Social support systems
Organisation and financing of social support to people with dementia and carers
Background information on the social/healthcare system in Greece
The Greek health care system is a mixture of the Bismarck model and the Beveridge model in that it functions mainly on the basis of social insurance contributions and State funding. A national health service was introduced in 1983. This was later divided into 17 administrations of health regions, each with a director and an administrative board. A national social care system was established in 1988 (Sissouras et al., 2002, Liarigovinou, 2005).
The organisation of social support for people with dementia and carers
The Ministry of Health and Social Solidarity is responsible for social support to people with dementia/dependent elderly people. It achieves this through the provision of psychological support for people with dementia and their carers, by providing financial and psycholocial support, including medication and a benefit for people with severe dementia, and through cognitive rehabilitation programmes for people with dementia. Needs must be first assessed by a medical committee. Support may be provided in kind or by means of payments or tax exemptions (European Commission, 2006).
Some local authorities provide home care services but such services are not provided uniformly throughout the country. This is further complicated by a lack of available information on entitlement and availability of services. The majority of older people continue to live at home either with their families or alone. Families play a key role in providing care, especially in rural areas. (Alzheimer Europe, 2006).
However, in the last two decades the State has taken measures to increase community care services for older people so that they can remain in their own homes for as long as possible thereby enabling them to maintain their independence and enhance their quality of life. These measures include the creation of open care community centres for older people (KAPIs) and the help at home programme (Alzheimer Europe, 2006).
The State supports Alzheimer associations by providing financial support. However, such support is limited.
The overall funding of social support for people with dementia and carers
The Ministry of Health and Social Solidarity is responsible for the financing of the National Health Service. It is also responsible for health and social services for the disabled and for elderly people (Goffin et al. 2007). Social support for people with dementia is funded through the obligatory health insurance. The insurance contribution is 2.55% of the salary of employees with an additional 5.1% contribution from the employer. For pensioners, 4% of their pension is deducted for the insurance contribution (European Commission, 2005).
The Greek Orthodox Church provides a range of services for the elderly, particularly those on a low income and who live alone. These services are all completely free of charge (Sissouras et al., 2002).
The legal framework surrounding the provision of social support
It is stated in the Constitution and in Civil Law that the family is responsible for the care of dependent relatives of all ages but also that the State will care for the health of citizens and will adopt special measures for the protection of young people, the elderly and invalids, as well as providing assistance to the needy. Consequently, if a family is unable to care for a dependent relative, the dependent person is taken care of by the Social Security system.
Law N.1397/1983 covers the provision of full health coverage to all citizens and is therefore linked to the creation of the National Health Service. Law N. 2889/2001 led to the division of the NHS into 17 regional health authorities. Law N.3329/2005 transformed them into 17 Administrations of Health Regions (Liarigovinou, 2005).
The transfer of responsibility for the management and operation of KAPIs to local authorities occurred as a result of article 68 of Law N.1416/84.
The relevant law concerning the help at home for the elderly programme is Law N.2082/92.
The setting up/administration of institutes and legal entities which provide social care services on behalf of the Greek Orthodox Church is regulated by Law 590/1977(Sissouras et al., 2002).
The suitability of social support for people with dementia and carers
Adequacy and accessibility in general
Social support and services are mainly adequate and accessible. However, they are not linked to rural areas and there are limited services for people with severe dementia. They respond to the psychological and cognitive needs of people with dementia, through rehabilitation programmes (although not in all parts of the country), but not to their financial and practical needs. Host houses and hospitals are needed as well as services providing cognitive and rehabilitation programmes throughout the whole country.
People from ethnic minorities
Services are accessible to people with dementia and carers from ethnic minorities.
Younger people with dementia
There are no services that are specifically designed for younger people with dementia.
Services and support for people with dementia and their carers
Types of care
In general, day care services are available for people in the early stages of dementia but not for people with severe dementia. They are partly funded by the State or NGOs. Amongst the different kinds of day care services available, there are KAPI centres, Help at Home services, Day Protection Centres for the Elderly and centres run by Alzheimer associations, NGOs and the Church.
“Centres for the open protection of the elderly” (known as KAPI) aim to provide the necessary support to enable elderly people (in relatively good health) to live independently in their own homes for as long as possible. Most offer the following services:
- Preventive medical services
- Physiotherapy programmes
- Ergotherapy programmes
- Health education
- Recreational activities (Daniilidou et al. 2005)
Help at Home
Many KAPI centres collaborate with the Help at Home project which offers a range of services to elderly people who are unable to manage on their own, i.e. social services (counselling and information) health care services and family assistance (with housework, personal care and eating as well as befriending) (Daniilidou et al. 2005).
Day Protection Centres for the Elderly
There are also Day Protection Centres for the Elderly which operate during normal working hours and are usually linked to KAPI centres and work in cooperation with bodies responsible for the provision of social services and Health Units. These small units are specifically for elderly people with social problems who have chronic or temporary physical or mental health problems, who are unable to care for themselves and who have limited financial resources (Sissouras et al., 2002).
Day care centres run by Alzheimer associations
The Greek Alzheimer and Associated Disorders Association has eight day centres (three in Athens, three in Thessaloniki, one in Volos and one in Chania on the island of Crete). The services offered at these day care centres include discussion groups, seminars for caregivers and professionals, memory training for patients presenting with early-stage disease, music therapy (for patients at all stages), speech therapy, physiotherapy, cognitive rehabilitation, psychotherapy and mental exercises.
Care Home Units offer respite care and are partly funded by the State but are not available throughout the whole of Greece. In many areas, neighbours, friends and volunteers also offer sitting services (Mestheneos et al., 2004). Respite care during the day and at night is limited. Some NGOs and the Church also provide respite care in the home. Short-term residential respite care also exists and is partly funded by the State. Again, it is not available throughout the whole country.
Long-term residential care
Long-term residential care for the elderly is provided in old people’s homes and nursing homes for the chronically ill and is mainly funded by the State. Places are usually given to people on a low income who have to contribute towards the cost unless they have no financial means, in which case, it is free of charge. Most of the nursing homes are in the big cities. In addition, there are homes called “houses of serenity” which are run by the Church and there are homes run by private organisations (Sissouras et al., 2002). However, according to Lamura (2003), less than 1% of people over 65 years of age lives in residential homes.
There are no services providing palliative care at home or in palliative care centres for people with dementia.
Monitoring in the home via alarm systems
In Greece, there is a private 24-hour tele-alarm system linked to family, neighbours, the police or the ambulance service (Mestheneos et al., 2004).
Personal assistance and home help
According to the Greek Association of Alzheimer’s Disease and Related Disorders, there are limited services funded by the State providing personal assistance and home help for people with dementia in Greece.
Transport is only provided for people attending day care centres and this is partly funded by the State. Some NGOs also run transport services. However, as mentioned earlier, certain services, such as shopping, laundry and cleaning, are provided to dependent elderly people on a low income through the Help at Home programme. Community care services, when available, are free at the point of use (Mestheneos et al., 2004).
Psychosocial support and training for people with dementia and carers
Some NGOs and volunteers organise counselling services for people with dementia which are partly funded by the State. People with dementia do not pay anything.
Counselling for carers is provided in day centres funded by the State and the European Community. Carers do not have to pay anything. NGOs also provide this service but it is not available everywhere in Greece.
There are no provisions for holidays for carers and/or people with dementia but training is available for carers in some parts of the country and this is partly funded by the State. NGOs, such as the Greek Red Cross and the Greek Alzheimer and Associated Disorders Association, also provide training for carers, as well as cognitive rehabilitation and psychotherapy for people with dementia.
Work/tax related support for people with dementia
People with dementia are not entitled to any tax benefits on the grounds of personal incapacity or for employing someone to provide home care. They are not entitled to grants for home adaptations or reduced costs for television and radio licences or public transport. Public insurance does not offer benefits to people who need assistance from a third party.
Insurance organisations offer a benefit to people who need assistance from a third person. This amounts to 50% of the basic pension. Certain conditions must be fulfilled in order to be eligible (MISSOC, 2006).
Work/tax related support for carers and carer allowances
Carers are not entitled to any direct benefits or allowances for the services and care they provide. However, they may be able to claim income tax relief for supporting a dependent elderly relative (Mestheneos et al., 2004).
Carers are not entitled to paid time off work or flexible working hours. However, labour legislation allows for carers employed in the public sector to take up to 6 days’ unpaid leave to fulfill their caring obligations (Mestheneos et al., 2004).
Spouses of people with a severe invalidity (more than 65%) can claim an old-age pension with favourable conditions but they must have been married for at least 10 years (European Commission, 2006). Apart from this, there are no special provisions for carers with regard to their pension fund contributions.
Unless otherwise stated, information provided by Nikolaidou Evdokia (Greek Association of Alzheimer’s disease and Related Disorders) in July 2007
- Alzheimer Europe (2006), Home care report, Greece, unpublished report
- Daniilidou, N., Economou, C., Zavras, D., Kyriopoulos, J. and Georgoussi, E. (2005) Health and social care in aging population: the case of an integrated care institution in Greece, http://www.integratedcarenetwork.org/publish/articles/000004/article.htm
- European Commission (2005), Health care – user charges, Info 02/2005, Employment, Social Affairs and Equal Opportunities DG http://ec.europa.eu/employment_social/missoc/2005/02/2005_02_el_en.pdf
- European Commission (2006), Long-term care in Europe, Info 02/2006, Employment, Social Affairs and Equal Opportunities DG, http://ec.europa.eu/employment_social/missoc/2006/02/2006_02_el_en.pdf
- Goffin, T., Nys, H., Borry, P. and Dierickx, K. (2007), Patient rights in the EU – Greece, European ethical–legal papers N°6, Leuven, 2007
- Lamura, G. (2003), Health and Social Services: Partners for a Social Europe, 11th European Social Services conference – Venice, 2nd-4th July 2003: Supporting carers of older people in Europe: a comparative report on six European countries, http://www.socialeurope.com/pdfs/Venice/presentations/lamura1.pdf
- Liarigovinou, A. 2005, 2nd LSE PhD Symposium on Modern Greece: The new role of the private health sector in the Welfare State in Greece, http://www.lse.ac.uk/collections/hellenicObservatory/pdf/2ndSymposium_papers_pdf/Angeliki_Liarigovinou_paper.pdf
- Mestheneos, E., Triantafillou, J. and Kontouka, S. (2004), National Background Report for Greece , EUROFAMCARE,
- Sissouras, A., Ketsetzopoulou, M. et al. (2002), Providing integrated health and social care for older persons in Greece, (Procare report), National Centre for Social Research (EKKE), http://www.imsersomayores.csic.es/documentos/documentos/procare-providinggrecia-01.pdf#search='Procare%20National%20Report%20Greece '
Last Updated: mercredi 15 juillet 2009