Social support systems
Organisation and financing of social support to people with dementia and carers
Background information on the social/healthcare system in Austria
The Republic of Austria is composed of nine federal states known as Länder . The Länder are divided into political districts which are further divided into local communities. The Parliament has two chambers: the Lower House of Parliament (the Nationalrat) and the Upper House (the Bundesrat). These two chambers and the Federal Ministry of Health and Women are primarily responsible for legislation in the domain of health.
Obligatory health and accident insurance was introduced in 1887/1888 and now covers 97.6% of the population. However, long-term care is financed through general taxation.
(Source: Hofmarcher and Rack, 2006)
The organisation of social support for people with dementia and carers
The Federal Ministry for Social and Consumer Protection (Bundesministerium für Soziales und Konsumentenschutz - BMSK) and the regional states are responsible for the organisation of social support to people with dementia/dependent elderly people. In regional areas, due to inadequate structures, there is some overlap between the health care and social welfare systems. The State, the private sector, the voluntary sector and NGOs all provide services.
The long-term care allowance (Pflegegeld) is granted to people whose disability necessitates a permanent need for personal care (at least 6 months). There are seven levels of disability and private physicians are responsible for deciding on eligibility and the level of disability. Level 1 is the lowest level and intended for people whose disability necessitates between 50 and 74 hours of care per month, whereas levels V to VII, are for people who require 180 hours of care or more. This benefit is intended to enable people to stay at home for as long as possible and to promote self determination and family support.
The overall funding of social support for people with dementia and carers
In Austria the principle of subsidiarity (Subsidiaritätsprinzip) is applied which means that financial responsibility for care follows a set order: 1st the family, 2nd the commune, 3rd the “Land” (provincial state) and 4th the state. Please refer to the sub-section on the legal framework surrounding the provision of social support for details of the extent of the family responsibility to provide maintenance.
The long-term care allowance is financed through general taxation, not through social insurance contributions. It is not means tested and is tax free. The amount that service users have to pay for services not covered by the long-term care allowance is based on their available financial means (Eigenleistung). This is, however, dependent on income and assets, including that of close relatives. According to Blaha (2006), the conditions for calculating people’s available financial means are still governed by regional state legislation despite efforts to harmonise these laws in the last 10 years.
People who have been judged eligible for the long-term care allowance are paid a cash benefit on a monthly basis independent of their income and assets or the reason why they need care. This is exempt from tax and can be spent in any way that the recipient sees fit e.g. to pay for services or to pay an informal carer. The allowance is paid directly to the person in need of care or to his/her legal representative/guardian. Although the hours of care are the same for Levels 5, 6 and 7, the conditions for entitlement are different. In 2006, the levels of the allowance were as follows:
- Level 1: €148.30 for care needs of more than 50 hours
- Level 2: €273.40 for care needs of more than 75 hours
- Level 3: €421.80 for care needs of more than 120 hours
- Level 4: €632.70 for care needs of more than 160 hours
- Level 5: €859.30 for care needs of more than 180 hours
- Level 6: €1171.70 for care needs of more than 180 hours
- Level 7: €1562.10 for care needs of more than 180 hours
(Source: Verband Steirischer Alten-Pflege und Betreuungsheime, 2006)
The State does not really support Alzheimer associations, but local authorities do provide a certain amount of support.
The legal framework surrounding the provision of social support
Social rights are not mentioned in the Austrian Constitution which dates back to 1857. However, the European Convention on Human Rights was ratified by Austria in 1958 and this has the same status as the Constitution (BVG 1964 BGBI Nr.59).
Paragraph 15a of the Constitution (B- VG) covers general measures taken by the State and the provincial states with regard to long-term care needs and an agreement regarding the overall aims and principles of long-term care throughout the whole of Austria (BGB1. Nr.866/1993, entered into force on 1 January 1994).
The Federal Long-Term Care Allowance Act and the Provincial Long-Term Care Allowance Act (BPGG, came into force on 1 July 1993) introduced a flat rate payment system for expenditure on long-term care. This made long-term care allowances uniform throughout Austria and introduced a legally enforceable entitlement provided that there is a need for care which will presumably last for at least 6 months (Hofmarcher and Rack, 2006).
The Federal Law on Guardianship of Disabled People came into force on 1 July 1984. It gives guardians the power to assist mentally disabled people in every area of life where they cannot manage without risk of endangering themselves. The amendment to this law (SWÄG of 1 July 2007) contains measures to reduce the intervention of guardians and extend the powers of family carers.
Patientenanwaltschaft: Since 1990, patient advocates/representatives have been independent and free from any kind of pressure from individuals, groups or institutions. Their role is to provide information about patients’ rights and services and help sort out disputes but they have no power to legally enforce decisions or to legally represent people.
The Federal Law on the Protection of Personal Freedom during a Stay in a Home or other Care Institution (Heimaufenthaltsgesetz – HeimAufG) - came into force on 1 July 2005. The Care Home Contract Law (HVerG, came into force on 1 July 2004), which is an integral part of the Law on Consumer Protection (§27b-27i), sets the conditions for care home contracts.
The basis for support for disabled people goes back to §23 of the “Bundesbehindertengesetz” of 1990 (formerly known as the Nationalfondsgesetz). There has been a support fund since June 2001, although payments for home transformations were even made prior to this date. Since 1.1.2004, the support fund has also granted payments to family carers when, as a result of illness, holiday, further training or other important reasons, they have been prevented from providing care and in cases of social hardship (limited income) BGBI Nr.71/2003.
Austria is made up of 9 federal states and some laws differ from one federal state to the next. According to Austrian civil law, married couples are legally responsible for each other’s maintenance. They can fulfill this obligation by means of payment or the provision of services. In Vienna, only married couples are responsible for each other but in almost all the other federal states, children are obliged to provide maintenance for their parents. In Vorarlberg, even grandchildren may be held responsible for the maintenance of their grandparents.
According to social assistance laws in most provinces, children may, in certain circumstances, be obliged to contribute towards the costs of community care and residential care for their parents. Numerous decisions have been made by the Supreme Federal Court with regard to the conditions upon which the provisional authorities can demand that relatives contribute towards the cost of care.
Other relevant laws include the Amendment to the Law on Social Rights which is part of the ASVG (the general social insurance law) and the Amendment to the Law on Social Rights of 2005 (BGB1 Nr.132/2005).
With regard to ongoing reforms, the Amendment to the Law on Social Rights of 2007 is expected to lead to an improvement in the social protection of informal carers. This is likely to result in improved conditions for care at home in accordance with a government programme covering a new way of organising care (24 hour care and financing). (Source: www.bmsk.gv.at , Pflegetelefon: 0800 201622)
A pilot project, which started in October 2006 and ended in September 2007, provided elderly people in need of care and their carers with a cost free advice/check of about 1.5 hours. This was carried out by qualified care personnel in each person’s usual care environment i.e. the home. Their willingness to have such a check and the usefulness of it were assessed.
The suitability of social support for people with dementia and carers
Adequacy and accessibility in general
There are no limits governing access to support on the grounds of age or type of dementia. On the other hand, insufficient attention is paid to the specific needs of people with dementia, although this is gradually improving.
People living in rural areas
In rural areas, there is a lack of support both quantitatively and qualitatively.
People with different types of dementia and younger people with dementia
There is no specific support for people with different types of dementia or for younger people with dementia.
People from ethnic minorities
There is no support that is specifically designed to meet the needs of people with dementia and their carers from ethnic minorities in Austria.
Services and support for people with dementia and their carers
Types of care
Day care in day care centres exists in Austria but this service is insufficient. Moreover, it is means tested so service users have to pay some or all of the cost themselves.
Respite care in the home is available but must be completely paid for by service users.
Short-term and long-term respite care is available and means tested. Consequently, it must be either partly or fully paid for by service users. Some NGOs also offer short-term and long-term respite care.
The Austrian Alzheimer Association considers all types of respite care services and long-term residential care available in Austria for people with dementia insufficient in terms of quality and quantity.
Long-term residential care
Long-term residential care (e.g. in nursing homes or old people’s homes) is financed from public subsidies and is also means tested. Prices can vary from about EUR 1,100 to EUR 3,600 per month. Up to 80% of a person’s pension may be used to pay for residential care (with 20% being considered as “pocket money”). The long-term care allowance may also be used towards the cost of care in such homes (Grilz-Wolf et al., 2003). A person’s personal savings (e.g. in a savings account) may be taken immediately and used to contribute towards the cost of residential care. If a person has property, the state can take some or all of the proceeds of the sale after the person’s death in order to pay for the residential care that he/she has received. The recuperation by the state of savings and proceeds from the sale of property only happens if the person received public subsidies.
Residential homes are run by non-profit organisations, public providers and commercial providers and there are considerable regional differences in terms of quality and quantity.
Palliative care at home is available. For most people, it is free but there are differences in how providers are financed from one regional state to the next.
There are also palliative care centres but service users may have to contribute partly or completely towards the cost of this service. Financing is different in each regional state but in general, there is a reduction in price after 14 days. This is not particularly good for service providers.
The above-mentioned palliative care services are also provided by NGOs and the Church. Volunteers provide palliative care but just at home. Nevertheless, the Austrian Alzheimer Association considers the provision of palliative care services insufficient.
Monitoring in the home via alarm systems
It is possible for people to have a tele-alarm system in their homes but they must pay for it themselves. NGOs provide some support for this service which is considered sufficient.
Personal assistance and home help
The following services are available:
- Assistance with personal hygiene
- Assistance dealing with incontinence
- Supervision/assistance taking medication
- Assistance eating and drinking
- Assistance with mobility e.g. lifting, moving and walking
- Assistance with skin care e.g. hydration and pressure sores
- Companionship/social activities
- Occupational therapy/ergotherapy
- Assistive devices
- Home adaptation/transformation
The first two services are considered by the Alzheimer Association as being sufficient on the whole. Both are also provided by NGOs. The rest of the services are considered sufficient with the exception of companionship/social activities and occupational therapy. The latter is sufficient in cities but not in rural areas. NGOs also provide assistance taking medication and with skin care, as well as assistance with mobility and companionship/social activities (which are also provided by volunteers). Church organisations provide companionship and social activities too.
With regard to the financing of these services, all are means tested and service users pay part or all of the cost depending on their available resources. The State may pay all the cost of assistive devices. Home adaptation/transformation are financed through a grant from the State which is means tested.
Assistance with housework (e.g. dusting, cleaning and tidying) is available. It is means tested and also provided by NGOs. The Austrian Alzheimer Association considers this service sufficient.
Help is provided with the preparation of meals and a meals-on-wheels service exists. Whereas the former is partly funded by the State and partly by service users, the latter is completely funded by service users, although it is possible that financial support for this is occasionally provided in some regions. NGOs also provide these services which are considered sufficient by the Austrian Alzheimer Association.
Shopping, transportation and laundry services are available. They are partly funded by the State and partly by service users, but users may have to pay the full cost of assistance with shopping. Fortunately, this is also provided by NGOs and volunteers. Assistance with shopping and laundry is considered sufficient. This is not the case for assistance with transportation.
Psychosocial support and training for people with dementia and carers
There are two services in Austria responsible for providing general information on access to services. Both are completely funded by the State. The first is the “Pflegetelefon”, a kind of care services helpline, which is free and available throughout the whole of Austria; the second is “Sozial Ruf Wien” which covers Vienna. These services are considered sufficient.
Counselling and holidays
Counselling services for people with dementia and for carers are insufficient. Those for people with dementia are based on private initiatives and are not funded by the State at all. Some are provided by NGOs and volunteers. For carers, the situation is slightly different. In addition to private initiatives which are not funded by the State and services provided by NGOs and volunteers, counselling is also provided through helpline services such as the Pflegetelefon and the Sozialruf (mentioned above) and through the Internet. These services are completely financed by the State.
Services designed to enable people with dementia to have a holiday are based on private initiatives and are insufficient. Some are organised by NGOs and volunteers. The State sometimes contributes towards the cost.
For carers, the situation is much the same except for the fact that the Federal Social Office may contribute towards this through its support fund. Money from this fund for people with disabilities is granted on the basis of §22 of the Law on Disability, §21a BPGG. A pilot project to provide relief to carers started on 1 February 2007 and will run until 31 January 2008. Since 1 September 2006, a pilot project of the KOBV (Association of War Victims and Disabled People) has been running to give family carers a holiday.
A pilot project to provide initial counselling to people with dementia and carers is being carried out by NGOs with the support of the Federal Ministry. It started in October 2006 and will end in 2007.
Training for carers is insufficient. It is provided solely by NGOs and volunteers. Service users have to pay for it completely themselves.
Work/tax related support for people with dementia
There are no legal provisions to protect the rights of people who have been diagnosed with dementia who are still in paid employment.
A tax allowance is granted to people with dementia who do not receive a care allowance (§35 EStG) and in the case of exceptional costs which exceed the amount of the care allowance (§34 EStG). There are no tax allowances for employing someone to provide home care services. Tax refunds, grants and other incentives for necessary home adaptations are means tested. The Federal Office for Social Affairs may coordinate with other providers.
As mentioned earlier, the long-term care allowance can be used to pay for services directly.
Everyone who receives a care allowance is exempt from paying the basic charge for a telephone. Exemption from paying television and radio licences is means tested. This is covered by the law FGO §47 Abs.1.
Work/tax related support for carers and carer allowances
Carers are not entitled to paid time off work or flexible working hours to help them care for someone with dementia. They may, however, take unpaid time off work for up to 6 months to care for someone who is dying. Carers are not entitled to any tax benefits or payments from the State for the care services they provide.
Carers may take out a voluntary additional insurance to cover them against losses to their pension fund resulting from stopping work to care for someone. However, according to the Amendment to the Social Law, which came into force on 1.7.2007, family carers are entitled to favourable/reduced pension fund contributions.
A reform of the Social Law of 2007 is currently being assessed. This would involve halving the contribution of insured people in order to promote further insurance contributions towards a pension fund for people who care for a close relative for a maximum of 48 months at Care Level 4 (there are 7 levels) and would cover the whole contribution from Care Level 5 onwards.
- Unless otherwise stated, information provided by Roswitha Bartsch and Antonia Croy (Alzheimer Angehörige Austria) in August 2007.
- Blaha, M. (2006): information provided for Alzheimer Europe report on home care services in Austria.
- Grilz-Wolf, M., Strümpel, C., Leichsenring, K. And Komp, K. (2003), Providing integrated health and social care for older persons in Austria, European Centre for Social Welfare Policy and Research: http://www.ucc.ie/acad/appsoc/tmp_store/procare/procare_Austria_NR.pdf
- Hofmarcher, M. and Rack, H. (2006), Health Systems in Transition: Hit summary: Austria 2006, European Observatory on Health Systems and Policies
- Verband Steirischer Alten-Pflege und Betreuungsheime (2006): http://www.vab.at/index.html
Last Updated: mercredi 15 juillet 2009