FAMILY CARE OF OLD PEOPLE IN SLOVENIA
As written in the Strategy of care for the elderly till 2010 – Solidarity, good intergenerational relations and quality ageing of the population, that was adopted by the government of Republic of Slovenia in September 2006, the countries and experts are facing a challenge to rapidly develop, implement and expand new models of help to the families with an old person, new programs for care of elderly that will be more adjusted to their needs and wishes, and other support networks for quality ageing and good intergenerational relations in the local community. Planning care for the elderly must aim to reach the balance between the family, new social programs for elderly and institutional care. In order to develop such programs of care, information was needed and this information was collected through the study on Slovenian family carers of elderly people, carried out within a doctoral thesis. In 2005, Simona Hvalič Touzery carried out the first extensive quantitative survey on family carers of old people in Slovenia to get the information on the needs and the situation of family carers and old people. The sample size was 218 family carers.
This study has shown that the willingness of family to care is much higher than many experts think. The biggest problem is not the willingness to care but rather the ability to care. Overall it was found that the motives like “emotional bonds”, “sense of duty” or “moral responsibility” are the most frequently mentioned motives for caring. Based on many data we can assume that family care will be less available due to the lack of support services to family carers and social policy measures rather than unwillingness to care.
The study examined the factors that influence family care. One such factor is social policy towards old people and family carers. By reviewing the currently available services in Slovenia the conclusion was made, that there is a great lack of social and health care services. They are many times unavailable and ineffective. The services mostly used by family carers and the people they care for are visits of a district nurse − that is available to all, but limited in time − and social home help.
Until recently Slovenia had no national policy that would deal with family carers directly. There are some acts, which indirectly concern family carers (The Act on Pension and Disability Insurance−APDI 1999 − mentions the right to attendance allowance; Health Care and Health Insurance Act−HCHIA − the right to compensation for care-giving to a close family member, with whom the insured lives in a common household) and only one (Act Amending the Social Security Act (SSA-C)) that enables family carers as family assistants to get, under specific rules, a financial compensation. However, if it even comes to it, this compensation is so low, that it doesn’t influence the decision of family carers to care for an old family member.
Otherwise, an important document for family carers of old people was adopted in Slovenia in April 2006 – the National Social Protection Programme 2006-2010. One of its goals is the support to the family and social networks at caring for people in need of help. Another important document is the Slovenia's Development Strategy 2006-2013, with its fourth development priority: a modern social state and higher employment that has as a goals: to improve the flexibility of employment and employment relationships (part-time work, working at home, telework, …); to facilitate the balancing of work and family life. A third important document is the Strategy of care for the elderly till 2010 - Solidarity, good intergenerational relations and quality ageing of the population. This strategy was adopted on 21st of September 2006. It is the only Slovenian document of this kind, in which different ministries joined together and set the goals regarding ageing population. One of the strategic orientations is the family policy in which two of the tasks are:
- to give adequate training and services on the local level (day care, respite care) to the families who care for a disabled elderly family member),
- to support measures allowing more flexible working arrangements (the right for part-time work without the danger that the carer would loose social security).
Many demographic factors will influence the availability of family carers: decreasing fertility rate, decrease in the average size of the household, longevity, later marriages, higher age of women at first birth, encouraging the employment of older people, rising share of single households of an old person (65+), etc. These socio-demographic trends are showing that the family care of an old person will be harder accessible in the future.
Accessibility of care is also connected with the characteristics of family carers. The feminisation of care is present also in Slovenia. The main carers of old people were children – mainly daughters – then partners and daughters-in-law. The study has shown that one third of the family carers cared more than 40 hours per week, which equals the full time employment. The number of caring hours increased along with the severity of the disease of the person cared-for. Alarming is the information, that spouses have a very weak supporting network; two-fifths received no help with caring responsibilities. The largest share of informal care to family carers was provided by grown-up children, partners and relatives from different household. More than half of family carers provided in-house care (living in the same household). The cared-for persons most frequently lived with their spouses, followed by the families of adult children.
The needs of family carers vary. They are related to the level of dependency of old person and the characteristics of the carer. However, the first need is in common to all family carers, the need for respite care services. This is proving two facts: that family care is a very demanding work, therefore occasional rest is important in order to prevent burnout of carers. Another fact is that currently in Slovenia there are not many possibilities for respite care. A large share of family carers wishes to have more frequent visits from a district nurse and larger accessibility of home help services. The need for more information is mostly expressed by carers from the city, family carers of partly dependent people, carers who provide care 40 hours and more per week, carers who provide out-of-house care, family carers who provide care up to two years and adult children who provide care. Currently there are not many sources of information available to family carers.
If we wish to ensure the quality life of old people in the future, we cannot assume that the family will be able to provide the same level of care to old people as today. On the other side we cannot expect that the state alone will provide care to old people. The solution is in the combination of public care services with the services provided by non-profit voluntary organisations, informal carers and private sector. It is important to implement diverse care services and the rights of family carers that will enable them to decide for caring. Previously mentioned Slovenian documents (Development strategy, Strategy of care for the elderly, National plan, …) indicate, that there is a growing interest to give the necessary support to family carers of old people.
Anton Trstenjak Institute of gerontology and intergenerational relations is already working in this direction. We are developing different programmes for quality ageing and good intergenerational relations. We provide short three day training courses for family members to better understand and communicate with the old family member. After the course finishes, family members get the possibility to monthly attend a self-support group called a relatives' club. In such group, they share their experiences, offer mutual support and receive continuous gerontological and intergenerational education. This autumn, we are planning a set of lectures with topics interesting for family carers of old people.
dr. Simona Hvalič Touzery
Source: Hvalič Touzery, Simona 2007. Družinska oskrba starih družinskih članov (Family care of old people in Slovenia): PhD thesis. Ljubljana. [COBISS.SI-ID 2728805]