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Romania

Social support systems

Organisation and financing of social support to people with dementia and carers

Background information on the social/healthcare system in Romania

In 1989, there was a revolution in Romania which brought the Communist government to an end and set up a Republic led by a President and governed by a two-chamber parliament. The Semashko health system (a centralised, tax-based system) which had been in place from 1949 to 1989 was gradually transformed into a decentralised and pluralistic social health insurance system based on a contractual relationship between the health insurance funds and service providers. Romania and its health care system are in a period of transition. Equity remains a problem, expenditure on health care pro capita remains fairly low and social care is limited but recent changes in legislation[1] are likely to have an impact on the provision of social care (Vladescu, C. et al. 2002).

The organisation of social support for people with dementia and carers

The Ministry of Labour, Social and Family Solidarity is responsible for social support to people with dementia/dependent elderly people. Since entering the European Union, several projects have been started which involve collaboration between the State and NGOs which apply to be partners for structural funds with the intention of developing day care centres and memory clinics.

A new law (Law 448) has been passed which regulates the rights and obligations of handicapped people in order to promote their social inclusion and integration. The methodological norms for Law 448 are not yet available.

Alzheimer Associations receive support from the State for set periods of time, usually several years. This support, which tends to be provided by the local authorities, consists of designated places for day care centres where the cost of utilities (e.g. water and electricity consumption) is borne by the local authorities. Therefore, the Alzheimer Society has not had to pay for utilities or rent.

The overall funding of social support for people with dementia and carers

Services and benefits provided by the State are funded through an obligatory health insurance and general taxation.

Employees and employers each pay 7% to the insurance fund. Pensioners also pay 7% but the handicapped have free access to health insurance. Unfortunately, there have been problems collecting health insurance contributions (Vladescu et al., 2002).

Taxes are still an important source of funding, representing 21.6% of healthcare financing in 1999.

The legal framework surrounding the provision of social support

There are two main laws of relevance to the provision of social support in Romania. The recently adopted Law 448, regulating the rights and obligations of handicapped people, led to the repeal of 4 other laws but as the methodological norms for this law have not yet been issued, the situation is somewhat unclear and the potential impact of the law is temporarily limited.

Any use of the term “the elderly” should be understood as referring to people who have reached the legal age of retirement. In July 2006, the standard age for retirement was 57 years and 10 months for women and 62 years and 10 months for men. This is gradually changing and by 2015, it will be 60 and 65 years respectively.

Laws

Number/reference

Date

Title/description

Law 487

8/8/2002

Law on Mental Health and Protection of People with Mental Disorders

Law 448

6/12/2006

This law regulates the rights and obligations of handicapped people in order to promote their social inclusion and integration.

Decrees and regulations

Number/reference

Date

Title/description

Order MSF 726

24/10/2002

Criteria for establishing the degree of handicap for adults and application of the measures of special protection

H.G. 1764

28/12/2005

Updating of the social allocation for blind adults and of the monthly fee granted to adults with a severe handicap other than blind people

Order of Ministry of Public Works 649

25/4/2001

Approval of the norms concerning the adaptation of civilian buildings and urban space for the special requirements of handicapped people

Order SSPH 79

29/7/2002

Approval of average monthly cost for maintenance of handicapped people in institutions of special protection

H.G. 329

4/4/2003

Approval of rules, organisational framework, and functioning of institutions for the special protection of handicapped people

Order MSF and MMSS 491/180

3/6/2003

Approval of the grid for the medical and social evaluation of people admitted into assistance institutions for medical and social services

H.G. 729

21/7/2005

Establishes the amount of money allocated for daily food provided by public institutions of public assistance

Order ANPH 205

16/8/2005

Approval of minimal standards of quality for residential centres for adult handicapped people (day care centres and sheltered housing)

O.G. 30

31/1/2004

Modification of OUG 170/1999 regarding the gratuity of medical assistance, drugs and prostheses for some categories of people with special needs

Order MTCT, MS and MMSSF 216/189/3469

1/7/2005

Approval of methodology and norms regarding the gratuity of transportation by metro and quantum for this gratuity for severely handicapped people and for their personal assistants

H.G. 1175

14/10/2005

Approval of the national strategy concerning the protection, integration and social inclusion of severely handicapped people in Romania from 2006 – 2013

Order ANPH 367

30/11/2005

Approval of criteria for the selection of projects in the field of protection, integration and social inclusion of the handicapped

Order ANPH 363

7/12/2005

Approval of the National Plan regarding the training of personnel from the system of protection of handicapped people in 2006-2008 and the framework for training and specific training of the personnel involved in the protection and care of handicapped adults

H.G. 427

7/5/2001

Approval of the methodological norms regarding the conditions for hiring personal assistants, and the rights and obligations of personal assistants of handicapped people

H.G. 197

1/3/2006

Approval of the programmes of national interest in the field of protection of the rights of handicapped people and in the field of social assistance of the elderly, the homeless and victims of family violence, as well as the financing for these programmes

Order ANPH 175

12/12/2006

Approval of minimal standards of quality for homecare social services for handicapped adults

The suitability of social support for people with dementia and carers

Adequacy and accessibility in general

There is a significant problem concerning adequacy and accessibility of services. First of all, there are very few services that are specifically designed for people with dementia. People with dementia can benefit from services designed either for handicapped people or elderly people but in a limited way (e.g. a person cannot attend a day care centre if cognitively impaired and he/she is not admitted into hospital due to a lack of personnel trained in dealing with dementia issues). There are few hospital wards able to provide specific care for people with dementia and a family member is required to provide care while his/her relative is hospitalised. Social assistance is very poorly represented.

People living in rural areas

There are many rural areas where a family doctor is not available, so for minor investigations or a simple medical consultation, the person has to go to the nearest hospital or polyclinic which in some cases is about a hundred kilometres away.

People with different types of dementia

People with different types of dementia have different rights. At this moment in time, only Alzheimer’s disease is recognised as a handicap by the commissions assessing handicap for adults. This means that people with other types of dementia cannot be granted the severe disability degree which would entitle them to support and services.

People from ethnic minorities

There is no specific support for people with dementia and their carers from ethnic minorities.

Younger people with dementia

Access to services and support from the State is dependent on eligibility for the severe handicap category and not on age. Consequently, younger people with dementia can access services (provided that they have Alzheimer’s disease and not another form of dementia) but these services are not necessarily adapted to the specific needs of younger people with dementia.

Services and support for people with dementia and their carers

Types of care

Day care

There are very few day care centres for people with dementia in Romania. A few were opened by the Romanian Alzheimer Society under the PHARE LIEN programme in Nehoiu, Galati, Bucharest and Timisoara but since the local authorities stopped supporting these projects, only the one in Timisoara is still functional. In the past, the State provided the premises and covered expenses for utilities.

There have been several project proposals from local authorities (town halls) to open day care centres but sometimes premises that are initially proposed for day care centres end up being used for other purposes, especially if alternative usage is likely to generate a profit. There is a growing number of project proposals and it remains to be seen in the coming months or years if any of these will be for people with dementia.

There are reports of two further day care centres, partly funded by Dutch organisations and partly by the local council in Bistrita Nasaud County.

There are several day care centres in the country which benefit from the support of the Church but they are for elderly people with social problems and not specifically for people with dementia. Some NGOs have developed day care centre projects but without the support of local authorities (i.e. for premises and utilities), they are unlikely to last for more than a couple of years.

Respite care

There are no organised services covering respite care at home. However, in rural areas, there have been isolated cases of carers asking their relatives to come and look after the person with dementia for a couple of weeks so that they can have a break or go on holiday.

Sometimes, when carers are no longer able to cope, they try to arrange for the person with dementia to be admitted into a psychiatric ward for several days. This is possible if they know a doctor who is understanding and willing to admit the person with dementia for a short time. Private homes exist which accept people with dementia for short periods of time. This usually costs between EUR 600 and EUR 1,400 per month.

Long-term residential care

Long-term residential care services funded by the State are not specifically designed for people with dementia. Means testing is applied and there may be out-of-pocket payments but property is not included in the calculation of available means.

There are long waiting lists for available places (sometimes over a year) and no social assistants to carry out accurate assessments. To make matters worse, there is a tremendous amount of bureaucracy surrounding applications for places in these institutions. As it is not possible to obtain assistance with the paperwork, this makes the whole process very difficult for carers and virtually impossible for people with dementia.

Private long-term residential homes also exist but they are not specifically designed for people with dementia either.

Palliative care

Several discrete attempts have been made by NGOs to provide palliative care at home. The Casa Sperantei from Brasov is a good example although it does not just provide this service for people with dementia. Apart from these limited attempts to provide palliative care, there are no palliative care services either at home or in centres.

Monitoring in the home via alarm systems

There are no tele-alarm systems whereby a person can signal for assistance in case of emergency.

Personal assistance and home help

Personal assistance

People who qualify for the severe handicap degree issued by the territorial commissions responsible for assessing adult handicap are entitled to the following services, for which they must nevertheless contribute towards the costs:

  1. Assistance with personal hygiene
  2. Supervision/assistance taking medication
  3. Assistance with eating and drinking
  4. Assistance with mobility (e.g. lifting, moving and walking)
  5. Assistance with incontinence
  6. Assistance with skin care

Services exist linked to companionship and assistance maintaining social activities but the costs must be covered totally by the service users. There are no services for occupational therapy/ergotherapy, assistive devices and home adaptation/transformation.

Home help

Assistance with housework, shopping and laundry services exist but must be totally funded by the service users. There are no transportation services. Help with the delivery of meals is available and is usually provided by NGOs and the Church. However, it is not specifically aimed at people with dementia as it is intended for people with a poor social and economic status. The NGOs are not directly involved in the preparation of meals but they transport food from restaurants and canteens, as well as food packages or food products, to people with dementia from poor families. This service does not function on a regular basis as it is dependent on the availability of funds i.e. from fund-raising activities or from local authorities. The Church also transports food to old people, some of whom have dementia.

Psychosocial support and training for people with dementia and carers

There is no general information service designed to inform people about available services in Romania.

Limited psychosocial support exists for people with dementia and their carers. For example, individual counselling for people with dementia may be offered by psychiatrists but only if they are specifically involved in the field of dementia. Psychiatrists are paid for a maximum of 14 consultations per day and cannot make a separate charge for counselling. Consequently, counselling is only offered by those who are willing to do it freely.

For carers, there are support groups organised by the Alzheimer Society in Bucharest. A token fee is requested from carers attending these groups. The rest of the costs are covered by the Romanian Alzheimer Association.

Training is available for carers. This is partly funded by the State and partly by the carers themselves.

There are no holiday services for people with dementia e.g. either alone, with carers or with personal assistants. Similarly, there are no provisions to enable carers to take a holiday e.g. payment or a substitute carer.

Work/tax related support for people with dementia

There are no specific provisions to protect people with dementia who are in paid employment e.g. from unfair dismissal or deterioration of their future social rights.

People with dementia are entitled to tax refunds and/or benefits due to their incapacity, direct payments from the State to pay for services (if eligible) and tax refunds/incentives for employing a person to provide home care services. They are not entitled to tax refunds, grants or other incentives for home transformations.

According to Law 488 of 2006, people with dementia are entitled to reductions on their television and radio licences and to free public transport. A person with dementia who owns his/her own house does not have to pay tax on it.

Work/tax related support for carers and carer allowances

Carers are not entitled to paid or unpaid time off work or flexibility in their working hours in order to care for a person with dementia. The State does not provide free or subsidised pension contributions to people who give up paid employment as a result of care giving.

Carers do not benefit from tax benefits or incentives for the care they provide. However, in accordance with Law 448 of 2006 and Law 487 of 2002, carers of people with dementia with the severe disability degree receive payments from the State towards the cost of caring. The National Authority for Handicapped People grants an allowance of EUR 100 per month and the local authorities, (the town councils) grant an allowance of EUR 20 per month. This is paid in the middle of each month (the handicapped person receives a separate coupon as proof that the money has been received).

Bibliography

Unless otherwise stated, information provided by Letitia Dobranici (Romania Alzheimer Society) between March and September 2007

[1] Please refer to the section on the legal framework surrounding the provision of social support.

 

 
 

Last Updated: Wednesday 15 July 2009

 

 
 

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