While the proportion of older persons in Romania is presently lower than the EU27 average, demographic projections show that the country will experience a faster ageing process than the EU27 average. As a result, in 2060, the share of elderly people in the Romanian population is expected to be higher than the EU average while both life and healthy life expectancy will remain lower.
In the period 2019-2060 the share of people aged 80+ is expected to gradually triple from 4.7% to 11.5% (EU-28: 5.8%-11.8%). Over the same period, the old age dependency ratio measured as the proportion of 65+ as a percentage of the 20-64-year-olds will rise from 28.1% (EU-28: 29.9%) to 58.8% (EU-28: 55.3%).
Life expectancy for men and women at age 65 is projected to rise from 14.2/17.6 years (EU-27: 17.5/21.0) in 2010 to 20.8/23.8 years (EU-27: 22.4/25.6) in 2060. In 2018, the healthy life expectancy for men and women was well below the EU average with 6.3 and 5.9 years, respectively (EU-28: 9.9/10).
Under an assumption of no policy change, the Ageing Report scenario suggests that public expenditure as share of GDP would double from 0.3% to 0.6% (EU-27: 1.6%-3.1%) by 2070. The impact of a progressive shift from informal to formal care in Romania would entail an increase by 166% in the share of GDP devoted to public expenditure on long-term care (128% on average for the EU27).
Long-term care (LTC) was first defined in the Romanian legislation in 2011 (social assistance law L292/2011) as ‘the care provided to a person who needs support for fulfilling daily life activities for more than 60 days. Long term care is to be ensured in people’s homes, in residential settings, in day care centres, within the home of the service providers and within the community.’ The personal services that may be offered are further described as: (a) medical care services; (b) rehabilitation and environment adaptation services, i.e. small adjustments, repairs, or other similar services; and (c) other rehabilitation services, i.e. kinesiotherapy, physiotherapy, medically recommended gymnastics, occupational therapy, psychotherapy, psycho-pedagogy, speech therapy and other forms of therapeutic recovery.
Despite a series of positive developments in the last decade, the provision of LTC remains dispersed among various sectors (health, social assistance, social protection of disabled people, social protection of children’s rights, pensions) while responsibility for the organisation and financing of LTC services is split between different ministries, national agencies and administrative levels (national/county/local). Overall, benefits and services targeting people in need of LTC fall under (a) social assistance policies (in the case of the frail elderly), (b) social protection of disabled people, (c) the public pension system (in the case of invalidity pensioners), and finally (d) the health care system (in the case of the chronically ill). In the absence of effective coordination, overlapping measures, inadequate coverage, uneven developments, unpredictability as well as funding instability and unsustainability have characterised the country’s LTC system over the years.
The Romanian LTC system, just like the entire social protection system, tends to favour financial benefits over in-kind services given their scarcity (in particular as regards services aiming to support independent living and deinstitutionalisation). Less than 1% of the total state expenditure on social assistance indeed goes to services whereas 99% is allocated to financial benefits. As a result, while the degree of institutionalisation is relatively low among the dependent population (2.5% in the case of people with a disability, 0.4% in the case of the elderly), the demand for residential services is still way higher than the supply due to the insignificant number of home care and community-based services available. Most residential centres are, traditionally, placed in rural areas (and maintained from local budgets) while non-residential services are provided in big cities. Against this backdrop, informal carers play a central role in the provision of LTC in Romania, with practically no recognition or support. Caregiving in Romania is indeed mostly an informal sector, with many people paying family members/relatives or hiring carers informally. This holds true for care services to the elderly, people with a disability and children. The size of this informal industry is hard to estimate.
Most of these challenges proceed from the fact that the financing of almost all social services, including residential centres, has progressively been decentralised over the last 15 years and most local authorities (90% of which are in rural areas) are unable to raise funds even for their own administration. Therefore, a very high proportion of the recently-developed social assistance and community-based services are to be found in larger cities, with residential centres condemned to underfinancing.
Standards for carers apply for the (professional) personal assistants of people with severe disabilities (Law 448/2006 and EGO 51/2017). The county-level decentralised agencies of the National Agency for Payments and Social Inspection (NAPIS) are in charge of the assessment of providers and social services (for accreditation purposes) and with the monitoring/enforcement of these quality standards.
Legislative amendments brought forward in 2017 aimed to correct this situation by recentralising some expenditure and benefits, and by taking over some of the co-payment responsibilities from the beneficiaries. Nevertheless, despite these promising amendments, the administrative and professional capacity to support a complex and fast-growing LTC service network is still lacking (due to understaffed communities, and low recognition and salaries for care professionals in both the public and private sectors). Moreover, the educational system is failing to meet the need for professionals in the care sector. Employment policies are also weak and ineffective in addressing these issues.
Number of carers
Data regarding the prevalence of informal care in Romania is extremely limited although informal carers are legally defined by the social assistance law However, according to the European Quality of Life Survey (2016), 16% of the country’s population reports being involved in the provision of care to someone with a disability or infirmity several days a week or every day. No quality standards are available for this category and, as a consequence, also no systematic support from the public institutions.
Recognition and definition of carers
There is no legal recognition of informal carers in Romania.
Access to respite care
The most important in-kind benefits available to carers and care recipients in Romania are: (a) specialised services for people with a disability in day centres or respite centres (which offer carers a break), as well as specialised training courses for the personal assistants of people with a severe disability (b) access to free medical supplies and free hospitalisation for carers while accompanying dependent persons, (c) free counselling on existing medical options, and (d) free public transport in town and up to 12 free interurban trips per year.
Social inclusion of carers, access to education and employment
Cash benefits specifically targeted at carers of dependent persons are limited to (a) indemnities for the carers of severely disabled/first-degree invalids (as an alternative to a personal assistant) and (b) support/child-raising indemnity for parents with disabled children, until the child turns 7.
The family or legal guardian of a severely disabled person can opt to claim a carer indemnity, as an alternative to the personal assistant option (L448/2006) (see below). This compensates for the cost of hiring a carer or for the informal care provided by family members. While opting to become a personal assistant establishes a formal employment relationship, with all the associated rights and obligations, the indemnity alternative simply consists in a compensatory cash benefit. In December 2015, the gross salary of a personal assistant was set at RON 1,313/month (about € 295), the level of a new employee of the public social assistance services. The level of the alternative benefit – the carer indemnity – is RON 956/month (about € 215), which corresponds to the net wage of a personal assistant.
The second important cash benefit for carers is the extended child-raising indemnity (and for parents not eligible to this, the monthly support indemnity). The monthly support indemnity – granted until the disabled child turns 7 – is similar to the child-raising indemnity, but depends on the severity of the disability.
Work arrangements for carers working outside the home are not well regulated (apart from in the case of the parents of disabled children), leaving the carers of adult dependants largely uncovered. Carers are indeed entitled to employment-related leave under two circumstances: (a) if they take up formal employment as the personal assistant of a severely disabled person, or (b) if they are the working parent of a disabled child.
Carers of people with a severe disability: One of the most important legal provisions for dependent persons with severe disabilities is their right to a personal assistant with formal employment status. Personal assistants can be (and mostly are) family members who care for the dependent person. However, the family can choose not to hire a personal assistant or to take up formal employment as a personal assistant; in which case, a carer indemnity – equivalent to the net salary of a personal assistant – is granted to the family. This latter option does not confer any legal employment responsibilities or rights on the carers/family members, and thus there are no in-kind benefits or leave provision available to them.
Personal assistants are the employees of the local public social assistance services (under the authority of the city halls/municipalities). While theoretically their salaries are transferred from the state budget, as earmarked transfers, in practice the funds allocated are always inadequate, as estimated need and actual expenditure can sometimes differ substantially. According to the labour code (L53/2003), personal assistants have the right to at least 20 working days of fully-paid annual leave (four calendar weeks). In accordance with law 448/2006 on social protection for people with a disability, the employer – i.e. the city hall – is obliged to provide a replacement for the personal assistant during his/her leave, a place in a respite centre or a compensatory extra monthly payment. This is compulsory, even if the personal assistant is part of the family. Should the employer not be able to provide a replacement, an extra indemnity will be paid to the personal assistant for the period of annual leave. All of these rights are associated with formal employment and thus do not apply to carers who have not been recognised as personal assistants.
Carers of children with disabilities: The parents of children with a disability are entitled to a child-raising leave of maximum 3 years paid at 85% of the average net income earned during the previous 12 months of employment (but with a minimum of 600 Romanian lei/€ 125 and maximum of 3,400 Romanian lei/€ 700 per month). The leave can be extended by an additional period of 4 years.
In addition, the parents of children with a severe disability are also entitled to reduced working hours (four hours a day) until the child turns 18, without any loss of social insurance benefits (regulated through L53/2003 and GEO 124/2011). The leave to care for a sick disabled child, which is available until the child turns 18, consists in a maximum of 45 calendar days of leave, with a possible extension to 90 days under special medical circumstances (GO 158/2005). The indemnity paid for medical leave for the carer of a sick child is 85% of the average net income earned in the last six months of work.
- The 2021 Long-Term Care Report, Trends, challenges and opportunities in an ageing society, EC 2021The 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, Romania, EC, 2018
- ESPN Thematic Report on work–life balance measures for persons of working age with dependent relatives, Romania, 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
Last Updated on March 21, 2023