Community Research and Development Information Service - CORDIS

Book: Marginaliseerumise riski vähendamine eakatel: pensionisüsteem, tervishoiuteenused, sotsiaalteenused

Estonia is one of the fastest ageing nations in Europe. In the beginning of year 2003, 15.6% of the population was 65 years old or older. According to the prognosis the proportion of seniors in the population will be over 19% in 2030. In the context of senior citizen policy, attention is mostly paid at citizens entitled to old-age pension. Reforms in the old-age pension system have been carried out during the last decade and will have much more impact on future pensions of persons being young or middle-aged nowadays than of those who are already retired. The mean old-age pension is less than 40% of the mean salary.

Services for the aged that aim at preventing marginalization are provided by two systems health care and social care which are quite seperate systems, causing problems for regional and local management of elderly care. Better cooperation, networks and a common data base for health and social care are needed. Implementation of interdisciplinary geriatric assessment would optimise allocation of resources and reduce unmet needs of seniors.

Health care reforms carried out since 1992 concentrated on decentralisation of health care administration, establishment of solidary health insurance, development of family physician care and reforming acute hospital care. Nursing care development started only in 2001. Primary health care by family physicians, specialised medical care and hospital care are available for older persons all over the country. Nursing care, especially home nursing is much less developed and there are big regional differences. Geriatric medicine is not available at all. Financial access to health care services is quite good for Estonian seniors. Long waiting lists for some health care services, limitations in financing of rehabilitative, nursing care and dental care services, but also high costs of drugs are the biggest problems.

The development of social care services is characterised by prioritisation of supporting independent coping. Persons with special needs can apply for a small allowance for themselves and for their personal informal carer. Senior centres (day centres) providing social counselling, recreational activities and services like sauna, washing laundry, massage etc at a discount, also home help services are available in all cities and bigger villages. Availability of placement in general care homes varies by regions. In big cities long waiting lists are common. Residents of care homes have quite often serious health problems needing intensive nursing and are placed into care homes only because of time restrictions in nursing hospitals. There are very few intermediate care services (intensive home care, supported living houses, care of older persons in a family, day care centres for people with dementia etc.) in Estonia. Financing of social care services includes almost always the person¿s own contribution which is small for seniors not having children but is rather big and often beyond one s strength for those having children.

In conclusion, for preventing marginalisation of older persons a better assessment of needs, more diverse services, a flexible financing system and improved cooperation between health and social care systems are needed in Estonia. Much more attention should also be paid to families caring of their elders.

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