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The European voice for informal carers

CROATIA

Towards carer-friendly societies
Demographic background

In the period 2013-2060 the share of people aged 80+ in the Croatian population is expected to grow from 4.3% to 11.0% (EU-28: 5.1%-11.8%), i.e. to more than double with most of the growth happening before 2045. At the same time the share of people 85+ will expand by more than a factor 3.5 from 1.6% to 5.9% (EU-28: 2.3%-7.0%).

Over the same period, the old-age dependency ratio measured the percentage of 65+ compared to the 20-64-year-old population will rise from 29.7% (EU-28: 29.9%) to 57.1% (EU-28: 55.3%). In 2012 healthy life expectancy for men and women with 7.7 and 8.2 years, respectively, was below the EU average.

The impact of a progressive shift from the informal to the formal sector of care in Croatia would entail an estimated increase by 101% in the share of GDP devoted to public expenditure on long-term care

Under an assumption of no policy change the Ageing Report scenario suggests that public expenditure as a share of GDP would rise from 0.9% to 1.3% (EU-27: 1.6%-3.1%) by 2070. The impact of a progressive shift from the informal to the formal sector of care in Croatia would entail an estimated increase by 101% in the share of GDP devoted to public expenditure on long-term care (128% on average for the EU27).

Current Long-term care provision

Croatia’s long-term care (LTC) system is underdeveloped and suffers from a lack – or absence – of co-ordination between social and health services; the national, regional and local levels; and public and private (not-for-profit and for-profit) providers. Croatia’s overall spending on LTC currently stands among the lowest in the EU at about 0.4% of GDP. Available LTC services are fragmented, not universally accessible and often inadequate to meet basic needs. As a result, the burden of LTC still excessively falls on informal carers or on a growing care sector rooted in the grey economy. Flexible employment measures and care leaves are unequally available and vary from one user group to another.

Demand for institutional care for older people already exceeds supply and, although more expensive, the growing private sector appears to respond more effectively to the shortfall than the public sector

Croatia faces both a rapidly ageing population and an increasing life expectancy which are not matched by increases in healthy life years. The Ministry of Demography, Family, Youth and Social Policy is in charge of benefits and services provided through the welfare system, while the healthcare needs of older people are provided through the healthcare system, which is also in charge of palliative care. Public homes for the elderly are owned by counties, though standards and rules of financing are set by the Ministry of Demography, Family, Youth and Social Policy. Counties, cities and municipalities can finance community care, which is significantly underdeveloped and fragmented. Demand for institutional care for older people already exceeds supply and, although more expensive, the growing private sector appears to respond more effectively to the shortfall than the public sector. This reflects the general shortage of places in public homes for the elderly and especially for infirm or frail persons in need of healthcare, e.g. those who are terminally ill or who suffer from various mental illnesses. Information on care provided in the private sector is nevertheless very scarce, in particular in relation to fees and quality of services.

Although more attention has been placed on home care services in recent years, these have often consisted in pilot programmes which, when integrated into mainstream services, suffer from significant cuts both in funding and in the number of beneficiaries. Deinstitutionalisation has so far not been explored in the context of LTC for older persons.

The system as a whole lacks adequate monitoring and real quality standards. Not only are key indicators not systematically calculated, but there is currently no strategic approach to LTC identifying short-, medium- and long-term priorities and setting out goals, responsibilities and, crucially, financing. Community and home-based services need to be expanded and rolled out across regions. In addition, innovative pilot programmes which demonstrate positive results need to be scaled up, funded adequately and integrated into mainstream services. The carers of those with significant long-term care needs are often faced with a choice between caring at home with very limited support from public services or placing the person in need of care in a long-term social welfare or health care facility.

Carer-friendly policy environment

Recognition and definition of carers

Carers are currently not recognised as a rights-bearing category in Croatian Law and practice, including the labour law and, crucially, social welfare law.

Access to respite care

Respite care in public care institutions: there are provisions in the Law on Social Welfare for temporary or short-term institutional placement, targeted at children with developmental difficulties and adults with disabilities. The main criteria are the needs of the dependent person, with placement for up to one year in the context of a rehabilitation plan. In addition, provisions exist for respite care to enable carers of children with developmental difficulties to take a break. There are three lengths of respite care available. In general, respite care can be for up to 15 days in one year. However, where the carer takes a vacation, respite care can be for 30 days per year. In situations where a carer may be temporarily incapable of caring for a child with developmental difficulties or an adult with disabilities because of their own illness, respite care can be available for up to 60 days in a year.

Carer’s Allowance

Croatia’s labour market is rather rigid with relatively low rates of part-time and flexible work which can pose a problem for work-life balance. The Croatian system provides for carers’ leaves only in the case of children with disabilities or who need special care, after the expiry of statutory maternity and parental leave. There is a time-limited right to work half-time until a child reaches three years of age; a right to extended parental leave until a child reaches the age of eight; and unlimited right to work half-time in cases of severe physical or mental incapacities which can extend into the time when a child reaches adulthood. All three leaves are assessed by medical commissions who may recommend shorter periods and may regularly re-assess. In each case, the carer automatically receives health insurance and basic pension insurance.

The Croatian system does not provide cash benefits to carers directly but only to the cared-for person. Cash benefits include: disability benefit which is individually means-tested; assistance and care allowance which is household means-tested; child benefits which are means-tested for children with health difficulties and not means-tested for children with severe health difficulties; and tax allowances which are increased for those with disabilities or severe disabilities.

Benefits in-kind are also primarily targeted to the cared-for not the carer. The most relevant of these are:

  • Assistance in the home for people with disabilities: This includes organised delivery of food or meals, shopping for food and other items, cleaning and ironing, and help with personal hygiene. Those eligible are those with physical or mental disabilities, mental health issues and those in temporary or permanent ill-health which means they require such assistance. Assessment is made by social workers from the Centre for Social Welfare. It is only available to those who do not receive any help from their own parents, spouse or children. It is also means-tested and limited to those whose monthly income, or the income of household members, is not more than 1,500 HRK (approximately €197).
  • Assistance at home or day care for vulnerable old people: The right to day care is assessed by social workers and can include full-day (between 6-10 hours) or half-day placements (4-6 hours) and can be between 1 and 5 days a week. Again, the key aim is to provide food, help with personal hygiene as well as psycho-social support. Despite various commitments, this benefit is currently not available nationwide but is dependent on a local authority showing interest in hosting such a scheme with agreements made based on fairly unclear criteria and not on needs.
References
  • The 2018 Ageing Report, Economic and Budgetary Projections for the EU Member States (2016-2070), EC, 2018
  • ESPN Thematic Report on Challenges in Long-Term Care, Croatia, EC, 2018
  • ESPN Thematic Report on work–life balance measures for persons of working age with dependent relatives, Croatia, 2016
  • Joint Report on Health Care and Long-Term Care Systems and Fiscal Sustainability, EC, 2016
  • Adequate social protection for long-term care needs in an ageing society, European Commission, 2014
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