it reasonable to standardize methodologies for assessing the need for assistance of any individual who has approached their local authority. 

Methodologies differ from local authority to local authority

At present, the methodologies used for assessing a person's need for assistance differ across local governments.

This does not mean that in any case, people get left without service provision, but differences in practice mean that there is a risk that not all needs are noticed uniformly and everywhere.

Public need is also constantly changing, while local governments are increasingly faced with the question of whether they should offer more than the minimum levels required by law.

Many local governments are already doing this, the audit office says.

Personal and other data being collected unnecessarily

The National Audit Office finds that local governments should formulate specific goals for domestic service to be monitored.

This is also presumed by the general quality principles of social services. Currently, the need for developing the service is based too much on the subjective knowledge of a social worker.

Paperwork, bureaucracy and the collection of unnecessary data should be cut down upon, especially when assessing a person's need for assistance.

In addition to the fact that assessments are different in the comparison of local governments, the link between the information collected during the assessment and the need for service also tends to be weak, the audit office says.

The question of why we collect information that is not actually used is justified.

The National Audit Office has also recommended local governments start checking the quality of the service more thoroughly in order to notice changes in the need for the service in time.

The practice employed by the audited local governments also showed scope for the elimination of deficiencies in domestic service in terms of various issues, such as introducing IT applications in the management of home help.

Some local governments have already done this, and the use of IT has been proven to reduce bureaucracy, and has enabled local governments to devote themselves towards more meaningful maintenance work, the audit office says.

As a result of the audit, the National Audit Office proposed more detailed recommendations to both the audited local governments and the Minister of Social Protection (currently Signe Riisalo (Reform)).

The 10 (of 79) audited local governments, home to over 50 percent of recipients of domestic service, were: The City of Tallinn, the City of Tartu, the City of Pärnu, the City of Narva, the City of Maardu, Saaremaa Rural Municipality, Väike-Maarja Rural Municipality, Kambja Rural Municipality, Viru-Nigula Rural Municipality and Mulgi Rural Municipality.

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Editor: Andrew Whyte

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