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Bulgaria

2013: National policies covering the care and support of people with dementia and their carers

Background information

Where people with dementia receive care and support

Place of residence

 

YES or NO

Estimated number/

Additional information

At home (alone)

Yes

An estimate was not possible.

At home (with relatives or close friends)

Yes

There are no official data or statistics. 

ABA estimates that 98.17 % – 98.37% of people with dementia live at home. This includes both diagnosed and undiagnosed cases.

At home (with other people with dementia)

-

There are no official statistics and an estimate was not possible.

In general/non-specialised residential homes

Yes

There are no official statistics.

ABA estimates that 5,648 people live in non-specialised public homes for the elderly. Approximately 1% of them have dementia.

The association also estimates that some 3,400 people live in non-specialised privately-owned homes for the elderly. Approximately 10% of them have dementia.

These percentages include both diagnosed and undiagnosed cases.

In specialised residential homes for people with dementia

Yes

There are no official statistics. ABA estimates that 1% of people with dementia live in specialised residential homes (836 people dispatched over 14 public homes). This only includes diagnosed cases.

In general/non-specialised nursing homes

 No

There are no nursing homes in Bulgaria.

In specialised nursing homes for people with dementia

 No

There are no nursing homes in Bulgaria.

In hospitals, special wards or medical units

 No

These services are not available in Bulgaria.

In psychiatric establishments

 Yes

There are no official statistics.  ABA estimates that between 0.1% – 0.3 % people with dementia are in psychiatric establishments.

Other: residential homes for people with psychiatric disorders

Yes

The organisation estimates that about 0.03% of people with dementia live in public residential homes for people with psychiatric disorders (1,049 people, with about 3% of them having dementia). This includes both diagnosed and undiagnosed cases.

*Note: estimates for the percentage of people with dementia who are housed in private non-specialised residential homes are not based on any statistical data due to lack of any public control over private residential homes.

The Regulation Act on the application of the Social Assistance Act gives a definition of a home for old people with dementia: it is a specialised institution providing a range of services to people with dementia, as established by protocol from a medical consultation commission and/or an expert decision of a territorial/national expert medical commission.

In specialised institutions for old people, including those with dementia, an obligatory evaluation of the needs of every institutionalised disabled person should be made, his/her need of support should be determined, including his/her capability of living in society. An important part of this process consists of including people with dementia as much as possible in the decision-making process concerning the type of care which will be chosen. According to Bulgarian legislation, social services are provided only after exhausting the possibilities offered by community services.

As of May 2013, there are 161 specialised institutions for old people in Bulgaria, with an overall capacity of 11,207 places, which include: 14 homes for older people with dementia with a capacity of 825 places, from which 799 places are occupied; 27 homes for older people with mental retardation with a capacity of 2,207 places; 13 homes for old people with mental disorders with a capacity of 1,049 places; 22 homes for older people with physical disabilities with a capacity of 1,345 places; 4 homes for older people with sensory disorders with a capacity of 133 places; 81 homes for older people with a capacity of 5,648 places. Those placed in homes for older people with dementia account for about 7% of the entire number of people placed in specialised institutions. Being diagnosed with the respective disorder and thus corresponding to the profile of the institution is a pre-requisite.

Overall organisation of care and support for people with dementia

The overall organisation of care and support

The transition from traditional Bulgarian institutionalised care, to services offered in the community and family environment, mostly consists of increasing the range of services such as day-care centres, centres for social rehabilitation and integration, protected housing, and development of the model for providing services in a home environment (personal assistant, social assistant, home assistant, and home social patronage). The efforts of the government in recent years have been directed towards the development of innovative intra-sector services for these people so as to satisfy their social and health service needs.

For the provision of social services within an institution, even for a short period of time, the efforts of the government are geared towards providing more community-based services adjusted to the specific needs of these people. The community social services are of a preventive nature and increase the social inclusion opportunities for people with dementia. The social services system has expanded considerably over the past few years as a result of the reforms directed towards improvement of planning, deinstitutionalisation and the provision of more services in community and family environments.

The policy environment

  • Project for a National Strategy for Long-term Care

In Bulgaria, a project for a National Strategy for Long-term Care is currently being developed. The main goal of this strategy is to create conditions for an independent and worthwhile life for elderly and disabled people by improving access to social services and the quality of these services, expanding the service network in the country, de-institutionalising, as well as encouraging interaction between health services and social services. The strategy outcome should ensure a holistic support for families that take care of disabled and older people. Once the strategy is accepted, an Action Plan will be drawn up, which will include specific projects in the field of long-term care. One of the projects will be geared towards the de-institutionalisation of people from the homes for older people with dementia. The plan will incorporate all necessary measures, amount and sources of financing, including EU Structural funds.

State institutions actively cooperate with non-governmental organisations in designing new approaches for the care of disabled people, including people with dementia, and in providing appropriate conditions for their full inclusion in the life of the community.

  • National dementia plan

The government is currently working on a national dementia plan. The Ministry of Health is talking mostly about people with disabilities instead of people with dementia. ABA wants to establish special programmes for people with dementia which are not covered by the programmes for Personal assistant, Social assistant and Home assistant.

The Ministry of Labour and Social Affairs is preparing a national strategy for long-term care. ABA is also working on the same strategy together with the Ministry of Labour and Social Affairs. ABA’s proposal is to establish special programmes for people with dementia. At the same time, coordination is needed for the two documents that will be prepared by the two Ministries. 

Supporting legal provisions

1.Law on Integration of Disabled People (LIDP)andRegulations on the implementation of the Law on Integration of Disabled People.

The law and regulations are based on the constitutional proposition that disabled people are placed under special protection of the state and society. It is based on the principles of prohibition and prevention of all forms of discrimination due to disabilities.                      

The Law on Integration of Disabled People (LIDP) clarifies the specific needs as well as the need to employ an individualised approach when choosing an equitable measure.

The Bulgarian legislator has created the necessary mechanisms for guaranteeing the fulfilment of disabled people’s right to independence and social integration. Equally, the law forbids manifestations of direct or indirect discrimination towards disabled people.

An essential component of the Law is the evaluation of the disability and the possibility for integration. The disability evaluation is performed by means of a medical expertise as well as a social assessment.

2. Socio-economic protection

Part of the national budget is used for investments, rehabilitation and the social integration of disabled people.

The social integration monthly allowance seeks to improve the social status of disabled people. The size of the allowance is calculated as a percentage of the guaranteed minimum income (GMI).  The amount of the social integration monthly allowance changes whenever the amount of the GMI changes.

The social integration monthly allowance covers the additional costs for transport services, information and telecommunication services, training, spa and rehabilitation services.

It is calculated on the basis of individual needs, type of disability and disability level or the level of the inability for social adaptation.

The monthly allowance and aid granted by LIDP are free from taxes and fees.

3. Implementation of the Convention on the Rights of Persons with Disabilities

On 26.01.2012 Bulgaria approved a Law on the Ratification of the United Nations Convention on the Rights of Persons with Disabilities. This law provides for additional scope in the areas of protection and discrimination on the basis of ‘disability’ in all spheres of public life.

An expert group was then set up to prepare a two-year action plan to implement the Law. The plan consists of three phases which respectively encompass the setting up of an expert group for coordinating the execution of the plan, developing concepts for changes and actions pertaining to the ratification of the supplementary protocol (Phase 1); approving changes in the Bulgarian legislation and introducing a coordinating mechanism as well as a mechanism for monitoring the Convention’s implementation (Phase 2); increasing the capacity of the structures responsible for implementing the Convention, as well as popularising the Convention among the public (Phase 3).

Training

Which social and healthcare professionals provide care and support

The following social and healthcare professionals are involved in the provision of care and support to people with dementia in residential care or living at home.

                                                   

Social or healthcare professional

Involved in the provision of care and support for people with dementia in residential care or at home

Nursing staff

Yes

Auxiliary staff

Yes

Allied health professionals

No

Specialists (e.g. psychiatrists, gerontologists, neurologists)*

No.

There are no gerontologists in Bulgaria as a medical profession.

There are no medical specialists on the pay-roll in residential homes. Their help is requested on a case-by-case basis.

Neurologists determine the diagnosis. After that, care is provided by families and psychiatrists if necessary.

General practitioners*

No

Other:

Yes (certified carers: manager/coordinator, social worker, employment therapist, medical specialist, and psychologist*.)

* In homes for older people with dementia and Family-Type Boarding Centres (FTBC), predetermined specialist posts necessary for the functioning of the social service include manager/coordinator, social worker, employment therapist, medical specialist, and psychologist.

With regard to the specialists who take care of people in specialised institutions and community social services, the standards and criteria for servicing personnel are described in the current legislation.

There are specific specialist posts for each type of service necessary for the functioning of the social service and ensuring the quality of care. Depending on the judgment of the social service manager and/or coordinator, other specialists can also be provided in accordance with the specific needs of the consumers and the social services. The number of medical specialists and ‘sanitars’ (health officers without any specialised education) in specialised institutions depends on the number of patients who need 24-hour uninterrupted care.

Staff should be prepared to perform the basic principles of the social service in their everyday work: individual support for every patient/resident; acceptance of individual uniqueness and differences; creating a feeling of security and comfort in the home; support in developing the self-sufficiency of patients/residents; participation of patients/residents in communal life to the extent of their needs, interests and resources.

So as to achieve the goals and improve the quality of service-provision, a team of external specialists can be employed part-time, including a psychologist, a social worker, a clinical social worker, a speech therapist, a rehabilitator and others who can contribute their expertise depending on the needs of the person concerned.

National Alzheimer Association

The Alzheimer Bulgaria Association provides the following services and support:

Helpline

x

Information activities (newsletters, publications)

x

Website

x

Awareness campaigns

x

Legal advice

x

Care coordination/Case management

 

Home help (cleaning, cooking, shopping)

 

Home care (personal hygiene, medication)

 

Incontinence help

 

Assistive technologies / ICT solutions

 

Tele Alarm

 

Adaptations to the home

 

Meals on wheels

 

Counselling

 

Support groups for people with dementia

 

Alzheimer cafes

 

Respite care at home (Sitting service etc)

 

Holidays for carers

 

Training for carers

 

Support groups for carers

x

Day care

 

Residential/Nursing home care

 

Palliative care

 

References

Dimitrov, I., Tzourio, C., Milanov, I., Deleva, N. & Traykov, L. (2012). Prevalence of Dementia and Mild Cognitive Impairment in a Bulgarian Urban Population. AmJ Alzheimers Dis Other Demen, 27, 2, 131-5.

Acknowledgements

Ivan Dimitrov, University Hospital St.Marina, Varna

Irina Ilieva, Executive Secretary, Alzheimer Bulgaria Association

Lazar Lazarov, Deputy – Ministry of Labour and Social Policy

 

 
 

Last Updated: Tuesday 25 February 2014

 

 
  • Acknowledgements

    The above information was published in the 2013 Dementia in Europe Yearbook as part of Alzheimer Europe's 2013 Work Plan which received funding from the European Union in the framework of the Health Programme.
  • European Union
 
 

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