2007: Social support systems
Organisation and financing of social support to people with dementia and carers
Background information on the social/healthcare system in the Czech Republic
On 31 December 1992, Czechoslovakia was peacefully dissolved and became two new countries, the Czech Republic and Slovakia. In January 1993, the Czech Republic adopted a new constitution and became a parliamentary democracy. With regard to healthcare, there was a transition following the Velvet Revolution from a national health system, in which healthcare was free, to an insurance-based system involving obligatory contributions to state health insurers. There has also been a transition away from policies and practices designed to segregate people with disabilities and dependent seniors from the rest of the so-called normal population (Holmerová, 2004).
The organisation of social support for people with dementia and carers
The Law 108 2006 (please see section below on the legal framework surrounding the provision of social support) provides the legal framework for the provision of social care. However, this legislation is new and has completely changed the provision of social care in the Czech Republic. The Law on Social Services came into force in January 2007. Therefore, it is difficult to evaluate the new system.
The Ministry of Labour and Social Affairs is responsible for coordination in the field of social care, decrees and recommendations etc. People who need care (including people with dementia) have the right to have an assessment and to a care allowance (if they are assessed as being in the 1st to 4th category). The allowance amounts to CZK 2,000, 4,000, 8,000 or 11,000 per month. It can be used to purchase social services but does not cover the complete cost. Social services are registered and there is a system of quality control including quality standards for care and standards for the qualifications of staff.
Providers of social care include the State, regional authorities, municipalities, NGOs and the private sector. Nowadays most providers are public but it is estimated that with the new legislation, the share of private social care providers will increase.
Long-term care is provided in both social and health care institutions.
The overall funding of social support for people with dementia and carers
Depending on the outcome of the assessment a care allowance may be paid to people who need care. Long-term care is still divided between the health and social care sectors. Long-term care hospitals and psychiatric hospitals are funded by the general health care insurance. Some social services (and residential homes) are co-funded by the State and regional authorities.
Alzheimer Associations may apply for grants from the Ministry of Health, the Ministry of Labour and Social Affairs and the regional authorities etc.
The legal framework surrounding the provision of social support
There is no legal definition of long-term care in the Czech Republic. However, Act No 108 2006 on Social Care (Zákon o sociální pé?i) is relevant as it covers care standards, quality control, care allowances and the right to assessment. It came into force on 1 January 2007 but it is still in the process of being implemented. The Decree Vyhláška 505 is also of relevance. It addresses practical issues covered by the law e.g. standards etc.
The Governmental Committee on Seniors has decided to deal with long-term care and to submit a proposal to the government.
The suitability of social support for people with dementia and carers
Adequacy and accessibility in general
The Czech Alzheimer Society provides a database (www.gerontologie.cz) with relevant information on care. However, care services for people with dementia are neither adequate nor accessible to all those who need them. They respond to specific needs in a very limited way (depending on each institution and municipality etc.). However, some residential homes are setting up new departments that better respect the specific needs of people with dementia. Hospitals, on the other hand, have no specialised services for dementia and often people with dementia are restrained in acute hospital care settings.
People living in rural areas
In some parts of the country, especially in rural areas, there are no relevant social services. However, this should change with the new law.
People with different types of dementia
There are no specialised services for people with different kinds of dementia.
People from ethnic minorities
There is no support specifically designed to meet the needs of people with dementia and carers from ethnic minorities.
Younger people with dementia
There are no specific services for younger people with dementia. They are usually treated by neurologists.
Services and support for people with dementia and their carers
Types of care
A limited number of day care centres exist in the Czech Republic but this may change when the new legislation is implemented. Day care is partly funded through the care allowance and partly through the budget for each day care centre. Some day care centres benefit from support from the Church, NGOs and volunteers.
The Czech Alzheimer Society organises respite care at home (granny sitting). This is partly financed through grants with users and their families also contributing towards costs. The new law on social services (please see previous section) defines respite services but this kind of service has not been greatly developed. It is not considered sufficient.
Residential short-term respite care is available but insufficient. This may change with the new legislation. Long-term residential respite care exists and is partly funded by the State. Residential care is well developed but long-term care (health and social care) is insufficient.
Services providing palliative care at home exist but are insufficient. The general health care insurance and other resources co-fund hospices but there is no specialised palliative care for people with dementia. There is only one small department for palliative care for people with dementia. Hospices focus mainly on people with oncological diagnoses.
Monitoring in the home via alarm systems
Telephone alarm systems exist but are rarely sufficient. They are funded by various means.
Personal assistance and home help
The following services exist but are considered insufficient:
- assistance with personal hygiene.
- assistance with eating and drinking (not the preparation of food).
- assistance dealing with incontinence and/or skin care (available if classed as part of home care)
Service users must contribute towards the cost of the above-mentioned services. Some services are organised and financed by municipalities. However, only some municipalities provide such services. If eligible for a care allowance, this can be used to contribute towards the cost of these services.
Services offering companionship and social activities are insufficient. They are funded in different ways. Some are provided by municipalities but this is rare. There are also some voluntary services.
Ergotherapy/occupational therapy, home adaptations and assistive devices are insufficient. These services are usually funded by municipalities.
Home nursing care
When provided by home care nursing agencies on the basis of a doctor’s prescription, assistance with mobility is funded by the general health care insurance. When provided by home help agencies, it is funded through the care allowance.
Assistance/supervision taking medication is sometimes provided by home care nursing agencies. In such cases, the service is funded through the general health care insurance.
The following services exist but are insufficient:
- Assistance with housework
- Help with the preparation of meals (including meals-on-wheels)
- Transportation service
Assistance with shopping is available and tends to be sufficient in areas where home help services are provided. Where laundry services exist they are usually sufficient.
Psychosocial support and training for people with dementia and carers
A general information system exists which provides information on access to services but it is insufficient.
Counselling services are available for people with dementia (most run by the Czech Alzheimer Society) but holiday services are not. For carers, counselling services, holidays (in order to have a break from caring) and training are available. All these services are considered insufficient by the Czech Alzheimer Society.
Counselling services are funded by the Czech Alzheimer Society. The other services are rare but are mostly organised and funded by municipalities or NGOs.
Work/tax related support for people with dementia
People with dementia are not entitled to protective measures if in paid employment, to tax refunds/benefits on the basis of incapacity or to tax refunds/incentives for employing a person to provide home care services. However, the Law 108 2006 (which came into force on 1 January 2007) entitles them to a care allowance. They receive this allowance personally and are free to decide who will provide the care they need. They could, for example, pay a family carer to provide the assistance they need. They can also use the allowance to pay for any kind of service but must be able to show that it was used for care purposes.
Grants for home adaptation exist, not only for people with dementia but also for people with incapacity, but they are rare. Various reductions exist for disabled people (e.g. for television licences and transport) but the system is chaotic. People who are entitled to special privileges on the basis of severe disability receive a “special privilege card”. This is issued by municipalities with extended powers.
Work/tax related support for carers and carer allowances
There is no work/tax related support for carers. They do not, for example, have the possibility of taking paid or unpaid time off work to care for a person with dementia or to have flexible working hours to help them fit caring into their work routine.
However, the Act on Sickness Insurance (Zákon 54 o nemocenském pojišt?ní zam?stnanc?. 1956) grants an allowance to men or women who cannot work because they have to care for a sick relative living in the same household. The allowance (which amounts to 69% of the average wage) is provided in the first nine days of the sickness and is granted only once for each diagnosis.
The State does not contribute towards pension contributions for people who give up paid employment in order to provide care, and carers are not entitled to payments or tax benefits/incentives from the State for the care they provide.
Unless otherwise stated, information provided by Iva Holmerová, M.D., Ph.D (the Czech Alzheimer Society) in July 2007.
- Holmerová, I. (2004), Eurofamcare report; National background report for the Czech Republic, http://www.uke.uni-hamburg.de/eurofamcare/
Last Updated: Wednesday 15 July 2009