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Justice chancellor petitioned over elder care home costs and fees

Ülle Madise.
Ülle Madise. Source: Kairit Leibold/ERR

Members of the public have appealed to the Office of the Chancellor of Justice over what they see as unfair treatment regarding care home places for the elderly in Estonia, more specifically relating to the costs of these places.

Members of the public have expressed dissatisfaction over, for instance, still having to pay for a local nursing home place for themselves of for a relative or other dependant, and in some cases having to pay even more, despite pledges of reduced costs following a reform to the care home system.

The Chancellor of Justice herself, Ülle Madise, says that it is up to local government to ascertain the extent to which a care home place, including food and other costs, are reasonably affordable to an average family.

Madise said: "A person also is required only to cover that portion of costs considered appropriate for their circumstances. Local government must ensure that, having paid for a place in a nursing home, that individual [paying] has residual money left over for, for example, the purchase of prescription drugs, aids and other necessary items, plus money for their own out-of-pocket expenses."

Madise expressed sympathy to the complainant who had raised the issue, reiterating that she had outlined to municipalities their responsibilities "years ago."

These responsibilities include both finding a care home place for an applicant within that municipality's jurisdiction, and ensuring that place remains affordable and does not exceed in cost the figures set out in the law.

The care home reform has not altered this, Madise noted; in fact the reforms made local governments liable for covering the costs of care workers included in the cost of a nursing home. The private individual must bear the remaining costs of the nursing home (accommodation, catering etc.) she added.

The municipality is required to make up any gap between the recipient's net income per month after all taxes and the average old-age state pension for the second quarter of the preceding year – which at present is €634.89.

The person's needs, reasonable expenses, and financial situation are then clarified, including whether the person in need has the right to receive maintenance from family members, as provided for under the Family Law Act.

"This assessment does not oblige the family member to provide that amount of maintenance, but only indicates what the financial situation of the person in need of assistance would be were that provider to so so," Madise said.

Taking into consideration the cost of the service, its volume, and the economic situation of the service recipient and their family, an appropriate fee is found which can be levied on that individual, in respect of the service.

Madise suggested that if the capacity of a relative of the person who approached them to pay for a place in a nursing home had been assessed before that place fee rises, the rural municipality or city government can be required to reduce the fee to the earlier level. In addition, a decision made by the municipality can be appealed or contested at the administrative court.

"In some cases, it may be more useful to file an appeal first and wait for the appeal decision, because this way you can find out the reasons why the municipality or the city has made the decision that they have. After that, one can consider whether it is expedient to apply to the administrative court," Madise went on.

Madise wrote to a second correspondent, informing them that their dependant can demand they be offered a service in a locale where the costs of care workers do not exceed the limit of care costs established by the local government

In this case, the applicant had said they were not satisfied with a decision by Viljandi municipality that they must help pay for a family member's place at a nursing home, even as, when planning the care reform, the pledge had been made that the children of those going to a care home would not have to bear the costs of their parents' place their. Specifically, the municipality has established a ceiling of care costs of €500 per month, but in this case the applicant's relative lives in a care home in Viljandi municipality where the cost of care workers is higher than that, at €620 per month.

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Editor: Andrew Whyte, Karin Koppel

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