Growth in number of elderly receiving nursing home services outstrips increase in home-based eldercare

Toomas Mattson | 5/12/2014 | 4:04 PM

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TALLINN, 12 May 2014 - An audit conducted by the National Audit Office on the Estonian eldercare system found that the number of elderly receiving nursing home services has grown about 80 percent in the last 10 years, while the number of those receiving such services at home has increased by only 10 percent. The National Audit Office believes that, looking ahead, significantly more attention should be devoted to services that allow the elderly to continue living at home longer. Not only is this the psychologically preferable option, it is also many times less costly than providing care in nursing homes.

Local governments have spent about 40 million euros a year on eldercare in recent years, most of it as funding for nursing-home-based eldercare. Many new nursing homes have been opened and the number of elderly in them has grown rapidly. Local government nursing homes have around 4,500 open spots, and private nursing homes approximately 1,900. In 2012, there were a total of about 350 open spots at local governments’ nursing homes.
Most of the local government nursing homes are full, however. If a need arises, there may not necessarily be a spot at a family’s preferred nursing home or one that is close to their home. Demand is undoubtedly significantly impacted by the price of service. The cost of a spot at a local government nursing home ranges from 400-600 euros. According to statistics as of the end of last year, by county, the shortage is most keenly felt on the islands and in Järva and Lääne counties.
The audited local governments state that applicants who have contacted the local government have received a spot in a nursing home, although not always near their home. It is a separate issue whether moving to a facility far from their home is what the elderly patient desires. In regions with a keener shortage of nursing home spots, local governments will have to address this problem.
The opinion of the National Audit Office is that local governments also have problems evaluating need for elder care. In evaluating need for care, local governments often neglect to compile a fully-formed overview of the social, economic, health-related and other factors that determine how the elderly person copes in society. Only two of the 15 local governments covered in the audit used an evaluation instrument recommended by the Ministry of Social Affairs to evaluate eldercare needs. If a thorough evaluation is not conducted, the result may be that money is spent on services that do not provide optimum assistance for people.
Living conditions in nursing homes can be considered generally good, although many nursing homes did not manage to comply with all health code requirements. The National Audit Office found that none of the shortcomings constituted a major obstacle to the organization of care. Nevertheless, they do undoubtedly affect people’s privacy, comfort and programmes for keeping the elderly active.
The National Audit Office found a number of problems related to funding of services. The most important one is the obligation of the elderly person’s family to provide financial support. The better off the family is financially, the lower the share of the local government (=taxpayer) should be in paying for the cost of the nursing home spot.
If the nursing home resident or his or her family are not able to pay the cost of the spot, the local government pitches in and provides partial funding. In cases where the local government decided to participate in funding nursing home service, it examined the family’s financial situation only 14 percent of the time.
In cases where information on the family’s financial status was not gathered, the local government decided to pay an average of 40 percent of the cost of the nursing home spot, and in some cases over 60 percent. In general, this meant the local government had a per-patient expenditure of around 100-200 euros a month. Considering that the number of such cases in some local governments was in the double digits, and the average length of stay in a nursing home is 8 months, the annual costs run into the thousands of euros. Considering the overall scale of the local governments’ activities, these are not large amounts, but it is a matter of principle.
Furthermore, with regard to funding the service, it remains unclear to the National Audit Office how large a share of the pension an elderly person must pay to the nursing home and why this percentage ranges from 80 percent in one case to 100 percent in another case in the same local government unit. The National Audit Office believes it is not appropriate to require an elderly person to pay his or her entire pension and that they should be left with something to cover needs not covered by the eldercare services.
The office also finds unsatisfactory a situation where there is a lack of a state-level agreement on important social services as well as no absolute minimum level of quality that must be provided. The legal framework laid down by the state is not sufficient, as there are a lack of requirements on content of service, service provider, provision process and the persons eligible to receive the service. The state has taken cautious steps toward establishing the requirements, seeking agreements with local government. The advisory guidelines proposed as an alternative to the obligatory requirements are not adhered to by many local governments – for instance, with regard to evaluating need for eldercare and quality assurance systems.


The number of the elderly (65+) and their share in the population is growing rapidly along with the social cost of eldercare. While 15% of the population was elderly in 2000, today the figure stands at 18 percent. The number of elderly people in absolute terms is 15 percent higher than it was in 2000. Estonia’s overall population decreased 6 percent during that period. In more than one-half of local governments, the number of elderly has increased even though the total population is decreasing. It is projected that by 2050, the elderly will make up 25 percent of Estonia’s population.
There are currently approximately 238,000 elderly people in Estonia, of whom an estimated one-fifth require eldercare. Local governments shoulder the main burden in eldercare, spending about 40 million euros a year in this area in recent years. Most of this expenditure has gone to providing care at eldercare facilities.
There are noteworthy differences in the share of elderly living in various municipalities. There are somewhat fewer elderly people in municipalities surrounding county seats (an average of 16 percent) as well as in these towns themselves. Attesting clearly to the population’s mobility trend seen in the last decade, the share of the elderly is especially low in the municipalities surrounding Tallinn and Tartu: just 11% on average. Elderly people make up 23 percent of the population in municipalities further away from county seats.
It is important that local governments be able to provide people the services they need. Provision of such care is the duty of local governments. It is just as important that availability and quality of key services are at a consistent level nationwide. irrespective of the person’s place of residence or location of the service provider.
The National Audit Office audited the system for providing nursing home services to the elderly (age 65+) in 15 local governments and at 10 local government nursing homes. In addition, 193 local governments and 74 local government nursing homes were surveyed. There are a total 102 local government nursing homes in Estonia. The cost of a place in the local government nursing homes ranges from 400-600 euros.

Toomas Mattson
National Audit Office communication service director
+372 640 0777
+372 513 4900

[email protected]
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  • Posted: 5/12/2014 4:04 PM
  • Last Update: 8/16/2015 12:02 AM
  • Last Review: 8/16/2015 12:02 AM

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