Legislation relating to the provision of home care services
There are several laws which relate to home care services (but only medical services). There are also laws regarding people with handicaps which also cover people with dementia.
There are two laws regulating the activity of personal assistants i.e. Law 519/12.07.2002 and Romanian Government Decision no. 427/2001 regarding the approval of Methodological Norms for working, rights and responsibilities of personal assistants for people with handicaps.
Organisation and financing of home care services
Medical home care services
Medical home care services are provided on the basis of contracts signed between the National Health Assurance Company and people or organisations accredited to provide such services, by GPs or specialists who recommend medical home care, taking into account the state of health of the person in need (who must have a health assurance) and the person’s dependency grade. There are 3 dependency grades: totally dependent, partially dependent and independent.
All Romanian citizens who have a health assurance can access medical home care but only for 56 days per year (art. 2, annex no.27, order.1220/24.12.2003). In the past, people were entitled to medical home care for as long as it was needed. This was limited to 14 days maximum in 2003 and then extended to 56 in 2005.
A person can apply for medical home care (not for a personal assistant, but for medical personnel – nurses) on the following conditions:
- they have been previously hospitalised for their disease
- the specialist/GP recommends medical home care
- the doctor who made the recommendation has a contract with the National Health Assurance Company
- The medical home care providers (most of them NGOs) should also have a contract with the National Health Assurance Company
Patients are offered a basic medical services package containing 23 types of medical interventions.
In order to be provided with a personal assistant, a person has to obtain a grade one handicap certificate. For a person with dementia, the following procedure applies:
- Diagnosis of dementia from a specialist (psychiatrist, neurologist) and a form describing the evolution and symptoms. The specialist should demonstrate that the patient needs permanent supervision and recommend either the necessity of a personal assistant or institutionalisation in a long-term institution
- An Expertise Commission for Persons with Handicap will examine the patient and his/her medical documents and will decide on the grade of handicap.
- The patient or the family should find a person willing to become the personal assistant. The personal assistant will be paid by the local authorities. Personal assistants must complete training programmes offered by local authorities.
- The patient’s condition is periodically revised by the Commission.
Personal assistants are considered and treated like staff hired by the local authority. They are paid for 8 hours’ work per day. They have to have a daily schedule and present an activity report every week. Their activity should be monitored by representatives of the Social Protection Departments, but the Romanian Alzheimer Society stresses that this is not always the case.
There are two types of certified carers (as they appear in the Romanian Occupational Code): home carers for people who are ill and home carers for elderly people. They are certified on the basis of Government Ordinance. 129/200 and they are legally certified by the Ministry of Employment. Their training should be organised by providers who have been accredited by the National Council for the Professional Training of Adults.
In the Romanian Job Monitor, issued by the Ministry of Employment, it is specified that a person can become a certified carer after attending a six-month training program. In order to be certified, home carers for people who are ill should attend 720 hours of training, and home carers for elderly people should attend 620 hours of training. This is the longest training in the field. Most people who are interested in it cannot afford to pay for it and the authorities are unable to organise it.
Once they are trained however, they can be hired by different organisations (state social departments, NGOs, private sector) or they can become authorised personnel in the field (i.e. they can be self-employed and pay their taxes). Such training courses are only organised by NGOs within different specific projects and the carers have a chance of being hired afterwards.
Private companies avoid having certified carers because the training period is too long and expensive. Most of the private companies work with untrained personnel; they only recommend “carers” and require a fee from the carer and from the beneficiary. Then the patient or the family illegally pays the carer. Taxes on wages are so high that only rich people can afford to hire a carer legally.
Kinds of home care services available
Family members complain that there are no specific home care services for people with dementia.
Available services include:
- State services – described above
- Services offered by NGOs – most of them are specialised in elderly care; some of them even refuse to offer services to people with dementia
- Private services – they offer home care for people with dementia but they do not have trained staff even if there are specific accreditation regulations
Consultation with people with dementia and carers
The Romanian Alzheimer Society is not aware of any specific obligation to obtain service users’ views about such services. It has found such specifications only in a guide issued by the Romanian Government in collaboration with the Ministry of Health and Social Protection and the National Institute for Preventing and Combating Social Exclusion of Persons with Handicap – “Occupational standards for personal assistants” author Dr. Verginia Cretu, 2003.
No specific reference is made to people with dementia.
Moreover, the Romanian Alzheimer Society is not aware of any initiatives by service providers to obtain and assess the opinions of people with dementia and carers about the quality of home care services.
- Information provided by Eugen Stefanut
Last Updated: mercredi 15 juillet 2009