Setting uniform payment assessment criteria for service accommodation

"The motley client payment specifications need to be standardized in order for the equality of citizens to be realized. Payments for public services of similar content must be levied using the same criteria, regardless of which municipality or service block they live in. Payment criteria must be made so comprehensible that everyone can find out about them even on a single reading," says MSAH Ministerial Adviser Päivi Voutilainen. "In order to make comparisons and choices, clients need clarity on what they get in return."

A working group chaired by Päivi Voutilainen is currently considering the reform of the system of round-the-clock care for older people. In line with the Social Welfare Act, the core task of the working group is the alignment of payment assessment criteria. The working group has been entrusted with this at the recommendation of the SATA committee, which is responsible for the reform of social security in Finland. Municipalities are also expecting to receive clear guidance on the issue.

"Hopes have been expressed to the Ministry that there will be clear guidance, including from the tour by the National Institute for Health and Welfare of 24 localities, which it conducted in 2009," Voutilainen explains.

"We've a system of long-term care for older people that is very complicated", says Voutilainen.

People needing this kind of care are attended to in long-term care wards at health centres, residential homes for older people and intensive sheltered housing units. Legislation on health care directs the work of health centres, while legislation concerning social care deals with the activities of homes for older people and intensive sheltered housing. Care in health centre hospitals and homes for older people comprises institutional care, while intensive sheltered housing includes overall outpatient care.

People in long-term institutional care pay a set fee, which is levied according to their ability to pay, and which is up to 85 percent of their monthly net income. An allowance of at least € 97 a month must be left over for the personal use of those in care. Payments for intensive sheltered housing, however, are not regulated by law, leading to highly disparate payment practices in municipalities.

With housing services, the client pays a separate excess share for rent and medicines in addition to the client fee. Unreasonable situations can arise with housing services where the payments that accrue from accommodation, services and medicines may exceed the income of the older client.

"The National Framework for High-Quality Care and Services for Older People contains the recommendation that in drawing up the client's care and service plan the client does not have excessive service payments. In some cases the client costs for intensive sheltered housing have been set so high that clients have had to be granted social assistance. It doesn't seem very sensible," says Voutilainen.

The SATA committee proposed that the fees for service housing be standardized nationwide. Fees would be income-linked and time-based, and they would contain support services, excluding meals services, transportation services, safety phones and the services associated with them. Clients would pay rent on service housing separately, and would receive housing allowance from the Social Insurance Institution, which provides social security benefits throughout Finland, if they were entitled to it according to their income.

"When people buy services, they don't always know what they are getting for their money. They might get very different services for the same number of euros. Payment criteria should be made so transparent and clear that those who need services know what they are getting, orderers know what to buy and producers know what to sell. They have to speak about the same things with the same concepts", says Voutilainen

A working group at the Ministry of Employment and the Economy is also deliberating over the concepts involved from the perspective of consumer protection.

Päivi Voutilainen stresses that the working group is not determining the prices of services, rather standard criteria for payments levied from clients in service housing. The working group is considering whether a basic fee in addition to the care fees should be levied, and whether clients should be left with a minimum allowance for personal use, as is the case with institutional care, and if so how large the sum should be.

"The working group's major challenge is that the client fee for intensive sheltered housing should be reasonable for the individual client, but that the system of client fees should safeguard the client fee accrual for municipalities at least at its current extent. Otherwise, municipalities will not be able to cope with the arrangement of services", says Voutilainen.

The working group will publish its proposals in September. Before this, the draft proposals will be debated in round-table discussions with the main interest groups.

Merja Moilanen