Demographic decline and ageing
During the coming decennia the population of Latvia will gradually decline, from 2.0 million inhabitants in 2016 to 1.3 million inhabitants in 2070. This 32% fall contrasts sharply with the EU average increase of 2%. Until now emigration has been the primary driver of population decline, in the future natural population change will take the lead role. Moreover, the rate of decline in the working-age population is set to accelerate over the next 20 years compared with the previous two decades.
In line with the general demographic trend in the EU, the percentage of older population (65 and above) is growing and is projected to increase further. In 2018, the proportion of people aged 65 and over amounted to 20.1 %, against 15.1 % in 2001. It is projected to reach 28,7% in 2050 (28.5 % in the EU).
In the period 2013-2060, the share of people aged 80+ in the Latvian population is expected to grow from 4.7% to 11% (EU-28: 5.1%-11.8%), i.e. to more than double, with most of the growth happening before 2045. (1) Over the same period the old age dependency ratio measured as 65+ as percentage of the 20-64 year olds will rise from 30.3% (EU-28: 29.9%) to all of 57.0% (EU-28: 55.3%).
Relatively low standards regarding public health
Life expectancy at birth continues to increase gradually in Latvia (79.6 years for women and 69.8 years for men in 2016) but it is far below the respective EU averages (83.6 and 78.2 years of life expectancy). The difference between male and female life expectancy in Lithuania is noticeably bigger than in average in the EU. At the same time, the percentage of the Latvian population having a long-standing illness or health problem is higher than in the Union as a whole (41.2% and 34.2% respectively in 2015). The percentage of the population indicating a self-perceived severe limitation in its daily activities was in 2015 10.1%, above the EU- average (8.1%). Healthy life years, at 54.9 years for women and 52.3 for men are below the EU averages of 64.2 and 63.5 in 2016.
These relatively low standards regarding public health are correlated with significant underfunding of the health system. Despite recent increases in spending, the share of GDP spent on health was 6.0 % in 2017, well below the EU average (9.8 %) and 0.5 percentage points less than the other Baltic States.
The proportion of the Latvian population reporting unmet medical needs is among the highest in Europe, with 6.2 % of Latvians reporting having foregone medical care. One of the major barriers to access is the level of out-of-pocket payments, which represent 41.8 % of total health spending (the third highest level in the EU and mainly driven by the costs of medicines).
The Latvia’s approach to long-term care (LTC) policy is characterised by a strong informal care orientation and little support for informal care.
Low public expenditure
Public expenditure on long-term care (0.4 % of GDP in 2016) is low compared to the average EU level of 1.6% of GDP. Under an assumption of no policy change, it is expected that public expenditure on long term care as share of GDP would rise from 0.4% to 0.6% between 2016 and 2070, remaining below EU average (EU-27: 1.6%-3.1%). The impact of a progressive shift from the informal to the formal sector of care in Lithuania would entail an estimated increase by 105 % in the share of GDP devoted to public expenditure on long-term care (128% on average for the EU27).
Low expenditure on home-base care
The distribution of expenditure between in-kind on the one hand and cash-benefits on the other hand is in line with the EU average: 84.7 % of the enefits are in-kind, while 15.3 % are cash benefits. (EU: 84.4 vs 15.6%). Care benefit is granted by local governments, mostly in cases where they cannot provide the service themselves or in cases where there are several service providers available in the municipality offering the possibility to patients to make a choice among them.
However, Latvia distinguishes itself by the low rate of public expenditure spent on care services provided at home. Indeed, the expenditure for institutional services makes up 82.3% of public in-kind expenditure (EU: 66.3%), 17.7% being spent for long-term care services provided at home, to be compared to 33.7% in average in the EU.
Municipalities are the main responsible for the delivery of LTC
LTC is organised in a relatively fragmented way: services provided for different target groups are organised in different ways and financed from different sources of public financing. Latvian legislation stipulates that in a situation when there is a need for care, municipalities need to organise the provision of services, which can be provided directly by the municipality, or by NGOs or private providers.
All types of long-term care for the elderly (institutional and residential – such as home care, day centres, etc.) are the responsibility of municipalities while long-term institutional social care for persons with mental disorders (children as well as adults) and long-term care (including both social and health) of chronic psychiatric patients are the responsibility of the Ministry of Welfare and the Ministry of Health.
Family is the main payer for LTC, in a country where risk of poverty among the elderly is particularly high.
Care recipients and their families normally cover the expenses of care. For recipients who live in a household with an average income below a given threshold (128 euro per month per person) and who have no spouse or child who is legally obliged to support them financially, municipalities will fully cover expenses of care. Municipalities can however set a higher-level income threshold for accessing the services free of charge.
The family’s responsibility for LTC is even more important that a relatively high and increasing share of the elderly are at risk poverty and social exclusion. The at-risk-of-poverty or social exclusion rate for the elderly continued to deteriorate and at 49.0% (2018) was significantly above the EU average of 18.2% (2017). From 2013 to 2018 the rate of poverty and social exclusion among women of 65 years of age and older has increased by 13.6 %. Moreover, the currently very low pension adequacy is projected to worsen in the long run.
Additional support is left to the discretion of municipalities
Municipalities are obliged to provide home care services in situations when the elderly or disabled person itself or persons’ family members are not able to take care of elderly or disabled person mentioned. Finally, the municipalities can decide to provide additional long-term care cash benefits to recipients or to those relatives with caring responsibilities, although they have no legal obligation to do so. Consequently, the amount of support can vary greatly between different municipalities.
A universal state benefit for disabled people was introduced in 2008. In 2018, financial support for foster families was increased and a communication campaign to overcome prejudices about adults with mental disabilities was launched. The policy is supported by the EU funds, however, only a part of overall needs for community-based care services are covered and further investment would be needed. In addition, the implementation of EU-funded projects has been delayed for almost 2 years, putting at risk its planned completion by 2023.
Additional financial support to informal carers is provided in a limited number of municipalities, including the possibility of a contract between the carer and the municipality.
In parallel to formal home care, a high proportion of home care services is provided informally without payment by family members, relatives or neighbours. As explained above, when a municipality does not provide directly home care services, it will often grant the benefits in cash to the recipients or their relatives. As a consequence, depending on the municipality, support might be granted in kind to the care-takers or/and in cash to the care- givers.
About 50% of municipalities have reported expenditures for financial support to care receivers or carers over the years. In 2016 only 19 municipalities out of 119 reported spending for financial support to carers. Depending on the municipality, support can be granted in the form of cash benefit to the family member providing the informal care or can be formulated as a formal payment for care services on the basis of a contract, therefore formalising informal care. Most often these types of contracts are made between a neighbour or a relative and the municipality.
Recent reforms in LTC
All in all, access to LTC is improving but remains weak. Despite progress in the delivery of home care services, unmet needs for homecare services due to financial reasons was 37.9% of households in need in 2016, above the EU average of 32.2%. Low remuneration of social workers and low population density is a challenge for quality care services in rural regions.
The Cabinet of Ministers worked on elaborating and aligning legislative acts and regulations in the field of LTC in 2017. All these measures involve much closer cooperation between family doctors, municipal authorities and social welfare providers to help an elderly person to receive home-care support for as long as possible or to opt for relocation to an institution.
Number of carers
As a result of the lack of relevant statistical data and research on care and caring related issues in Latvia, there is no official data regarding the number of informal carers. However, according to the European Quality of Life Survey the proportion of people taking care for a disabled or infirm family members, neighbours or friends aged 75 or over at least several days a week in 2017 was is 12.4 %, while the EU average of 7.5 %. The prevalence of informal care within the working population is comparatively very high in Latvia, with 13.8% of people in employment managing care for an elderly, against 6.4 % in average in the EU.
Unlike many other countries, a similar proportion of women (12.6) and men (12.2) are involved in caring for the elderly in Latvia.
Recognition and definition of carers
The responsibility of the family for taking care of the elderly is set in law. The Civil Law of Latvia states: “The duty to maintain parents and, in cases of necessity, also grandparents, lies upon all of the children equally. If the respective financial state of the children is unequal, a court may determine their duty of maintenance commensurately to the financial state of each child” (article 118).
There are no special rules concerning carers’ leave in Latvia, except sickness benefit for a child (under 14) who is being cared for from the first to the fourteenth day of the child’s sickness.
Social inclusion of carers, access to education and employment
Cash benefits in the case of disability
Since 2006, there have been two kinds of cash benefits for children’s carers: a disabled child care benefit, and a supplement to the family state benefit for a child with disabilities. In 2008, a benefit for a disabled person in need of care was introduced. This cash benefit is to pay for care services provided directly to the person being cared for, rather than to the carer. The number of recipients of this benefit has doubled since its introduction.
Support to carers of persons with disability granted the status of assistant
In January 2013, a new programme for persons with disabilities (irrespective of age) was introduced in order to facilitate independent living and foster carers’ integration into the labour market: the services of an assistant to accompany the disabled person for activities outside the home, e.g. visiting a doctor, rehabilitation centre, education institution, etc. Many family members have applied for the status of assistant, especially in communities with high levels of unemployment. . In October 2015, the government approved amendments to regulations strengthening the criteria for determining the assistant’s remuneration, and also the monitoring procedure.
A parent (or guardian) who, for at least eight years, has cared for a child who, again for at least eight years, has been recognised as disabled has the right to draw old-age pension five years before the statutory pension age, provided their insurance record is at least 25 years. A person who receives disabled child care benefit has his/her pension insurance paid from the state budget: this period is included in that person’s insurance record.
- Adequate social protection for long-term care needs in an ageing society, European Commission, Social Protection Committee, 2014
- The 2018 Ageing Report, Economic and Budgetary Projections for the EU Member States (2016-2070), EC, 2018
- Eurofound, European Quality of Life Survey 2016, Data visualisation, accessed on 12/02/2020 https://www.eurofound.europa.eu/data/european-quality-of-life-survey
- European Semester, Country Report Latvia, Commission Staff Working Document, 2019
- Ageing Europe, Eurostat https://ec.europa.eu/eurostat/cache/digpub/ageing/
- ESPN Thematic Report on Challenges in Long-Term Care, Latvia, EC, 2018
- ESPN Thematic Report on work–life balance measures for persons of working age with dependent relatives, Latvia, 2016
- Latvia Health Care & Long-Term Care Systems – An excerpt from the Joint Report on Health Care and Long-Term Care Systems & Fiscal Sustainability, Country documents, 2019 Update, EC, EPC, 2019.
- Lithuania: Country Health Profile, OECD/European Observatory on Health Systems and Policies (2019)