Social protection of informal carers

Why was this example implemented?

Before 2001, informal carers in Slovakia were not systematically mentioned in social welfare legislation – they did not qualify for social insurance, and respite services as well as economic support for informal carers were lacking. Over the past decade, several legal amendments have therefore been introduced to close this gap. By doing so, both national and local government levels are contributing within their area of competence. The example thus shows how previous gaps in different areas of informal carers’ social protection (basic income, health and social insurance, right to take a rest) and gaps between various public authorities by taking over public responsibilities towards this target group have been addressed in Slovakia. The set of measures is focused explicitly on informal carers (at present almost 57,000 adults), and implicitly on persons with care needs (at present almost 59,000 people above the age of 6, of which more than 65 per cent are people above the age of 65) and other supporting family members.

Description

Since the year 2001, the Slovak state administration has started to ensure basic income (care allowance) as well as health insurance for informal carers and, since the year 2006, their social insurance too. However, providing informal carers with legal rights to take time-off, while benefiting from ‘respite care services’, was not possible before adopting the new Act on Social Services which came into force since January 2009 (Act No. 448/2008 Coll., §54).

The introduction of this informal care friendly provision into the Slovak legal system was initiated by the Ministry of Social Affairs after a visit of some representatives to the Australian social administration where detailed information about the Australian respite care scheme was collected. Since January 2009 the legal responsibilities on respite care services for informal carers, including the bulk of financing, have been taken over by local authorities (towns and municipalitie

Informal carers are now entitled to take time-off for a maximum of 30 days per calendar year. During the informal carer’s respite period municipal social services provide substitutive social services according to the older person’s own choice, e.g. formal home care services (theoretically also 24 hours per day) or temporary residential care. In case an informal carer stays at home during the respite time, formal carers provide care for the older person in need of care in their own or in the informal carer’s home. The major part of public money spent for support of informal carers is, however, provided by the state budget. For instance, care allowances stipulate, on average, a payment of about €2,500/person per year (€206 per month; in comparison, the national average net wage in 2009 was about €593 monthly) per entitled informal carer. The individual entitlement can be lower for individuals as care allowances are means-tested. Thus, in June 2010, the actual average amount was about €170 (source: Ministry of Labour, Social and Family Affairs of the Slovak republic, on request). For compulsory social insurance, the state contributes about €925 annually for each informal carer to the pension fund and about €420 per year for health insurance.

Municipalities/towns are now responsible for the provision of services in kind, i.e. respite care services that are able to substitute for the informal carers’ activities. Local authorities guarantee to fund such services for a maximum of 30 days in the home of the older person needing care or as temporary residential care. On average, costs for residential care amount to about €650-700 per recipient (Aktuálne, 2010). This sum may vary depending on the type of residential service chosen. Cooperation of state and local authorities leads to saving time and money, as the results of the older persons’ needs assessment that is conducted by statutory authorities to assess the eligibility of their informal carers for care allowances are also used by local authorities to provide substitutive social care services for older people in need of care.

What are/were the effects?

Informal carers appreciate statutory contributions for their health and pension insurance. However, as the individual contribution is derived from the minimal wage threshold informal carers can only expect minimal old-age pensions in the future, in particular as contributions for social insurance are paid only for a limited period (maximally for 12 years). Also the legal rules related to the care allowance have been criticised heavily. Its absolute rate is very low and the fact that it is a means-tested entitlement leads to very dissimilar rates for individual carers, or even to a loss of the entitlement due to the income of other family members (Repkova, 2010). As the right to respite care services has only been introduced in 2009, it is too early to provide final evidence of its impact on continuity of care by a flexible combination of formal and informal care provision. However, a qualitative study conducted half a year after the introduction of respite care into legislation and practice showed that only 5 out of 30 interviewed carers had heard about the availability of this service. Only 9 informal carers welcomed the service theoretically, but the majority of interviewed persons underlined the barriers for taking up respite care, namely (Repkova, 2009):

• Relationships between cared for and caring persons were too close;
• No tradition to combine intensive family care with formal care services: cared for persons and carers felt uneasy with the presence of ‘strangers’ (professional carers) in their households;
• Informal carers tend to underestimate the negative impact of intensive long-term care on their own health conditions;
• There is generally low trust in professional care. 

According to other surveys (Bednarik, 2010a; 2010b) in 2009 only 253 informal carers – care allowance recipients – from 824 monitored towns and municipalities were provided with respite care services, i.e. less than 2 per cent of all potential recipients of the monitored local units. In 81% of all cases home care services were provided as substitutive social service for older persons during the respite time (Bednarik, 2010a). During the first half of 2010 the take-up rate further decreased, as only 40 persons from the 728 monitored towns and municipalities were provided with respite care services, but now the majority of users (70%) chose some form of residential care (Bednarik, 2010b). Beyond the above-mentioned reasons for this low uptake of respite care services, there were some problems to finance substitutive care for dependent older persons by local governments and lack of information about this new supportive provision among informal carers.

What are the strengths and limitations?

Strengths

• Acknowledgement of informal carers by statutory authorities and legal rights of carers.
• All mentioned legislative measures are based upon the national legislation, thus guaranteeing equal general conditions for all informal carers. 

Weaknesses

• Lack of information about respite care among informal carers and their families.
• The limited period of social insurance contributions paid for informal carers creates particular risks for informal carers at pre-pension age.
• Some types of social risks for informal carers are still not covered, e.g. there is no possibility for longer care leave with protected employment rights for informal carers.
• Lack of local (municipal) resources for social services, including respite care services that were implemented in a time of economic crisis.
• Other local priorities than social services.
• Administrative burdens and procedural problems, e.g. concerning the timely application for respite care or the monitoring of the total annual amount of respite time with reference to care allowance entitlement. 

Opportunities

• Adoption of new fiscal rules and other legal reforms.
• Increasing awareness of informal carers and older people in need of care concerning legal rights.
• Informal carers who have used respite care and made positive experiences will share these with other caring families.
• Existence of a European supportive framework (e.g. European Charter of Family Carers). 

Threats

• State funds to increase care allowance payments might be scarce in the future.
• The lack of funds might also endanger the implementation of costly substitutive social services to provide informal carers with real respite possibilities.

Credits

Author: Kvetoslava Repkova
Reviewer 1: Francesca Ceruzzi
Reviewer 2: Michel Naiditch
Verified by: Lýdia Brichtová, Director of the social services department, Ministry of Labour, Social affairs and Family of the Slovak republic

Links to other INTERLINKS practice examples

• Care Leave Act
• Direct payments for informal carers
• Municipal LTC obligations to support informal carers
• ‘We Care’ – Representative body of informal carers, relatives and friends in Germany

External Links and References

• Aktuálne otázky sociálnych služieb (Actual problems of social services). Zborník materiálov z Výročnej konferencie SocioFóra a sprievodných workshopov. Bratislava: 28th-29th June, 2010. 
• Bednarik, R. (2010a). Monitoring implementácie zákona č. 448/2008 Z.z. o sociálnych službách v obciach a vyšších územných celkoch. Súhrn ra rok 2009. (Monitoring on implementation of the Act No. 448/2008 Coll. on social services by municipalities and regions. 2009 Summary). Bratislava: IVPR.
• Bednarik, R. (2010b). Monitoring implementácie zákona č. 448/2008 Z.z. o sociálnych službách v obciach a vyšších územných celkoch. I. polrok 2010. (Monitoring on implementation of the Act No. 448/2008 Coll. on social services by municipalities and regions. First half of year 2010). Bratislava: IVPR. 
• European Charter of Family Carers. 
• Repkova, K. (2009). Podpora rodinných opatrovateľov/liek – nástroje efektívneho zosúlaďovania práce a opatrovania (Support of family carers – measures for working and caring reconciliation). Bratislava: IVPR.