ESPN Thematic Report on Challenges in Long-Term Care
Social protection for older people consists of income security and services in kind, arranged as a part of social and health care. Entitlement to long-term care (LTC) services in Finland is based on residence in a municipality. Services are granted on the basis of an individual needs assessment. There is a wide range of in-kind benefits such as home care, sheltered homes, more intense institutional care, and health care centres; as well as cash benefits such as care allowance, tax deductions for services, and informal care support. Municipalities can provide in-kind services themselves or buy them from other municipalities or from private service providers. Therefore most of the costs of private service providers are also paid for by the municipalities. Municipalities may also give vouchers for the elderly to buy services themselves from private service providers. Most of the costs are covered by taxes even though client fees are collected. In 2014, clients paid 18.5 % of the costs of services for the elderly.
The problems lie perhaps more in take-up rates, rather than coverage. The system is so complicated that many clients cannot cope in the web of multiple services and service providers. Therefore, families may not always find the services they need the most. Access to services should be made simpler and more transparent for clients. Instead of strictly defined service packages, care workers should be left with wider discretion to decide which service is really needed by the family in question. This method has worked in child welfare services, and the model could be applied in LTC as well. Allocating elderly people with their ‘own’ social worker is also needed as a way to help them find and coordinate services − especially those who do not have family members to help them.
Even though LTC is a public responsibility, families play an important role − not only as guides to find services, but also as helpers and carers. Maintaining the carer’s well-being is important if they provide full-time care to a family member, since it affects not only the carer but also the quality of care they provide.
Thus, Finland’s care regime is a mixed one, combining public, private and individual provision. A characteristic of this care regime is a strong gender bias in care obligations, and hence gendered employment patterns.
The whole Finnish social and health care service system – including LTC – will be totally changed under the social and health care reform (SOTE), which is planned to come into force in 2020. Instead of the municipalities, 18 counties will organise care. Furthermore, the SOTE reform will open more room for private for-profit service providers to operate. There are already many private service providers offering ‘service housing’ (i.e. housing for people who need some help but not institutional care) and home care but freedom of choice will be expanded by introducing individual care budgets and additional vouchers. The opponents of the SOTE reform fear that international companies will dominate the care market and eat up small-scale local enterprises and not-for-profit third sector providers that traditionally have had an important role in Finland. For the time being, nobody knows what the eventual outcome of the SOTE will be.
Laura Kalliomaa-Puha, Olli Kangas
- Vertaisarvioitu: ei.
- Avoin saatavuus: kyllä.
- Koko viite: Kalliomaa-Puha, L., & Kangas, O. (2018). ESPN Thematic Report on Challenges in Long-Term Care. European Commission. https://data.europa.eu/doi/10.2767/84573