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Social protection and ageing of the Finnish population

Head of Functional Capacity Unit, Research Manager, Minna- Liisa Luoma

&

Senior researcher, Eero Siljander, CHESS/THL.

9.6.2014 Esityksen nimi / Tekijä 1

Content of the presentation

• Nordic model of welfare

• Social protection

– Strategies : Pension reform (2005), & New Health care act (2011)

• Income security ES

• Long term care ES

• Financing the services ES

– Strategies : National Framework for high quality services for older people, New draft Act on care Services for the elderly (MLL)

• Preventive services (MLL)

• Housing services (MLL)

• Home services & nursing care (MLL)

• Memory rehabilitation (MLL)


Social protection and ageing of the population

Social protection promotion in society aims to strengthen people's participation and to prevent poverty and social exclusion.

Social protection for older people consists of services and income security, arranged as a part of social care and health care.

The aim of the ageing policy is to further older people's

– Functional capacity

– Independent living

– Active involvement in society


Mira Koivusilta | Nordic Congress on Gerontology | Reykjavik | 2 June 2010 4

• TÄHÄN KUVA

The population context – rapid ageing scenario.

• Tackling the “ageing of society” issue is important:

• - Expansion of long-term care services and pension finance to be expected because of population structure change and longevity.

• - Cost-effectiveness and quality of services need to be addressed.

• - Informal care and home care of older people rising on the political agenda.

• Facts:

• Population of 5,4 million people: 2 748 733 women and 2 652 534 men in 2011 .

• 65 % 15-64 years old and It is forecasted that the number over 65+ population will double from current 900 000 to 1,8 million by 2060.

• It is forecasted that the demographic dependency ratio will change from 50,3 in 2008 to:

• - 70,5 (+ 40 percent) by year 2026.

• - 79,1 (+ 60 percent) by 2060.

• (this is the ratio of under 15 and 65+ to 15-64 working ages)


Welfare-mix in Finland/Older People

SOCIAL SUPPORT NETWORK OF AN OLDER PERSON

•Complementary provider •Spouse, children, relatives •Friends, neighbours •70 % of the need of social care

PUBLIC SERVICES •Primary provider •Provided by the local authorities (municipalities) •Purchased from private or public providers (the purchasing-provider model •30 % of the need of social care

COMMERCIAL, FOR-PROFIT SERVICES, FIRMS • Supplementary provider •Private professionals •Private enterprises •Increasing especially in home care, service housing and leisure activities •“silver markets”

NON-GOVERNMENTAL ORGANISATIONS – NGO’S •Supplementary provider •Organisations and foundations •Voluntary work

Nordic model – the welfare state

• Finland is a Beveridge -orientated welfare state, belonging to the so called Nordic welfare model, together with Scandinavian countries

• state and public sector major provider, tax-financed, state having a guiding role in form of legislation, recommendations, national development programs and information guidance

• The government subsidises social and health care services provided by the municipalities through state grants.

– Every municipality is in principle (n=336) is a service organizing unit. Median and mean inhabitant size is low = 5000 - 6000.

– However, in practise co-organizing is also applicable and for many municipalities the only reasonable option.

– Finland is unique in the EU in health and social care service finance and production with widespread responsibility.

– Reforms of municipal structure is top priority of the current Katainen administration. The target is to ensure financially strong enough local government units for the future.



Social and elderly care services in a municipality


Non-

institutional

care

Mix-type

services

Mix-type

services

Mostly long-

term care

Non-

institutional

care

Inpatient

specialised health care

- somatic

- psychiatric

Day hospitals/day centres

Day and night care etc.

Residential home

HEALTH CARE

SOCIAL SERVICES

LONG-TERM CARE AND

SOCIAL SERVICES FOR

OLDER PEOPLE

Home help

Support services

- meals-on-wheels, transport

service etc.

Support for informal care

Home nursing

Outpatient primary health

care

Outpatient specialised health

care

- somatic

- psychiatric

Service housing (ordinary/ with 24-hour

assistance)

Inpatient care in

primary health care

Emergency

inpatient care

Emergency/

long-term

inpatient care

Gerontological

Social Work

CURRENT HEALTH CARE SYSTEM AND ITS CHALLENGES





Finland - New Health and social care legislation. New Health care act (enacted in 2011)

• - freedom of provider choice in primary and specialized care (at this stage regional but will be expanded to cover whole country later),

• - enforced access timetables (tighter time limits to waiting lists),

• - vouchers and new providers (enabling vouchers for social and health care services, more public-private partnership & private producers).

• - nurse prescription rights (limited to a list of basic drugs and some antibiotics).

• - New social care and old people care acts expected to be in force under current administration. Under construction.


Financing of health and LTC care - Finland (A)

• health care is financed by state, municipalities, employers, employees and patients/clients.

• Households finance 62,7 % and companies 37,3 %.

• Multi-channel funding, cost-shifting, sub-optimizing strategies (proposal by THL to make one-channel funded, 2011).

• Use of private health care is partially compensated by the public insurance. Dental care is 50 percent private.

• Municipalities get state subsidies/grants, and they collect local taxes to finance the public costs.

• One of highest client fee -systems among the OECD-countries. 85 of net disposable income in LTC for example.



LONG-TERM CARE IN FINLAND


INCOME SECURITY

• employee pension

• national pension

• housing allowance

• care allowance


Pension system (1) – Finland.

• two main schemes, both are statutory public schemes

– (1) National pension scheme for 65+, co-ordinated with other pensions and incomes

– (2) Employment Pension Schemes to secure the level of consumption attained, flexible retirement age from 63 to 68.

– (2+)extra bonus if staying in work 63+, increase to 4.5 % in accrue rate (compared to under 2).

– Future pensions will decrease as compared to wages by a so-called life-time multiplier. This is due to population longevity. The current replacement rate is 60 of gross income.

– Private (voluntary) Pension Schemes are becoming more popular. Private (voluntary) LTC care insurance is on the planning table as well.


Pension types, supplements and allowances (2)

• Types:

• A) old-age pension, B) disability pension, C) unemployment pension, D) part-time pension, E) rehabilitation benefits, F) survivors’ pension, farmers’ G) early retirement aid.

• Details: – Housing allowance for pensioners, pensioner's care allowance,

war veteran's supplements.

– family care allowance and services to support informal care at home.

– tax deductions for purchasing help for cleaning and other home works, garden works, renovations, care etc. (apply for all population groups, not just the old).

– At the end of 2011, there were 1,483,000 pension recipients, the majority of whom drew an old-age pension (77 %) second largest group was surviving spouse’s pensions (18%) and third largest disability pensions (18 %).


Key figures – pensions (3)

• The average total pension calculated for all pension recipients is the average figure for the most extensive group of pension recipients possible. In 2011, this figure was EUR 1,328/ month. The figure includes pensions paid abroad as well as survivors' pensions. There is no ceiling on pension levels.

• If the group of pension recipients is limited to persons residing in Finland who receive only a pension based on their own working career (pension in their own right), the average total pension at the end of 2011 amounted to EUR 1,415/month. Part-time pensions are not included in these calculations.

• According to the results, the median of the replacement ratio of retired employees in the early 2000s was approximately 60 percent of the wage-earner’s earnings from a few years ago.

• By 2030 the life-time multiplier is expected to reduce the replacement ratio to below 50 percent maybe even 40.




Longevity, services and social expenditure as % of Gross domestic product (GDP) – Scenarios.


- If service and care needs

are postponed by 100 or 50

percent with longevity then

major savings in social

expenditure are expected.

(Myhrman, Alila, Siljander,

2009)

- The scenario presented

earlier indicates the same

result with 3 years

postponement in LTC care.

(Häkkinen, 2008).

The Key in curbing

expenditure is reduction in

morbidity in common

population diseases and

postponement of LTC care.



References – more information

• See THL, Ministry and Finnish Centre for Pensions web-pages:

• www.thl.fi

• www.etk.fi

• www.stm.fi

• Literature:

• Myhrman R. & Alila A. & Siljander E. (2009): Scenarios on Finnish health and social expenditures in the long-run – SOME-model (in finnish language), Ministry of Social Affairs and health – publication, 7:2009.

• Häkkinen U., Martikainen P., Noro A., Nihtilä E., Peltola M. (2008). Aging, health expenditure, proximity to death and income in Finland. Health Economics, Policy and Law, 3: 165-195.


Thank you for your attention!

Social protection: care services

National Framework for high quality services for older people, New draft Act on care Services for the elderly (Mll)

• Preventive services (MLL)

• Housing services (MLL)

• Home services & nursing care (MLL)

• Memory rehabilitation (MLL)


National Framework for High-Quality Services for Older People

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The framework aims at promoting old-age health

and welfare and improving the quality and

effectiveness of services.

http://www.stm.fi/julkaisut/julkaisuja-

sarja/nayta/_julkaisu/1063089#en

National Framework for High-Quality Services for Older People 2001, 2008, (2013)

• the aim is to promote the health and welfare of older people and to boost the quality and effectiveness of services

• is designed to help municipalities and cooperation districts to develop their services for older people on a basis of local needs and resources, jointly with the third sector, private-sector service providers, and clients, their relations and other local residents.

• It sets national quantitative targets for services for older people that municipalities and cooperation districts can use as a basis for fixing their own targets.

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Framework stresses importance of….

• the structure of a joint advice and service centre network of social and health care

– Low threshold

– Able assess and monitor the functional capacity and health

• increasing the number of home visits promoting wellbeing and establishing them as an integral part of the service provision for older people

– Risk groups

• Rehabilitation and rehabilitative care that begin immediately after acute treatment bring results

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Preventive services


• Prevention services

– Older people's functional capacity is supported using preventive services and rehabilitation. These services include Senior Info, home visits, day centres, and vaccinations.

• Service needs assessment

– All over 75 years of age and those receiving a special care allowance should have an assessment of their non-emergency service needs by the seventh working day from the day of contact.

– If an older person requires home services, informal care, institutional care, services for older people, social assistance or other social care services, for these to be granted a municipal official assesses the client's service needs.

– In urgent situations, the need for all services must be assessed at once, regardless of age.


Increasing the number of home visits promoting wellbeing

• ‘The target group is selected on the basis of either (1) age or (2) the age and if the person belongs to a risk group.

• to be targeted primarily to persons aged 70–85 years who do not receive regular services or to a certain age class within this group.

• During a home visit an overall assessment will be made of the person’s functional capacity, the risk factors in the housing environment will be considered, and guidance given for self-motivated promotion of wellbeing.

• The clients are also told about the services available in the municipality

09/06/2014 36

Housing services

• Older people's independent housing is supported by housing services by granting reimbursements for housing renovation work

• by providing service accommodation.

•


Home services and home nursing care

• Home service and home nursing care assist when an older person requires help at home due to diminished functional capacity or illness.

• Support services are used to supplement home services, for instance to provide meals, home cleaning, bathing clients and transport.

•


Home Care • the percentage of people in

need of continuous 24-hour care varied between 4.3 to and 22.9 %

• Just under a quarter (22.8%) of clients receiving home-care services had had more than 60 visits a month.

• It was estimated by the staff that a great majority (84.2%) of clients had received the treatment best suited to their needs, that is, home care.


Informal care allowance

Municipalities may grant informal care support for a relative or friend of a person being cared for.


Support for informal care

• In 2010, municipal support for informal care was granted to some 37 000 care givers for older, this support involving approximately the same number of care receivers.

• In 2012 Minimum amount 364,35 €/ month and If the carer is unable to be gainfully employed during a transitional stage with the nature of care being heavy support is 728,69 €/month

• The person receiving support for informal care is entitled to have at least two days off in any month during which the nature of the care is extremely restraining. The municipality provides for the care during the statutory time off.

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Memory rehabilitation

• Social and health care professionals offer guidance and advice for people with memory disorders in need of special services.

• Many municipalities have nurses, advisers or coordinators for memory disorders. Also, the regional specialists and support centres of the associations for memory disorders and dementia provide advice and guidance.



The new draft Act on Care Services for the Elderly

• Access to social services for the elderly to be made easier and faster

• The basis for access to services will be the capabilities of the elderly person, rather than age in itself.

• Right to apply for services orally as well as in writing

• In urgent cases, make decision on, and arrange, services without delay.

• non-urgent services have been approved, right to receive the service within three months of the approval decision

• Granting services required by the elderly would be facilitated by the service need's clarification from a number of perspectives.

09/06/2014 44

Act on Care Services for the Elderly (II)

• Municipalities must provide systematic support for the elderly

• Municipality must draw up a plan on measures for promoting the wellbeing, health, capabilities and independent living of, as well as arranging and developing services

• Municipalities must have a sufficient level of expertise on the following areas: the promotion of wellbeing and health, geriatric care and social work, geriatrics, safe medication, nutrition, rehabilitation and oral healthcare.

• Service units providing services for the aged must have sufficient staff, whose qualifications and duty structures match the number of elderly clients and the service need set by their capabilities.


Vielä muistiohjlemasta


Merci de votre attention!

09/06/2014 48

Thank you for your attention!

9.6.2014 48

Esityksen nimi / Tekijä

Sustainable Strategies: Socio-economic Security

• Pension reform 2005 - longer working life: 63-68 years - rise in employment rate of 63+ higher min. pension for lowest 10% (2011)

• Strategy for Social Protection 2015 (2010) (health, work, poverty, services)

• Health promotion HIAP 2006 Universal Social Health Insurance - including home care services - Act on Support for Informal Care 2006

• National Framework for High-Quality Services for Older People 2001, 2008 KASTE framework 2008-11

• The new draft Act on Care Services for the Elderly 2013


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