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Romania

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

The Romanian Alzheimer Society did not have any data regarding the place of residence of people with dementia

The organisation of care and support for people with dementia

The overall organisation of care and support

The health system is a decentralised and pluralistic social health insurance system based on a contractual relationship between the health insurance funds and service providers.

The Ministry of Labour, Social and Family Solidarity is responsible for social support to people with dementia/dependent elderly people.

Services and benefits provided by the State are funded through an obligatory health insurance and general taxation.

Alzheimer’s disease, vascular and Parkinson dementia are now recognised as handicaps.

In Romania, a specific legislation, distinct from anti-discrimination legislation, refers to ‘handicap’ and, until September 2010, ‘persons with disabilities’ were defined as those “lacking abilities to normally carry out daily activities due to a physical, mental or sensory impairment and requiring protective measures for rehabilitation, integration and social inclusion” (Article 2 of Romanian Act 448/2006448448/2006448/2006 on the Protection and promotion of the rights of people with a handicap). This definition was amended in September 2010 by Emergency Ordinance 84/2010 to “persons whose social environment hinders completely or limits their access to equal opportunities in the life of society, requiring protective measures to support their integration and social inclusion, as the social environment is not adapted to their physical, sensory, psychological, mental and/or associated impairments” (Emergency Ordinance 84/2010 on amending Act 448/2006448448/2006448/2006 on the protection and promotion of the rights of persons with a handicap), which goes beyond the definition of disability used in Chacón Navas as the emphasis is put on the duty to secure accessibility and on the intertwining of social and medical elements in disability (European Commission, 2012).The specific legislation on disability further maintains the definition of disability (handicap) in Article 5 (16), which was not amended following the September 2010 changes. Handicap is defined as “the generic term for impairments/deficiencies, limitations in activity and restrictions in participation defined according to the International Classification of Functioning, Disability and Health adopted by the World Health Organisation, and which highlight the negative aspect of the interaction between the individual and the environment” (Article 3 (16) of Romanian Act 448/2006448448/2006448/2006 on the Protection and promotion of the rights of persons with a handicap) (European Commission, 2012).

Access to services and support from the State is dependent on eligibility for the severe handicap category and not on age. Consequently, younger people with dementia can access services (provided that they have Alzheimer’s disease and not another form of dementia) but these services are not necessarily adapted to the specific needs of younger people with dementia. There is a significant problem concerning adequacy and accessibility of services. First of all, there are very few services that are specifically designed for people with dementia. People with dementia can benefit from services designed either for handicapped people or elderly people but in a limited way (e.g. a person cannot attend a day care centre if cognitively impaired and he/she is not admitted into hospital due to a lack of personnel trained in dealing with dementia issues). There are few hospital wards able to provide specific care for people with dementia and a family member is required to provide care while his/her relative is hospitalised. Social assistance is very poorly represented.

There are many rural areas where a family doctor is not available, so for minor investigations or a simple medical consultation, the person has to go to the nearest hospital or polyclinic which in some cases is about a hundred kilometres away.

There is no specific support for people with dementia and their carers from ethnic minorities.

How specific aspects of care and support are addressed

Day care

There have been several project proposals from local authorities (municipalities) to open day care centres but sometimes premises that were initially proposed for day care centres ended up being used for other purposes, especially if alternative usage was likely to generate a profit. There are several day care centres in the country which benefit from the support of the Church but they are for elderly people with social problems and not specifically for people with dementia.

Long-term residential care

Long-term residential care services funded by the State are not specifically designed for people with dementia. Means testing is applied and there may be out-of-pocket payments but property is not included in the calculation of available means.

There are long waiting lists for available places (sometimes over a year) and no social assistants to carry out accurate assessments. To make matters worse, there is a tremendous amount of bureaucracy surrounding applications for places in these institutions. As it is not possible to obtain assistance with the paperwork, this makes the whole process very difficult for carers and virtually impossible for people with dementia.

Private long-term residential homes also exist but they are not specifically designed for people with dementia either.

Palliative care

Several discrete attempts have been made by NGOs to provide palliative care at home. The Casa Sperantei from Brasov and Bucharest are good examples although it does not just provide this service for people with dementia. Apart from these limited attempts to provide palliative care, there are no palliative care services either at home or in centres.

Personal assistance and home help

Personal assistance

People who qualify for the severe handicap degree issued by the territorial commissions responsible for assessing adult handicap are entitled to the following services, for which they must nevertheless contribute towards the costs:

  1. Assistance with personal hygiene
  2. Supervision/assistance taking medication
  3. Assistance with eating and drinking
  4. Assistance with mobility (e.g. lifting, moving and walking)
  5. Assistance with incontinence
  6. Assistance with skin care

Services exist linked to companionship and assistance maintaining social activities but the costs must be covered totally by the service users. There are no services for occupational therapy/ergotherapy, assistive devices and home adaptation/transformation.

In order to be provided with a personal assistant, a person has to obtain a grade one handicap certificate. For a person with dementia, the following procedure applies:

- Diagnosis of dementia from a specialist (psychiatrist, neurologist) and a form  describing the evolution and symptoms. The specialist should demonstrate that the patient needs permanent supervision and recommend either the necessity of a personal assistant or institutionalisation in a long-term institution

 - An Expertise Commission for Persons with Handicap will examine the patient and    his/her medical documents and will decide on the grade of handicap.

- The patient or the family should find a person willing to become the personal assistant. The personal assistant will be paid by the local authorities. Personal assistants must complete training programmes offered by local authorities.

- The patient’s condition is periodically revised by the Commission.

Personal assistants are considered and treated like staff hired by the local authority. They are paid for 8 hours’ work per day. They have to have a daily schedule and present an activity report every week. Their activity should be monitored by representatives of the Social Protection Departments, but the Romanian Alzheimer Society stresses that this is not always the case.

Home help

Assistance with housework, shopping and laundry services exists but must be totally funded by the service users. There are no transportation services. Help with the delivery of meals is available. However, it is not specifically aimed at people with dementia as it is intended for people with a poor social and economic status. The NGOs are not directly involved in the preparation of meals but they transport food from restaurants and canteens, as well as food packages or food products, to people with dementia from poor families. This service does not function on a regular basis as it is dependent on the availability of funds i.e. from fund-raising activities or from local authorities. The Church also transports food to old people, some of whom have dementia.

Psychosocial support and training for people with dementia and carers

There is no general information service designed to inform people about available services in Romania.

Limited psychosocial support exists for people with dementia and their carers. For example, individual counselling for people with dementia may be offered by psychiatrists but only if they are specifically involved in the field of dementia. Psychiatrists are paid for a maximum of 14 consultations per day and cannot make a separate charge for counselling. Consequently, counselling is only offered by those who are willing to do it freely.

Training

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 to people with dementia in residential care or at home

Nursing staff

No

Auxiliary staff

No

Allied health professionals

No

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

No

General practitioners*

No

Other

Yes, certified carers

 

The type of training that social and healthcare professionals receive

Certified carers

There are two types of certified carers (as they appear in the Romanian Occupational Code): home carers for people who are ill and home carers for elderly people. They are certified on the basis of Government Ordinance. 129/200 and they are legally certified by the Ministry of Employment. Their training should be organised by providers who have been accredited by the National Council for the Professional Training of Adults.

In Romania, a person can become a certified carer after attending a training course. The course is open to anyone interested in obtaining such qualifications in order to find a job or those for whom this type of activity is a part of everyday life such as having an older family member in need of care.  In order to be certified, home carers of elderly dependent people should follow 11 training modules over 360 hours of training (120 hours for theory and 240 for practice). More information, in Romanian, can be found on: http://developeyourself.wordpress.com/2011/11/24/curs-de-ingrijitor-batrani-la-domiciliu/., Any NGO that is accredited by the State can organise courses for carers. The State only sets the number of hours and curricula for these courses. The qualified people can then be hired by different organisations (state social departments, NGOs, private sector) or become authorised personnel in the field (i.e. they can be self-employed).

Private companies avoid having certified carers because the training period is too long and expensive. Most of the private companies work with untrained personnel; they only recommend “carers” and require a fee from the carer and from the beneficiary. Then the patient or the family illegally pays the carer. Taxes on wages are so high that only rich people can afford to hire a carer legally.

Support for informal carers

Respite

There are no organised services covering respite care at home. However, in rural areas, there have been isolated cases of carers asking their relatives to come and look after the person with dementia for a couple of weeks so that they can have a break or go on holiday.

Sometimes, when carers are no longer able to cope, they try to arrange for the person with dementia to be admitted into a psychiatric ward for several days. This is possible if they know a doctor who is understanding and willing to admit the person with dementia for a short time. Private homes exist which accept people with dementia for short periods of time. This usually costs between EUR 600 and EUR 1,400 per month.

Training

Training is available for carers. This is partly funded by the State and partly by the carers themselves. More information can be found on:

 http://developeyourself.wordpress.com/2011/11/24/curs-de-ingrijitor-batrani-la-domiciliu/.

Consultation/involvement in care decisions

The Romanian Alzheimer Society is not aware of any specific obligation to obtain service users’ views about such services. It has found such specifications only in a guide issued by the Romanian Government in collaboration with the Ministry of Health and Social Protection and the National Institute for Preventing and Combating Social Exclusion of Persons with Handicap – “Occupational standards for personal assistants” author Dr. Verginia Cretu, 2003.

Moreover, the Romanian Alzheimer Society is not aware of any initiatives by service providers to obtain and assess the opinions of people with dementia and carers about the quality of home care services.

Work/tax related support for carers and carer allowances

Carers are not entitled to paid or unpaid time off work or flexibility in their working hours in order to care for a person with dementia. The State does not provide free or subsidised pension contributions to people who give up paid employment as a result of care giving.

Carers do not benefit from tax benefits or incentives for the care they provide. However, carers of people with dementia with the severe disability degree receive payments from the State towards the cost of caring. The National Authority for Handicapped People grants an allowance of EUR 177 per month.

National Alzheimer Association

The Alzheimer Association of Romania provides the following services and support:

Helpline

 

Information activities (newsletters, publications)

x

Website

x

Awareness campaigns

x

Legal advice

 

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

x

Support groups for people with dementia

x

Alzheimer cafes

 

Respite care at home (Sitting service etc.)

 

Holidays for carers

 

Training for carers

x

Support groups for carers

x

Day care*

x

Residential/Nursing home care

 

Palliative care

 

*This service will be available very soon after the publication of this book.

References

Chopin, I. & Uyen, Do T. (2012).Developing Anti-Discrimination Law in Europe. The 27 EU Member States, Croatia, Former Yugoslav Republic of Macedonia, Iceland, Liechtenstein, Norway and Turkey compared.European Commission

Acknowledgements

Catalina Tudose, President of Romanian Alzheimer Society

Maria Moglan, Vice-President of Romanian Alzheimer Society

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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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