VALLI - The Union for Senior Services
The OMPAS Project 2001 – 2005
Developing Informal Care with the Service Voucher System and Networking
The Present Situation of Informal Care in Finland
There are over 300,000 family caregivers in Finland who provide care for a disabled, long-term ill or elderly relative or friend at home. Approximately 26,000 carers receive Home Care Allowance from the municipalities of their residence. In Finland, it is the municipalities that have the primary responsibility to provide social welfare and health care services for all their residents. Legislation on social welfare and health care services, such as the Social Welfare Act (710/1982), obliges municipalities to provide income support and organise home help services and institutional care for elderly people when necessary. However, the municipalities have the freedom to arrange the provision of these services as they see fit. The Home Care Allowance for family carers is also based on the Social Welfare Act, but rather than a subjective right guaranteed to everybody who fulfils certain preconditions, it is a means-tested right and therefore based on financial or other need, as well as the resources of the municipality.
Home Care Allowance is granted by the municipality on the basis of a service contract that is drawn between the municipality and the family caregiver. An individual care plan that specifies the services and the service provider and must be agreed upon by the care recipient, the carer and the municipality is an essential part of the contract. Home Care Allowance can be granted in the form of money, services or both. The rate depends on the required time and extent of the assistance, and varies greatly in different municipalities from € 30 to € 1260/month. A high care allowance can be granted, for instance, when a person that would otherwise require institutional care is cared for in his or her own home.
Development of Informal Care
Between 1995 -1997, a nation-wide trial of the service voucher system in the provision of respite care in the sphere of the informal care system was carried out in Finland. The aim was to diversify the forms and models of providing respite care by supporting the creation of a private service market. Another aim was to increase the freedom of choice of care recipients and their carers. The national service voucher system, which was introduced in 2004 in the municipal home care and support services, aims at the same target.
VALLI - The Union for Senior Services and its member associations have been implementing a development project OMPAS (Developing Informal Care with the Service Voucher System and Networking) in respite care since the beginning of the year 2001. The national service voucher currently at use in many municipalities concerns only municipal home care and support services, whereas the OMPAS Project experiments with the use of a service voucher particularly in the sphere of informal care. The project takes place in the areas of five municipalities; in some, alongside with the regular service vouches system, and concentrates particularly on how the service voucher system functions as a measure to alleviate the heavy work load of family carers. The OMPAS Project, as well as various other development projects of informal care, is financed by the Finnish Slot Machine Association. The project continues until the end of 2005, and the up-to-date experiences of the project are very promising and encourageing.
The working environment of family carers has significantly changed in recent couple of years. In the beginning of 2002, legislation was changed to entitle family carers to have two days off per month instead of the previous one day/month. Moreover, Home Care Allowance recipients have full insurance security, as well as full pension security, in case they are not already receiving a pension.
Even though a family carer is entitled to have free time, the municipality is not mandated to arrange temporary care. Rather, this depends on the financial and other resources of the municipality. In the OMPAS Project, we attempt to reach as many informal carers as possible who receive no support from the municipality. In most municipalities the money allocated for informal care is scarce, and many carers remain outside any support systems. The OMPAS Project can not organise services that by law are the responsibility of the public authorities. Hence, the Project concentrates on areas of extra services, such as family crisis situations and holidays or other periods of free time for the family carers. The OMPAS Project actively encourages caregivers to take some time off and to otherwise take a good care of themselves.
As mentioned above, the project operates on the regions of five municipalities: Kotka, Hämeenlinna, Northern Helsinki, Rauma and Ulvila. Therefore, the geographical sphere of the project is fairly limited. Each municipality has a project coordinator who seeks out family caregivers and meets them regularly. The coordinator assists the carers to apply for service vouchers and helps them to find a suitable service provider. Four of the five municipalities contribute financially to compensate for the service costs. This is significant, because the regular use of services may be very expensive for the carer. One important outcome of the project indeed is that the municipalities have become involved also with a financial input; this indicates that cost-compensation continues also in the future.
A network of all the possible service providers is created for every locality. Currently there are 34 service providers in the project areas that offer respite care either in or outside the home of the client. The latter has turned out to be the most popular form of services due to the opportunity it provides for the carer to have a longer leave than otherwise would be possible. The second most popular form of service is day care services outside the home. Respite care at home usually only means a period of a few hours to give the carers some time for themselves. Rehabilitative groups, in which the client can participate either on his or her own or with the carer, are also well liked. The groups meet weekly for a few hours and are led by a physical therapist or a nurse.
The Voucher Process
The basic principle of the project is to grant service vouchers in the sector of informal care to provide the carer with the opportunity to take a sufficient amount of time off. The work load of informal carers is heavy and full-time, and the opportunities to have time for oneself are scarce and far apart. The actual client who applies for the voucher is the care recipient. When application has been submitted, either the project coordinator or the service provider meets with the client and the carer, and together they draw a ‘coping plan’, which specifies the need for respite care also in the future. According to several studies, those caregivers who get regular free time according to the service plan drawn in advance cope better and are more satisfied with the provided respite care than those whose free time is irregular and more arbitrary. After the initial application has been approved of and the voucher granted, the coping plan functions as the basis for the application of future vouchers.
When the carer has had their time off, namely, the service has been realised, the service provider sends separate bills for their share of the service costs to the client and the Association for Old Age and Neighbour Service, as well as to the municipality in those areas where the public authorities have agreed to compensate for part of the costs. Thus far we have been able to meet the demand. However, the number of clients has grown significantly and we have been forced to restrict the quantity of vouchers granted to individual clients. In 2003, the average value of vouchers per client/year was € 511.00, but actual use of vouchers varied a lot. The voucher value is based on the type of service. The voucher value for care given in the home of the client is € 10.00/hr or € 170.00/24-hr period. Care outside the home costs € 17.00/4 hrs and € 35.00/8 hr period. The cost of 24-hour care outside the home is € 42.00. Most commonly, the voucher covers approximately one half of the service costs, and the client pays the rest him/herself. In case the municipality has agreed to compensate for some of the costs, the client pays less.
It is true that aged people cared at home by a family carer are in a poor state of health and need a lot of help and attention. However, being cared for in their own homes is the one thing they most want for. The OMPAS Project pays special attention to the high quality of services, because rehabilitative care is proven to increase coping skills at home and alleviate the work load of the caregiver. Developing services for this kind of a relatively small client group is problematic in the sense that there are still far too few small service units available where the caregiving relatives can leave the care recipients with an easy mind.
The OMPAS Project creates service forms that are best applicable in concern of the specific needs in the region. Peer group activities for informal carers have become very popular. It would indeed be most desirable if family carers found their way to participate in these groups in as early stage as possible, because the groups also function as significant distributors of information. Moreover, we organise various events for people involved in informal care and otherwise attempt to make informal care as visible as possible.
The first and foremost task of all the various projects implemented by VALLI - The Union for Senior Services is to make sure that aged people have access to all the services they need and to safeguard pluralism also in service provision.
By:
Riitta Husso
Project Planner, M.Soc.Sc.
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