National Audit Office: Preventive social work targeted at the elderly must become more active

10/26/2021 | 11:00 AM

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TALLINN, 26 October 2021. – Many elderly people who are likely to need help are not in the field of view of municipal social work. Reaching those in need requires a much more proactive approach, which presumes both additional resources and a clearer understanding of what information can be used to identify elderly people at risk.

"The elderly who live alone, the elderly with disabilities, and the elderly who do not visit their doctor – we consider them as a risk group," Auditor General Janar Holm commented on the audit findings. "There are significantly more people belonging to risk groups who actually need assistance than those who are dealt with by municipal social workers. The fact that they have not come to ask for help themselves does not mean that they do not need it as there may be obstacles elsewhere. For example, they are not aware of the possibilities of help. In addition, social assistance for the older generation often has got a bad reputation. This obstacle can be overcome by explanatory work."

In the five local governments analysed in more detail by the audit, i.e. Tallinn, Saaremaa, Kohtla-Järve, Valga, and Viljandi Rural Municipality, there were e.g. three times more people aged 75+ who did not visit a family doctor than those who had asked their local government for help. "By far not everyone in the risk group needs help of the self-local government, and accepting it is eventually a person's free choice," the Auditor General Janar Holm admitted. "But such a large gap in statistics indicates that we have quite a few elderly people who may need help and who are not on the so-called radar screen for local self-governments." Although both local self-governments and the Ministry of Social Affairs acknowledge the problem, progress towards a solution has been running into difficulties.

The National Audit Office finds that home visits and other forms of direct communication with the elderly are far too few to get an overview of the people in need. The lack of home visits has been highlighted as a problem by health professionals and professional associations working with the elderly. The municipalities have made preventive home visits to about 1–2% of the elderly. "These figures suggest that it is necessary to be more active in providing social work. Municipalities have to find the elderly who need help themselves, not just wait until the person in need knocks on their door,” Auditor General Janar Holm said.

The crisis caused by the coronavirus pointed to untapped opportunities for prevention and a lack of overview of the needs of the elderly, when municipal employees called the elderly during the first wave of the crisis based on the contacts received from the Rescue Board or elsewhere to provide food assistance during movement restrictions, etc. Beside the need of specific help caused by crises the people who needed other social services were detected as well.  Unfortunately, under normal circumstances, many local self-governments do not continue their practice during the crisis, offering a lack of resources as one of the reasons.  

In the course of the audit, the NAO inquired all Estonian local self-governments, 87% of which found that their activities to date in noticing the problems of the elderly were insufficient. 68% thought that those who had not approached the local self-government themselves should be dealt with more. The most mentioned obstacle to increasing prevention work was the lack of human resources. The solution of the resource problem depends primarily on heads of the local self-governments. At the same time, prevention also needs a better supportive environment, which should be developed in the country centrally.

In the opinion of the National Audit Office, serious consideration should be given to designating prevention work in the Social Welfare Act as a statutory task of a local government. Presently, the responsibilities of a municipality in social work are based on the initiative of persons in need of help or on hints received about them. Meanwhile, the meaning of prevention work is broader in the parties' perceptions than is expected of local self-governments by law. Both the Ministry of Social Affairs and municipalities are of the opinion that social work must also involve those about whom the local self-government has not received information, but who may need help based on certain risks.

In a situation where municipalities are short of people for prevention work, the use of data in databases could be helpful. This is not done as it is not clear to what extent the use of the data is justified and permitted. First of all, this applies to personal data. Until there is clarity, local self-governments will be hesitant to use the data, rather avoid it, and opportunities to target prevention more precisely will be untapped.

The NAO considers that the Ministry of Social Affairs, in co-operation with the Data Protection Inspectorate, should develop explanatory guidelines for local self-governments on the possibilities of using data in state databases in preventive social work. The guidelines should clarify the nature and level of detail of the data that can already be collected through data requests, and the nature of the data that require an additional legal basis. Those in need could be reached faster and with less resource costs by analysing the data.

The National Audit Office recommends that the Social Insurance Board prepare guidelines for the local self-governments on the practical organisation of preventive social work for the elderly. Based on the service, the Board has already prepared quality guidelines and service instructions for the local governments. There could be a similar guide on prevention as well. Such guidelines to preventive social work could provide advice on how to deal with more complex issues, such as clarifying the boundaries of intervention, provide methodological assistance in planning activities, and introduce various good practices, such as networking.


In the report, the NAO also highlighted the practice of several other European countries in preventing the coping risks of the elderly. In Denmark and Finland, the law clearly compels to visit the elderly at home. In Denmark, the obligation to carry out preventive home visits has been in place for more than 20 years, and there are precise instructions given to municipalities de jure on the age at which the elderly must be offered a home visit. This must be done at least once a year for the people aged 80+. At least one home visit must also be offered to people who have reached the age of 75 (considered a critical limit) and, where appropriate, to those aged at least 65 who are at risk of worsening social or health problems.

As in many other countries, the number of elderly people in Estonia is growing rapidly. In 2020, there were about 268,000 elderly people (aged 65+) in Estonia, which is about a third more than in 2000. Meanwhile, the share of the elderly in the population has increased from 15% to 20%. The care of the elderly is one of the main tasks of a local government. The main focus of the audit was on how prevention work related to the elderly is organised in local governments. It was discussed how the meaning of noticing and prevention is presented, as well as what practical activities are carried out for this purpose. The National Audit Office interviewed all local self-governments and examined in more detail the practice of five local governments (Tallinn, Kohtla-Järve, Saaremaa, Valga, and Viljandi Rural Municipality).

Priit Simson
Head of Communications of the National Audit Office of Estonia
+372 640 0102
+372 5615 0280
[email protected]
[email protected]

  • Posted: 10/26/2021 11:00 AM
  • Last Update: 10/26/2021 9:58 AM
  • Last Review: 10/26/2021 9:58 AM

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