Social support systems
Organisation and financing of social support to people with dementia and carers
Background information on the social/healthcare system in France
After a long period of Soviet occupation, Latvia regained its independence on 21 August 1991 and elected the Saeima (Latvia’s parliament) in 1993. Since regaining independence, the healthcare system has been reformed several times. Latvia is administratively divided into 26 districts, with an additional 7 cities (with separate status) and 483 municipalities (pagasts) (Karaskevica et al., 2001).
The organisation of social support for people with dementia and carers
The Ministry of Welfare of the Republic of Latvia, the Ministry of Health of the Republic of Latvia and the local communities of the regions of Latvia are responsible for social support to people with dementia.
Generally, support for people with dementia is provided by the state – by social care institutions (e.g. old people’s homes, etc.) and by hospitals, and in other ways - by support provided by communities (e.g. day centres, half way houses, etc.). A third kind of social assistance is provided by NGOs, the church and volunteer organisations. In this way, the state provides support in social care centres and mental health care hospitals and the local communities provide out-patient care through day centres and half-way houses etc. The communities provide financial support for NGO care services. However, there is no specialised assistance for people with dementia and their carers. There is only one day centre in Latvia (in Riga) that provides general support for people with dementia and their carers. Services from voluntary associations have not yet been developed in this specific field and there are as yet no self-help organisations for people with Alzheimer’s disease or other forms of dementia.
The overall funding of social support for people with dementia and carers
Support for people with dementia (e.g. Alzheimer’s disease) is provided through general taxation. Support is provided in old people’s home and during stays in specific departments as well as at mental health care hospitals. During their stay there, the hospital provides social care. Over 25% (approximately) of people with dementia stay in hospital for over a year just to receive social support, not for treatment.
People with dementia who are considered disabled (and who have a specific degree of disability as assessed by a specialist) are entitled to home care services funded by the state provided that their relatives cannot provide the necessary assistance.
The legal framework surrounding the provision of social support
The main relevant laws are as follows:
- The Law of Social Assistance and Social Services (accepted by Saeima i.e. the. Parliament on 25.11. 2004). This covers general social assistance and social service aspects for people with disabilities and mental health problems, not specifically social assistance for people with dementia (Alzheimer diagnosis).
- The Law of Communities (accepted by Saeima on 19.05. 1994 including lots of changes – the last ones on 18.03.2005). This Law contains general regulations for both kinds of communities (local and regional), economic background, competency and collaboration with other institutions.
- The Law of Medical and Social Security of Disabled Persons (accepted by Saeima on 01.01.1993.
The above-mentioned laws cover general social assistance and social service issues for people with disabilities and mental health problems. They do not specifically refer to social assistance for people with dementia.
Draft guidelines “Improvement of mental health 2007 – 2017 for inhabitants of Latvia” have recently been produced. They were initially based on the work of specialists of the Mental Health State Agency and the Ministry of Health, but now the work is being continued by the Public Health Agency. The draft guidelines, as a draft document, are currently being discussed by all the competent institutions. They include developments in all aspects of mental health including the care of people with different kinds of dementia.
There are also now draft “Guidelines on the policy to reduce disability and its consequences 2005-2015” which include different kinds of support for people with mental health problems (including Alzheimer’s disease and other forms of dementia).
The suitability of social support for people with dementia and carers
Adequacy and accessibility in general
Specific services for people with dementia (including those diagnosed with Alzheimer’s disease) should be developed, paying attention to out-patient care (e.g. community care). In hospitals there are general departments for elderly people - geriatric departments in general hospitals and in psychiatric clinics for people with dementia, where these people can receive support and help. Thus, the support system of social services for people with dementia is currently based solely on an institutional approach, rather than on out-patient care and services. In Latvia, there is only one community social day centre “Ozolaine” (in Riga) which provides support for people with dementia and their carers, ensuring a range of services such as social and health services, legal services, ergotherapy, physiotherapy, movement therapy, support groups, counselling and different cultural activities. The number of such centres should be increased to ensure accessibility and the possibility to receive adequate support.
Community care (or out-patient care) for people with dementia has only just started to develop in recent years and it should be promoted in order to shorten their stay and reduce the need for social care in state-run general hospitals (known as “profile state hospitals”), as well as to develop a support system for their carers.
People from ethnic minorities
There is sufficient support for people from ethnic minorities (mainly Russian speaking). The population of Latvia is not very multinational and almost all ethnic minorities speak/understand Latvian, Russian or English.
Services and support for people with dementia and their carers
Types of care
Day care centres are completely financed by the State. However, few provide support for people with mental health problems and there is only one day centre “Ozolaine” which provides services designed for people with dementia. “Ozolaine” is supported by the regional community and is located in a district of Riga.
Support for elderly people who live on their own as well as for mentally handicapped people is provided by the Riga Samaritan Union, St John Help, “Saulessvece”, as well as some public organisations but the support is not specially designed for people with dementia.
There are no services for respite care in the home that are specifically designed for people with dementia.
Short-term and long-term residential respite care is available and completely funded by the State. This is nevertheless considered insufficient as it is provided in the geriatric departments of general hospitals, in old people’s homes or in mental hospitals but not within the community care system. Draft guidelines on the improvement of people’s mental health are being produced that will eventually affect the provision of social support to people with different mental health problems (including people with dementia), including measures to promote mental health such as the creation of day centres, halfway houses and other forms of support.
NGOs, volunteers and the Church do not provide short-term residential respite care that is specifically for people with dementia. They do, however, accept people with dementia in their establishments and try to cope with individual cases.
Different kinds of palliative care at home (i.e. services and support) are available, which are partly financed by the State, but are not specifically for people with dementia. Therefore, such services are not considered sufficient.
Palliative care is also available and completely funded by the state at the Latvian Oncology Centre, in specific departments of general hospitals and in old people’s homes but not in the form of community care and support. Services have not yet been developed to deal with the specific problems of people with dementia. Services provided by NGOs, volunteers and the Church are not specifically for people with dementia either.
Palliative care is covered in the draft guidelines for the improvement of mental health (mentioned earlier).
Monitoring in the home via alarm systems
A tele-alarm system exists and is partly funded by the State but it is not targeted at people with dementia. A special kind of tele-alarm system specifically for people with dementia is being developed by the Riga City Council in collaboration with the Riga Samaritan Union.
Personal assistance and home help
The following services are available but are not specifically designed for people with dementia. With the exception of assistance with eating and drinking, which is partly financed by service users, they are all completely financed by the State:
- Assistance with personal hygiene
- Assistance with eating and drinking
- Assistance with mobility lifting and moving: provided by state centres and local communities
- Assistance with incontinence: since 2007 people with incontinence (including people with dementia) have been entitled to purchase necessary equipment for incontinence at 50% of the price thanks to the public organisation Inco Centre in collaboration with NGOs. Also, consultations with specialists are now free of charge.
- Assistance with skin care: available at hospitals, rehabilitation centres and old people’s homes
- Occupational therapy/ergotherapy: subject to the fulfillment of conditions
- Assistive devices: developed and provided by state institutions (Centre for Technical Assistance)
- Home adaptations
Assistance/supervision taking medical and companionship/social activities are not available.
With regard to occupational therapy/ergotherapy, general services are provided by public organisations and day centres with the exception of the day centre “Ozolaine” in Riga which provides a service specifically designed for people with dementia. A trend has been started to develop such services in the home environment. Access to occupational therapy/ergotherapy, is dependent on disability status and a functional assessment carried out by a professional ergotherapist.
NGOs, volunteers and the Church
There is no information available about services for personal assistance provided by NGOs, volunteers or the Church that are specifically aimed at people with dementia. However, NGOs are very active and work closely with the patient union and Inco Centre to provide services for people suffering from incontinence. Also, public organisations such as “Gaismas stars” and church volunteers (e.g. St John Help “Saulessvece” and the Diacony Centre) provide general occupational therapy but again not specifically for people with dementia. A general service providing assistance with eating and drinking for old people is provided by Riga Samaritan Union and some church volunteers (not by state institutions) but is not specifically for people with dementia.
The following services are available in Latvia but, with the exception of assistance with housework, must be partly financed by service users.
- Assistance with housework
- Help with the preparation of meals (incl. meals-on-wheels)
- Assistance with shopping
- Assistance with laundry
- Assistance with transport
The above-mentioned services are not specifically designed for people with dementia. They are provided by local communities in collaboration with the Riga Samaritan Union, the Diacony Centre and regional volunteer organisations of disabled people and their relatives. Specific home help services for people with dementia, to be provided at state level, are mentioned in the draft guidelines on mental health promotion.
Psychosocial support and training for people with dementia and carers
Information on support groups is provided by the public organisation “Sustento” but this is not specifically for people with dementia. “Sustento” is a local organisation for people with special needs (including those with mental health problems) and it is a member organisation of the European Disability Forum (EDF) which unites 23 NGOs from different European countries. Information about general services is also provided by local communities (by social services institutions). The only day centre for people with dementia “Ozolaine” (in Riga) also provides information about access to services.
Counselling is completely financed by the state. However, it is insufficient as there is only one day centre for people for dementia (“Ozolaine” which is supported by Riga City Council) that provides counselling for people with dementia as well as for their carers. The counselling provided covers different domains e.g. psychological, health care, legal issues, employment, recreation possibilities and housing issues. Counselling services for people with mental health problems and their carers (not specifically for people with dementia) are also provided by “Sustento”, “Gaismas stars” (within the ESF financed projects), “Dzirksts” (support groups) and St. John Help “Saulessvece” (church). Specific services and counselling for people with dementia are mentioned in the guidelines of mental health promotion and will eventually be provided by the state throughout the whole country.
Holidays for people with dementia and carers are available uniquely through the “Ozolaine” day centre and they are completely financed by the State. The need for this kind of service should be included in the guidelines on mental health promotion.
Training for carers is provided by the day care centre for people with dementia “Ozolaine” (Riga) as well as individually by doctors, nurses at hospitals and social workers at social service institutions but not sufficiently for carers of people with dementia. It is organised as group training covering different aspects of care and is completely funded by the state. This kind of training (including courses, seminars and workshops) for the carers of people with dementia is mentioned in the draft guidelines of mental health promotion and will therefore soon be provided by the state throughout the whole country.
Work/tax related support for people with dementia
State employment legislation policy covers employee security and health, but regulations do not specifically refer to people diagnosed with dementia in paid employment. The Ministry of Welfare and institutions such as the State Work Inspectorate and the National Tripartite Council are responsible for these issues. The relevant laws are as follows:
- The Law of Social Assistance and Social Services (accepted by Saeima i.e. the Parliament, on 25. 11.2004)
- The Law of Work (accepted by Saeima on 06.01.2001; last changes on 21.09. 2006.)
- The Law of Work Protection (accepted by Saeima on 01.01.2002.; last changes on 16.12. 2004)
- The Law of State Work Inspection (accepted by Saeima on 01.01.2002.; last changes on 07.10. 2004)
Allowances and benefits
If the person with dementia is considered disabled (according to a specific degree of disability assessed by specialists), he/she may receive a disability benefit as well as cost free or reduced price technical mobility devices and transport, tax refunds and special credit facilities for special accommodation adapted to their specific needs, different kinds of insurance and possibilities to access professional rehabilitation services. This is covered by the following laws:
- The Law of Medical and social security of disabled persons (accepted by Saeima on 01.01.1993)
- The Law of Social Assistance and Social Services (accepted by Saeima on 25.11. 2004)
- The Law on Tax Income (accepted by Saeima on 11.05. 1993)
- The law of Communities (accepted by Saeima on 19.05.1994 with numerous amendments up to 18.03.2005)
Tax refunds/incentives to employ a person to provide home care services are being considered by certain communities.
Work/tax related support for carers and carer allowances
There are no provisions to enable carers to combine paid employment with caring such as flexible hours or paid or unpaid leave. They do not benefit from subsidised pension contributions, payment for the care they provide or tax benefits.
Unless otherwise stated, information provided by Docent M?ris Taube, MD from the Public Health Agency in August 2007
- Karaskevica, J. et al. (2001), Health care systems in transition, European Observatory on Health Care Systems, WHO: http://www.euro.who.int/document/e72467.pdf
- www.lm.gov.lv (Ministry of Welfare of Latvia Republic)
- www.vm.gov.lv (Ministry of Health of Latvia Republic)
- www.sustento.lv (local public organisation of people with specific needs)
- www.spf.lv (Administration of social services)
- www.likumi.lv (Latvia and Europe legislation)
- www.rehab.lv (internet site on rehabilitation issues)
- www.koledzarrc.lv (home page of Social integration centre)
- www.lps.lv (Association of Communities, Latvia)
Last Updated: mercredi 15 juillet 2009