Analysis of service development and crucial elements for success

A. Number of users

The number of children with disabilities is slightly increasing. The number of children aged 0–17 with a profound level of disability resulting in complex dependency needs has, according to administrative data, remained stable. Social Insurance Board administrative data shows that in September 2021 the total number of children with disabilities was 9,736. In September 2022, the number had increased to 9,865.

The target group of the interval care for adults with severe and profound disability is people of working age (18–64 years). The number of people with profound disabilities in September 2021 was 5,553. By September 2022 it was 4,774. This shows a decrease, but it should be noted that the re-evaluation of disability status and re-evaluation of capacity for work have in recent years led to a number of people with disabilities being categorized under a different severity level, with the overall picture not changing. The number of people of working age with severe disabilities in September 2022 was 16,112 persons.

B. Aim to offer choice

Since the early 1990s, de-institutionalization processes have been taking place in Estonia. With the support of the European Union, the dismantling of large care facilities for special care has taken place and the ecosystem of special care has been diversified, with State-owned providers operating under the umbrella of Hoolekandeteenused Ltd. One large institution with a capacity for 180 persons remains open but will be closed in 2023, and the State-owned service provider is offering services in 63 units across the country for 1,700 users.

A wide variety of special care providers have also been developed, including at the grassroots level. Such providers are often civil society organizations established by parents of children with disabilities, carers of young adults or stakeholders aiming to effect change in the society in terms of the rights of people with disabilities, independent living and the implementation of the CRPD.

C. EU support mechanisms for reorganizing special care

The recent EU budget for the 2014–2020 period offered co-funding for the reorganization of special care provision. In the two calls for proposals, civil society stakeholders were also able to apply for establishing community-based living units, including interval care units to support a shift to independent living.[1] €47,600,000 was used to reorganize or establish 1,756 places on community-based services, including for interval care. Thirty-seven projects were co-funded, with 1,423 reorganized service places and 333 new service places.

D. Public-private partnership approach

Special care provision and the offer of childcare for children with disabilities requires the correct environment and readiness to cater for the special needs of the service recipient. That means fully accessible premises, resilience for intensive use, the fulfilment of dietary requirements and good sound isolation should be taken into account. This is often not the case for accommodation units used publicly.

Therefore, for both childcare and interval care for adults, service providers have requested that financing is made available for the creation of service units that suit the users. Here, EU funds along with State budget funding and private sponsorships have resulted in establishing service units where NGOs are acting alongside with public body stakeholders. Units supporting independent living are predominantly established in cities, with some exceptions where service units are also placed in smaller communities (given that Estonia is an extremely sparsely populated country).

Gradually, de-institutionalizing has resulted in the reorganization of all special care institutions and replacing them with small units, moving towards increasingly offering assistance in the location where the person is living rather than moving the person out of their normal environment.

To offer childcare with the aim of letting the family rest or take a mini-vacation (respite care), the State have entered into partnership with the private Estonian-Swedish jointly established Estonian Agrenska Foundation. With the Foundation’s own funding and support from the State and private donors, a new child-care provision unit was inaugurated in 2022 (ready for operation in March 2022). Normally, childcare is delivered with a 1:1 or 1:2 personnel-to-child ratio, with facilities being equipped to accommodate three persons staying in the room. Alternatively, for participants in a diagnosis-based family stay, family rooms are available in which four persons can be accommodated.