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The European voice for informal carers

POLAND

Towards carer-friendly societies
Demographic background

Poland still has a relatively young population – the old age dependency ratio in 2018 (25.3%) measured as the 65+ population as percentage of the 15-64-year olds remains among the lowest in the EU and much lower than the EU-28 average (30.5%). This is due to high fertility and low life expectancy before 1990. However, with declining fertility and rising life expectancy population ageing is underway. The age composition will change dramatically and in 2060 Poland is forecast to have one of the oldest populations in Europe. In the period 2019-2050, the old age dependency ratio will rise to 66.8% (EU-28: 55.3%).

Over the same period, the share of people aged 65+ in the Polish population is expected to grow from 17.7% to 29.7% (EU-28: 20%-28.5%), with most of the growth happening before 2035. At the same time the share of people 85+ will more than double from 2% to 5.7% (EU-28: 2.7%-6.1%).

Life expectancy for men and women at age 65 is projected to rise from 15.9/20.2 years (EU-28: 18.1/21.4) in 2017 to 21.2/24.8 years (EU-28: 22.4/25.6) in 2060. From 2013 to 2017 healthy life expectancy at age 65 for men and women increased by 1.1 and 0.8 years respectively, remaining below the EU average.

Under an assumption of no policy change the Ageing Report scenario suggests that public expenditure as share of GDP would rise from 0.5% 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 Poland would entail an estimated increase by 320% 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 Polish long-term care (LTC) system still very much considers the family as the main provider of care to elderly persons with limitations in the activities of daily living (ADL). Two indicators can be used to depict the significant role played by informal carers: the ‘co-residence’ index (elderly parents residing with their children) and the index of ‘non-working women aged 55-64’. Both indicators underline Poland’s reliance on family commitment. In the field of social protection, Poland belongs to the EU group of countries with a family-based welfare model. The development of formalised, non-family long-term care (LTC) is only in its initial stage.

LTC is very fragmented; i.e., there is no separate long-term insurance or protection. Even the term long-term care (opieka długoterminowa) is often only used by experts, especially in the health sector.

Informal carers provide the lion’s share of long-term care and this for various reasons:

  • Traditionally strong family relations, including high share of elderly residing with their children,
  • Traditional gender division of roles: women retire early (lower retirement age for women has been functional in this respect), also to care for their parents/ parents-in-law,
  • Insufficient institutional supply of publicly financed care,
  • Lack of affordable private care establishments.

The very low level of coverage by formal LTC in Poland can be seen as an important driver in the share of disabled people (15+) receiving informal or no care. This amounted to 92.9% for Poland in 2010, the second highest share in the EU after Bulgaria, with only 5.2% covered by institutional care and 1.9% by home care. The change of approached projected by 2060 is relatively modest: 89.7% are still expected to rely on informal care or receive no care at all. Only some 0.9% of the Polish population over the age of 65 received institutional long-term care in 2008, well below the OECD average of 4.2% (OECD 2011).

Cash and in-kind benefits for long-term care both exist in Poland.

Besides social assistance benefits (which may also be awarded to persons in need of long-term care in difficult situations), cash benefits include medical care supplement and medical care allowance.

The medical care supplement (dodatek pielęgnacyjny) is granted to persons entitled to an old-age, invalidity or survivors’ pension who have reached the age of 75, as well as to persons of any age entitled to an old-age, invalidity or survivors’ pension who are totally incapable of work and require assistance from another person.

The Medical care allowance (zasiłek pielęgnacyjny) is paid to persons fulfilling the health and age criteria, regardless of family income:

  • Children up to the age of 16 requiring permanent assistance from another person,
  • Children over the age of 16 with a moderate disability that began at the age of entitlement to the family allowance, or seriously disabled persons, without age criteria.

The formal LTC in Poland operates within both the health and social assistance sectors. There are six types of social assistance centres dedicated to:

  • Elderly people,
  • Chronically somatically ill people,
  • Chronically mentally ill people,
  • Mentally disabled adult people,
  • Mentally disabled children and young people,
  • Physically disabled people.

Long-term care in the country is financed on a public-private basis. Informal care, i.e. the prevailing form of care, is financed privately while healthcare services are financed via health insurance contributions and social assistance homes (funded by general taxation). (Formal) long-term care spending was estimated at 0.7% of GDP in 2010 but it is projected that this amount will increase much faster than in most EU countries, reaching 1.9% of GDP in 2060.

The medical care supplement (dodatek pielęgnacyjny), which is granted to persons who have reached the age of 75 and who are entitled to an old-age, invalidity or survivors’ pension, is the only universal benefit. All in-kind benefits require a co-payment by the patient. In the health sector, it covers the cost of accommodation and board while in the social assistance sector, the monthly payment by care recipients equates to 250% of the lowest pension, with a maximum of 70% of the monthly individual income of the care recipient.

The quality of residential care in Poland is uneven, although improvements have been observed. Standardisation of facilities is only part of the solution and there is a need for continued action in this field. Some argue for more private involvement in residential care, supported by state (inter alia fiscal) incentives, more competition, better information and higher involvement of NGOs in quality monitoring.

Access to long-term care is often a problem in Poland. Waiting lists are long given the insufficient number of social welfare homes or many are unable to pay for private care.

Carer-friendly policy environment

Number of carers

Long-term care for elderly people in Poland is traditionally and legally a family domain, which is strongly supported by traditionalist values and social expectations. Informal carers clearly dominate long-term care in Poland. According to a recent survey, 93.5% of all dependent elderly people receive care through an informal carer (Łuczak 2013, p. 170). Research shows that a typical carer in Poland is a retired or pre-retired woman (of 51 years of age on average), often in poor health herself, especially when providing intensive care.

Traditionally, women’s retirement age has been low in the country (60, with many early retirement options). This is partly driven by the traditional role of women as carers for their grandchildren and/or parents (in law). In wealthier households, family carers may be supported by immigrants employed on the black market, which is not reflected in statistics.

According to the European Quality of Life Survey (2016), at least 4 million people provide informal care on a regular basis in Poland (i.e. 18.3% of the working age population).

Access to respite care

In the period 2014–2020, the development of support, counselling or respite care centres by local governments or NGOs has benefited from the support of the European Social Fund.

Social inclusion of carers, access to education and employment

Carer’s leave: Leave entitlements for taking care of a disabled/chronically ill child or adult family member are scarce. In this respect, informal carers of children are in a much better position.

The most obvious policy option for carers of a disabled child is their right to additional child-raising leave (dodatkowy urlop wychowawczy). In general, paid maternity/paternity/parental leave lasts altogether for a maximum of 52 weeks and may be followed by up to 36 months of unpaid child-raising leave, to be used before the child’s fifth birthday. In the case of a child’s disability (certificate needed), an additional 36 months may be claimed, to be used before the child turns 18 years. As for other leaves, parents’ work record has to extend for at least six months in order to be eligible. The leave can be taken in up to five blocks, and can be exchanged with employment or education, assuming that the care is provided by the parent in person. Both parents can take up to four months’ leave at the same time.

During the child-raising leave, the state budget pays pension contributions for the carer (the amount is strictly limited). Also, a supplement to the family allowance may be received, at a monthly rate of PLN 400 (about €95), assuming that the family passes a general income test, with a threshold set at PLN 764 (€173) per capita per month.

Employees covered by compulsory or voluntary sickness insurance under the Social Insurance Institution have an entitlement of up to 60 days off per year to take care of a sick child or other family member, assuming that a medical certificate is presented and there is no other carer in the family (the latter condition does not apply if the child is under 2 years of age). During this leave, a care allowance (zasiłek opiekuńczy), set at 80% of the individual’s average annual wage, is payable for the whole period if the child is under 14, and for a maximum of 14 days otherwise.

Flexible working arrangements: The main forms of support to help informal carers enhance their work-life balance consist in flexible working arrangements and labour market reintegration measures. A measure introduced in 2013, through an amendment to the Labour Code, allows for an extension of the reference period for the work settlement from 4 to 12 months, and for the introduction of flexible working hours (opportunity to individually agree time of starting and finishing the workday).

In 2015, the government introduced benefits supporting labour market reintegration for former informal carers, via subsidised employment measures; however, the use of the benefits in the first year was marginal.

Cash benefits: Several cash benefits related to the provision of long-term care are available either to carers themselves or the care recipient (or potential care recipient, in the case of older people). Importantly, the rules governing the benefits available to the carers of children and of adults/seniors usually differ, being more advantageous in the former case. Benefits are tax free and the state pays the social and health contributions for the beneficiary.

It should also be noted that cash benefits for carers of the disabled/chronically ill are rarely designed specifically to balance work and care. Their aim is to support wellbeing rather than work opportunities for informal carers.

Nursing benefits (świadczenie pielęgnacyjne) were introduced to support carers who do not participate (or leave) the labour market as a result of their caregiving toward a disabled child (i.e. not to a dependent elderly). The age of the dependant is not taken into consideration but the disability must have existed from childhood (thus before the age of 18, or 25 if in full-time education; condition introduced in 2013) and must be legally certified. In 2015, the rate of nursing benefit was set at PLN 1,200 per month (€286), and was then increased to PLN 1,300 (€295) in January 2016. As of 2017, the benefit level is regularly indexed in correlation with increases of the minimum wage. The amount of this benefit remains the same irrespective of the number of disabled children or the nature of their disability.

A more restricted benefit called special care allowance (specjalny zasiłek opiekuńczy) is granted to the carers of disabled adults. This benefit can be received by the parents or spouse of a person with a certified disability/functional incapacity and in need of all-day care, provided the carer concerned either does not take up employment or has quit employment due to his/her care obligations. Importantly, special care allowance is income tested. It is available if the claimant’s net per capita family income is below PLN 764 (ca. EUR 174). The rate of special care allowance is only PLN 520 (ca. EUR 118).

Additionally, carers who lost their right to nursing benefit due to the new eligibility criteria introduced in 2013 can access a care allowance (zasiłek dla opiekunów) of PLN 520 (€118) using the old/previous rules.

There are no cash benefits available to carers of older people, unless the older person holds a disability certificate.

Access to information and advice

Programmes aimed at recognising the needs of informal care providers and introducing training or counselling are in the very early stages of development. Occasionally, they are offered by NGOs, often with public financial support (information exchange, counselling, psychological support for parents). Discussion regarding the empowerment of care providers, recognition of their needs and the adequate response to meet the latter have all recently become the topic of local and regional research, as well as of regional and local social policy.

Carers’ mental and physical health

Research in the Łódzkie region (voivodship) has revealed that the needs of informal carers in Poland include psychological support to prevent depression and burnout, first-aid training, training in care for chronically ill and immobile patients, training in simple medical procedures (such as performing injections), massage as well as simple rehabilitation (Janowicz, 2014).

Training and recognition of carers’ skills

Support for informal carers in the form of training, rehabilitation or psychological support is rare. Typically, this type of intervention is provided thanks to community initiatives, mostly organised by non-governmental organisations and supported through European Social Fund (ESF) resources.

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 – Poland, EC, 2018
  • ESPN Thematic Report on work–life balance measures for persons of working age with dependent relatives, Poland, 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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