State system of the social service of the elderly

Review by Julia Kachalova

     In the Soviet period the information on the state of affairs about the least protected groups of citizens was «closed» and never published either in the mass-media or in the specialized scientific editions. Moreover, while women’s and children’s problems were mentioned now and then, troubles of the elderly were treated as if they had never existed.
      In 1987 the Supreme Soviet deputies were informed for the first time of the distressful situation of senior citizens and the disabled. That information had a shocking effect on the deputies. It caused them to take several decisions in the shortest possible time that made it possible to found the global state system of social care ¹. In the course of the next 10 years these decisions were followed by normative acts and enactments regulating rights and guarantees of the elderly. New forms of social service have developed, the number of hospitals for the elderly and disabled has grown; the forming network of social service centers gave birth to a new profession – social worker.
      Before the middle of the 80-s there were two types of state establishments in the USSR in the system of the social service of the elderly: «sobes’es» (short for «social welfare») whose business was pensions, resort and sanatorium trip tickets, exemptions – i.e. controlling functions. The second type was presented by the establishments of social service itself – rest houses and hospitals for chronic psychotics. Beginning with 1987 sobes’es and part of the rest-houses acquired home-care departments. The development of new forms of social service that followed led to several federal laws issued in 1995 which regulated their activities. First there was the Federal Law «On the social service of the elderly citizens and the disabled», four months later it was followed by the Law «On the basics of social service of the population of the Russian Federation». The latter established the concepts of social service, social service customer, social welfare, distressful life situation; determined the principles and standards of social service. In 1995-1996 several decrees of the government were issued that related to the problem of social service. They included the forms of social welfare guaranteed by the state, the list and order of social services given to elderly and disabled citizens.

      The forms of social welfare
      Sections 16-20 of the Federal Law «On the social service of the elderly citizens and the disabled» No.122-FZ dated 08/02/95 determines the following forms of social service of the elderly and disabled:
      1) in-patient treatment in rest-houses, retirement communities and other establishments of social service of the elderly irrespective of their name; 2) social home-care (including medical care);
      3) semi-stationary social service in day (night) care departments of social service facilities;
      4) emergency social care
      5) consultative social service.

      By January 1st 1999 the system of social care of the Russian Federation population counted 1156 in-patient establishments ², which 278 more than in 1975. At the same time the demand for rest-houses is growing steadily and keeps far ahead of the rate of establishing new ones. The waitlist for rest-houses has grown by 17.5 thousand people in the last 7-8 years.
      To make this waitlist somewhat smaller, the network of ambulatory establishments was set up over the last 10 years, the so-called municipal centers of social service (CSS). They are responsible for home-care, provide day-stay facilities and urgent help with food, clothes and consultations to people who have found themselves in a distressful situation.
      Social home-care is carried out by special departments of the municipal centers of social service. Home-care includes the following services guaranteed by the state:
      1) supplying food, including «meals-on-wheels» service;
      2) help in buying and delivering drugs, food and industrial goods;
      3) assistance in obtaining medical aid, including escort to medical facilities;
      4) keeping living conditions up to hygienic standards;
      5) assistance in legal aid and other juridical services;
      6) assistance in burial services.
      Home care is provided for seniors and disabled who are not capable of keeping the house themselves.
      Semi-stationary social service in temporary stay departments includes providing clients with hot dinner, organizing cultural events (lectures, talks, concerts, excursions etc.), medical examinations and remedial gymnastics. Semi-stationary service is provided on the basis of distributing 24-day tickets which can be obtained once in about three years. The cost price of such a 24-day program in Moscow is approximately 396 rubles. Day-stay departments, as a rule, are visited by elderly people who can move around actively.
      Departments of emergency social care provide urgent help with food and essential goods to retired and disabled citizens in emergency. Some of the CSS’s also offer consultative help. Their staff includes lawyers and psychologists.

      Centers of social service (CSS)
      Centers of social service belong to municipal organizations and are therefore financed exclusively from local budgets. In Moscow the situation is relatively well-off comparing with other regions; today there are 112 centers of social service, 9 affiliates and 1 experimental integrated center working in the city. Home-care is provided for 116 thousand elderly Muscovites and unemployable disabled citizens. To the mind of the head of the social service and welfare organization (belonging to the Social Service Committee of Moscow Government), V.D. Kochetov, home-care is provided for most of those who need it. According to the integrated program of social welfare approved by Moscow Government, the number of people provided with home-care will go up to 118 thousand by the end of 1999. It should be mentioned that social home-care is free for Muscovites according to the Moscow Government decision.
      At the present moment there are 143 day-stay departments working in Moscow belonging to the system of CSS and social welfare facilities. They are simultaneously visited by 4200 pensioners. By the end of 1999 the number of temporary stay units is planned to go up to 185, and the number of their visitors – up to 5550 people.
      Departments of emergency social care are today an essential part of every CSS. These departments hand out 19 thousand food multipacks a month; during last year the total number of people who got some help was more than 400 thousand ³. After the economic crisis the number of appeals to emergency social care departments for food and essential goods has grown up sharply, and those who need it now have to wait for their turn for two months or longer.
      According to the establishment of the Ministry of Labor and Social Development, each district or municipal area should have a minimum of one CSS. But there are many regions that do not have a full-scale network of these organizations. The total number of the centers in the country is 1680, while there are more than 12 thousand municipalities ⁴, therefore the ones working are not able to satisfy the population’s need for social services completely. Besides, there is a number of limitations concerning the range of social services guaranteed by the state, which keep within limits of basic social amenities, as well as insufficient means of social organizations to give sizable help, unclear status of social workers and their extremely low salary (according to the Federal wade rate, a social worker’s salary is 190 rubles. In Moscow a social worker on full pay gets 380 rubles and 200 rubles additionally for travel expenses).
      With this wage rate little could be demanded of social workers (according to the result of the poll conducted by G.G.Romachova in 1993, more than half of the elderly provided with home-care (51.7%) reported that a social worker’s visit lasted 5 to 15 minutes ⁵), and their situation is even more vulnerable that their retired clients’. «Today a common retiree’s pension is higher than the salary of a social worker who visits him, to tell nothing of the disabled and war veterans’ pensions which are several times higher than social workers’ salary». ⁶
      Medical help to the elderly provided by social and medical institutions Medical help carried out by social welfare organizations is aimed at providing home-care for elderly persons in the case of illness and if they are unable to maintain their basic needs. The help provided by the state and municipal healthcare institutions includes necessary care, therapy, and maintaining active way of life.
      Social and medical services of this kind can also be provided at home or in the form of in-patient treatment. The latter include hospitals or departments of nurse care that are usually formed on the base of local country hospitals. These hospitals generally report to the higher healthcare institutions, but some ways are discussed to assign them (partly at least) to the social service system. Today the system of social service itself counts 16 Charity Houses that work according to the principles of nurse care hospitals, and more than 800 departments in rest-houses, gerontology centers, psychiatric hospitals and other stationary units.
      Stationary hospices which have recently appeared in our country offer integrated social and medical help to patients with terminal stages of disease. We did not manage to obtain complete statistic results on hospices. According to the data available today there are about 30 such institutions⁷.
      Since 1997 centers of social service have included specialized departments of social and medical home-care. This work is carried out most intensively in the regions least covered by the Red Cross activities. In some regions the share of medical services reaches up to 30 or even 40 percent of all social services provided for elderly people, while in Moscow where the Red Cross is very active, the share of medical help is only 1.3 percent. To the opinion of the head of the Ministry of Labor and Social Development Department of war veterans and elderly people affairs, V.M.Vasilchikov, healthcare institutions are often replaced by social and medical care departments, while the system of district policlinics takes much less part in elderly people’s problems.
      As the bounds between the obligations of healthcare institutions and medical help that is to be provided by the social welfare system are somewhat fuzzy, and besides both of them have to deal with extremely limited budgets, it is not surprising that both departments often tend to put the responsibility on each other. Specialists consider it necessary to work out the concept of integrated medical-social aid to elderly citizens. It should be the result of united efforts of all interested departments and organizations.

      Limited abilities of the state in the area of social service of the elderly Today social services can satisfy basic social and household needs of the most feeble people. However, scientists suggest accepting a wider concept of «social service»: it should include social amenities as well as environmental impact and psychological and moral support ⁸. But it is hardly possible without raising higher demands to social workers’ qualification and rising the status of this profession.
      It is unlikely that the spectrum of social services provided by the state will be extended in near future according to the needs of various groups of elderly people. Such differentiated approach to forming social services that will take into account different ways of life of the elderly groups, demands additional finances as well as the clear concept of the social policy concerning elderly people that does not exist so far.
      At the same time limited abilities of the state concerning problems of the elderly are not a specific Russian feature – it is a worldwide situation. Some researchers pay attention to the fact that the state system of social welfare and support of the senior age group was constructed out of nothing. «It is evident that one had no time to think over the question: «How could these helpless people who are now taken care of by the state survive when there were no social care institutions?» In the meantime, during all the years before this problem was paid attention to by the state, its place was taken by informal social and volunteer initiative. People were just following the panhuman traditions of charity, independent of their own situation. This was the substantial factor of survival of the least protected social groups. We should not forget about it today» ⁹.
      Many of the experts note that today not a single government can solve the task of support of senior generation if it relies just on the state budget. Even the richest states lay great hopes on religious and social organizations as well as individual citizens’ initiative who have honorary duties to support elderly people.