Interval care service provision: Size and satisfaction levels

The Estonian Social Insurance Board is the State agency funding the interval care service for young adults in search of independent living provision. Since the establishment of the service, 23 service providers have been offering 208 service places. Of those operational places, 179 were taken and 29 were vacant as of April 2022.[1] The reason for their being vacant was due to mismatch between provider and user, location and timing, but also the current situation where it is very difficult to hire care staff, in particular for adults with extensive care needs.

The distribution of provision across geographical locations in Estonia is somewhat uneven. Furthermore, the State-run special care units of Hoolekandeteenused Ltd. are not offering the service, as it is more time-consuming due to need for planning, interaction with families and identifying their needs, among other considerations, as well as a relatively high level of predictability – as the service is meant to fit each family’s schedule and be readily offered when the family requests it.

Such provision requires the flexibility of personnel, which is very difficult to ensure, given increased commodity prices and the general shortage of care personnel. The need for an increased hourly rate from the Social Insurance Board, who is administrating the service, is addressed in a separate chapter of this paper.

Geographical division

Estonia has a small population and generally is a sparsely populated society. Major urban areas are the capital area of Tallinn and neighbouring municipalities, making up 500,000 inhabitants, and the Tartu area with about 110,000 inhabitants. The 23 service providers are located in almost all counties although some of these counties have very few service places.

1. Tallinn and Harju County – the capital area

The relatively new service for interval care leading to independent living is one of the special care services. Many potential users are put on waiting lists and it is often not possible to access services close to home, hence the waiting lists. In the capital area, 197 individuals are on the waiting list.[2] Also, not everyone who potentially needs the service has filed an application to become a service user, meaning the number of people who are expecting a service but cannot get one could be higher.

While the interval service leading to independent living options is predominantly meant for people whose care needs are high, it is not possible to determine the exact number of potential users. While the overall number of people of working age with the most severe level of care need, according to administrative data from the Social Insurance Board for the end of September 2022, amounts to 4,774 individuals, even if only 2,000 individuals require interval care, the 208 places available mean that only about 10 per cent of the total number of potential beneficiaries are currently being assisted.

2. Governance and service issues across municipalities

Municipal governance has improved in recent years. After the municipal reform in 2017, instead of 213 municipalities, only 79 remain. Given the small population, the fact that there are still 79 municipalities conducting different municipal policies is a challenge for service users. Civil society organizations for people with disabilities are calling for equal treatment of people across locations, in urban and rural areas. The significant difference in municipal populations poses a challenge to offering good quality services.[3]

Furthermore, the total amount of interval care hours per person per year is not without limit, meaning that the hours required are also much higher than the currently available provision.

The service is also staff-heavy given the need to be flexible and take into consideration the needs of service user, the time of the year and the working cycle of the family members, among other elements. The number of staff involved in service provision could be as high as the number of service places. The case studies explored later in this paper indicate the current number of staff involved in service provision.

In the current economic situation, the staff wages of €4.50–€5.00 per hour are not feasible, making it very hard to find staff.