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The European voice for informal carers

LITHUANIA

Towards carer-friendly societies
Demographic background

Lithuania is one of the fastest-ageing EU member states, which also faces a rapid shrinking of its population.

Lithuania’s population has indeed fallen by nearly 25 % since the early 1990s. There were 2,971,900 inhabitants in Lithuania at the beginning of 2013, while there were 2,794,184 in 2019. This figure is decreasing every year, mainly due to emigration and low fertility rates. Since 2009, there was a reduction of 389,672 inhabitants.

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 19.6 %, against 13.9 % in 2001. It is projected to reach 31,2% in 2060.

In the period 2013-2060, the share of people aged 80+ in the Lithuanian population is expected to grow from 4.8% to 11.5% (EU-28: 5.1%-11.8%), i.e. to more than double, with most of the growth happening before 2045.

Over the period 2013-2060, the old age dependency ratio measured as 65+ as percentage of the 20-64-year-old is expected to rise from 30% (EU-28: 29.9%) to 52% (EU-28: 55.3%).

Life expectancy in Lithuania remains lower than the EU average, despite having increased in the last years. In 2017, average life expectancy in Lithuania was 75.8 years (70.7 for males, 80.05 for females), compared to 80,9 years for the EU-28 (males -78.3, females – 83.5). Life expectancy at age 65 in 2017 was 17.4 years (males – 14.4; females – 19.4). The difference between male and female life expectancy in Lithuania noticeably bigger than in average in the EU.

Compared to most other EU countries, relatively few years of life after 65 are lived in good health. At age 65, the healthy life expectancy is around five and a half for women and men, when it is around 10 years in average in the EU.

Under an assumption of no policy change, it is expected that public expenditure on long term care as share of GDP would rise from 1% to 2% 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 127% in the share of GDP devoted to public expenditure on long-term care (128% on average for the EU27).

Current Long-term care provision

The prominent role of informal carers

Public expenditure on long-term care is low compared to other member states. Most of the care to the elderly and disabled in Lithuania is provided by informal carers: i.e. family, neighbours, friends and volunteers. This is due to deeply engrained traditions of family care, the lack of capacity in the formal care sector and the high cost of private services.

The deinstitutionalisation programme, launched in 2014, aims at moving people with disabilities and

children from institutional care to home- and community-based care services. Its implementation is progressing well as regards reducing the number of children in institutional care, but is less advanced when it comes to persons experiencing mental health problems.

Per-capita public spending on residential care and on assistance in carrying out daily tasks is very low compared to the EU average. The majority of municipalities are not able to offer a set of social services that allow an elderly person to live at home autonomously for as long as possible.

Day-care services for children with disabilities are better developed, but fees are charged on the basis of family income (means-tested), and this limits their usage.

 

Long term care provision system

There is no unified legislation on the provision of long-term care, which can be granted through various channels. The central government is responsible for programmes, strategies, as well as setting requirements and standards. Within the central government, the responsibility for long-term care provision policies is divided between the Ministry of Social Security and Labour on the one hand, responsible for social care, and the Ministry of Health on the other hand, responsible for healthcare services. Analysis of the current situation point out to the need for a better integration of medical and social care through a renewed legal framework. The need for integrated social and health services will continue to grow as elderly people report having particularly low health status.

At the local level, municipalities prepare and implement municipal programmes aiming at social integration of disabled people, being responsible for the organisation of social services provision, the determination of local need for social services, the supervision of social services as well as the organisation and provision of primary health care (including nursing hospitals).

The development of integrated home care services that combine social care and nursing services started only a few years ago, and few municipalities have such services. Mostly municipality social service centres provide home care services, and there are few private or non-governmental organisation services in this area. A deinstitutionalisation programme, launched in 2014, aims at moving people with disabilities and children from institutional care to home- and community-based care services. This programme is less advanced concerning people with mental health issues. At EU level, improving equal access to affordable and good quality healthcare and long-term care is considered as an objective guiding on Cohesion Policy Funding.

 

Long-term care services in kind represent 64.8 % of the benefits in 2016.

In-kind long-term care is provided through day centres, home care services, residential social care institutions and nursing hospitals.

The proportion of people aged 65+ receiving long term institutional care has remained close to 1% in the recent years. Long-term care residential services are more and more provided by non-governmental organisations, within the framework of public tenders. Not all needs are met. In 2014, 47 % of elderly people in need of long-term care were on the waiting list.

On the contrary, the proposition of population aged 65 + receiving help at home has been increasing (from 0.9% in 2001 to 2.8 % in 2016). Many of the home-help services in Lithuania are provided by municipal public services, although private providers have also started delivering such services.

The expenditure for long-term care services provided at home makes up 66.4% of public expenditure for in-kind services.

Cash benefits represent 35.2 % of the benefits for long-term care, a proportion that is high than the EU average (16%).

There are three types of long-term care-related cash for dependent persons (disabled and persons of retirement age).

Principally, there are two types of special ‘compensation’ (‘compensation for care’ and for ‘compensation for attendance’) the level of which depends upon the intensity of the need for care. Since 1 January 2007, the ‘compensation for care’ has been set at 2.5 times the social insurance basic pension for all categories. The ‘compensation for attendance’ corresponds to 0.5 times the social insurance basic pension.

Additionally, Social Care Benefit is a cash benefit which may be paid in lieu of home-help services if the home-help agency so decides and if the client agrees.

The amount of the payment is related to the cost of the home help, and is different for each person, depending on the need for services. The mechanisms for accessing this benefit haven’t been very much developed, therefore it is rarely used.

All three cash benefits are paid directly to the dependent person; who is in all cases, free to choose between public or private providers. It seems that these benefits are also used to compensate financially informal carers.

Carer-friendly policy environment

Number of carers

As a result of the lack of relevant statistical data and research on care and caring related issues in Lithuania, there is no official data regarding the number of informal carers. However, according to the European Quality of Life Survey 2016, the proportion of people taking care for a disabled or infirm family members, neighbours or friends aged 75 or over, is 8.2 %, while the EU average of 7.5 %. The prevalence of informal care within the working population is comparatively very high in Lithuania, with 9.1% of people in employment managing care for an elderly, against 6.4 % in average in the EU.

Women are more likely to be informal carers (10.4 % are providing care several times a week) than men (5.6 %).

Access to respite care

The only service for people who care for their relatives is respite care (since 2007). However, this service is only available in some municipalities, and in 2013 only 180 carers benefited from respite care. EU structural funds have partly contributed to finance the introduction of respite care in municipalities.

Social inclusion of carers, access to education and employment

Under the Health Insurance Act 1996, carers have health insurance if they provide care to someone with a high care need that has been recognised by the court.

Public help (cash benefits or services) for families who take care of disabled and elderly family members remains negligible in Lithuania. There are no specific benefits for informal carers.

Home care is in most the cases only delivered to dependent people living alone, and not when he/ she is living with family members.

However, cash-benefits granted to the person in need of care can amount to 75 % of the minimum wage and therefore provide an additional source of income for the household, including informal carers.

Recognition and definition of carers

There is neither official recognition nor definition of informal carers as such in Lithuania. Caring seems historically considered as a normal duty to one’s parents, as confirmed by the law. Indeed, the Constitution of the Republic of Lithuania (1992) states that ‘the duty of children should be to respect their parents, to care for them in their old age’.

According to a survey, only about 58% of people aged 50-65 agree with that statement. Meanwhile, 13% disagreed, and about 22% argued that they would take care of their relatives only if they were paid for doing so (7% did not answered). Another important fact highlighted by the survey is that 47% of people currently aged 50-65 reported having children who live abroad; hence it will be more difficult for them to take care of their parents in old age.

Work-Life Balance

The Code of Labour provides for some support for working carers, such as flexible working time, part-time work and leave for employees bringing up disabled children.

These include several special provisions for employees raising disabled children. While the standard minimum annual leave is 28 calendar days in Lithuania, single parents bringing up a disabled child aged under 18 qualify for a minimum of 35 calendar days. On request, up to 30 calendar days of unpaid leave are available to employees bringing up a disabled child aged under 18. An employee may request unpaid leave to take care of a sick family member, the duration to be recommended by a health institution.

Employees raising a child aged under 18 with disabilities are given an extra resting day each month (or have their weekly working time shortened by two hours) while continuing to be paid their average wage.

Single parents raising a disabled child under 16 years of age may be assigned to work on rest days only with their consent. A single parent raising a disabled child aged under 18 or an employee nursing a sick family member may ask to have their part-time daily working time or part-time weekly working time set in line with the recommendation of a healthcare institution. Single parents bringing up a disabled child aged under 18 may be assigned to do overtime or to work at night or be “on call” at the enterprise or at home only with their consent.

References
  • 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 26/11/2019 https://www.eurofound.europa.eu/data/european-quality-of-life-survey
  • European Semester, Country Report Lithuania, 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, Lithuania, EC, 2018
  • ESPN Thematic Report on work–life balance measures for persons of working age with dependent relatives, Belgium, 2016
  • Lithuania 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 (2017)
  • Lithuanian Research Council, Transformation of elderly care sector: demand for services and labour force and quality of work, Project No. GER-012/2015, 2017.
  • The 2018 Ageing Report Economic & Budgetary Projections for the 28 EU Member States (2016-2070), European Commission, 2018
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