Disability services according to people’s needs

The acts on intellectual disabilities and disability services are being combined into a new special law for all disability groups. "The main aim is to safeguard services promoting participation and equality according to a disabled person's required needs. When need is essential and long-term, we want to ensure the appropriate services regardless of diagnosis," says ministerial counsellor Jaana Huhta.

The problems of applying the heterogeneous and in part out-dated regulations of the two parallel laws, and the need to do away with the separation of the service systems have impelled the comprehensive reform of disability legislation. Change is also being promoted through the development of international human and fundamental rights, in particular with the UN Convention on the Rights of Persons with Disabilities.

Finland's Disability Policy Programme 2010-2015 highlights the need to bring Finnish legislation in line with changes required by the UN Convention, which Finland has signed. They enable Finland to proceed with ratifying the Convention, and in early December, the government submitted to Parliament a proposal on the ratification of the UN Convention, as well as proposals for the necessary legislative reforms.

A main determinant of change is the development of how disabilities are conceptualized.
"In current legal thinking, disability groups should not be differentiated based on the nature of their disability or illness. The necessary assistance must be provided regardless of whether the limitation on functional capacity is physical, mental, cognitive or social," Huhta explains.

Since 2009, the act on disability services has been preeminent in relation to the act on intellectual disabilities. This is why services for people with intellectual disabilities should be organised according to the act on disability services, when they are adequate, appropriate and in the interests of the recipients.

In practice, the actualisation of intellectual disabilities leads to the comprehensive application of the act on intellectual disabilities, in part due to the differentiated nature of the service structure. Problems are also caused by the fact that the laws provide for the same sorts of services but the demarcation of their client groups or the criteria for client fees contain unjustifiable differences from an equality perspective.

"Although the act on intellectual disabilities has ensured comprehensive services, on the other hand it has excluded people with intellectual disabilities from general services and other disability services. The disability service system is also criticised for its old fashioned conception of disability, which circumscribes the self-determination, equality and freedom of choice of those who are included within it," says Huhta.

One of the aims of the legislative reform is to prevent the danger of people falling between cracks in the service system. "At present, for example, people suffering from various forms of autism or neurological disorder may find themselves left without services. Their need for assistance is not being properly recognised."

The new legislation will strengthen the direction according to which people with disabilities will primarily use general social and health services. If these services are not sufficient and in the interests of clients with disabilities, they will be entitled to special services.

"There have to be services when they are required, in other words when a person cannot manage in every-day life without assistance. Different needs naturally require different forms of assistance. For some it is support in doing certain things, for others it is about communicating or understanding," Huhta observes.

Under the current law, people with severe disabilities have a subjective right to certain services that their municipality must arrange regardless of funding allocations. The criteria of severe disability are determined per service. The new law, on the other hand, presupposes the necessity of service requirements for all groups of people with disabilities. Huhta points out that the new legislative design does not alter the baseline of the law.

"If the need for assistance is assessed as essential and recurrent, the service will be granted. The point is therefore to maintain the subjective right of equal, inclusive and essential care to ensure services such as personal assistance and comprehensive housing and mobility services. The necessary conditions and services included in the sphere of subjective rights or other services will be determined separately according to each specific service."

Huhta stresses that identifying constraints on functional capacity and assessing special service needs as a basis for deciding on disability services are hardly new.

"There is no disability or illness that currently carries an automatic entitlement to services. Rather, the grounds always involve an individual assessment of impeded functional capacity. With disability services, entitlement is not the same as, for instance, in child day care, where being a certain age means being entitled to services."

The legislative reform will to some extent at least mean that service coverage will extend to new people. Huhta points out that financial concerns have nevertheless steered the preparatory work for the new law away from excessive cost burdens. In some respects, the reform will reduce the costs of special services.

"The clearer law will reduce the amount of work needed for decisions and appeals. Also, the broader application of the law would be limited in situations in which an individual's need for services start at an advanced age. In such cases normal services for older people would apply. The new law will increase flexibility. Among other things, mobility support services will take account of public transport, as well as other forms of mobility support."

Though the drafting of laws always includes cost assessments, Huhta stresses that regulations essentially reflect the values society chooses.

"The most important aim is to guarantee that people with different sorts of disability receive the necessary services according to their needs."

Text: Paula Mannonen & Mark Weller