Social institutions for older people. Technology of social services for elderly citizens and disabled people in inpatient institutions
Question 74. Social services for older citizens and disabled people.
Social services for elderly citizens and disabled people
Regulated by the Federal Law of August 2, 1995 On Social Services for Elderly and Disabled Citizens. This type of social service is a set of social services that are provided to specified persons at home or in social service institutions, regardless of the form of ownership.
Activities in this area are based on the following principles:
1. Respect for human and civil rights
2. Providing state guarantees in the field of social services
3. Equality of opportunities to receive social services and their accessibility
4. Focus on the individual needs of these individuals
5. Priority of social adaptation measures
6. Continuity of all types of social services
7. Responsibility of state bodies. authorities and institutions, officials for ensuring the rights of these persons in the field of social services.
The right to social services has women over 55 years of age and men over 60 years of age, as well as disabled people (including disabled children) who need outside help temporarily or permanently due to the loss of the ability to independently satisfy their life needs (in whole or in part). ).
Social services for these persons are carried out by decision of the social protection authorities in institutions subordinate to them or under agreements concluded by the social protection authorities with commercial organizations providing social services.
When receiving social services, elderly disabled citizens have the following rights:
1. respectful and humane treatment on the part of employees of a social service institution
2. the choice of institution and form of social services. service
3. for information about their rights and obligations, as well as about the conditions for the provision of social services.
4. Consent or refusal of social services
5. confidentiality of personal information
6. to protect your rights and interests
Social services are provided with the voluntary consent of the individuals themselves, with the exception of:
1. persons under 14 years of age
2. persons recognized as incompetent in accordance with the law
In this case, consent is given by the legal representative. Consent is expressed in a written statement, on the basis of which the person is placed in a social service institution.
The Law of the Russian Federation of July 2, 1992 On psychiatric care and guarantees of the rights of citizens during its provision provides for the possibility of placing an elderly citizen or disabled person in a social service institution without their consent.
As a general rule, these persons can refuse social services, and social service workers must explain to them the negative consequences of the decision. In this case, persons formalize their refusal of social services in writing.
Elderly citizens and disabled people may be provided with living quarters in social housing stock. At the same time, at the request of the individuals themselves, their social services can be provided both on a permanent and temporary basis.
Social services at home is aimed at maximizing the possible extension of the stay of elderly citizens and disabled people in their familiar environment in order to maintain their social status. The list of state-guaranteed social services includes the following as home-based services:
1. catering, including home delivery of food
2. assistance in purchasing essential medicines, food and industrial goods.
3. assistance in obtaining medical care, including transfer to medical institutions.
4. maintaining living conditions in accordance with hygienic requirements
5. assistance in providing legal assistance and legal services
6. assistance in organizing funeral services.
7. If these persons live in residential premises without central heating and/or water supply, then the list of guaranteed services includes the provision of fuel or water.
In addition, these persons may be provided with other additional services on the condition of partial or full payment.
If elderly citizens or people with disabilities suffer from mental disorders, cancer, tuberculosis, sexually transmitted diseases, chronic alcoholism and other similar diseases that require treatment, they may be denied social services at home and referred to health care institutions.
Semi-stationary social services: includes social, medical and cultural services for elderly citizens and people with disabilities, organizing their meals, recreation, ensuring their feasible work and maintaining an active lifestyle. Persons who are capable of self-care and active movement and have no medical contraindications are accepted for semi-stationary social services. Semi-stationary social services can be provided in day and night care homes. These social service institutions are created primarily for persons without a fixed place of residence. The night stay home accepts persons who apply both independently and those referred there by social services. protection or ATS. Some persons may be provided with these services (listed above) for inter-individual indications.
Inpatient social services is aimed at providing social and domestic assistance to citizens who have lost the ability to self-care or who need it for health reasons. This type of social service includes rehabilitation measures of a medical, social, therapeutic and labor nature, appropriate to age and health status, provision of care, medical assistance, organization of recreation and leisure. These persons have the following rights:
1. providing living conditions that meet sanitary and hygienic requirements
2. primary health care and dental care
3. socio-medical rehabilitation and social adaptation
4. voluntary participation in the medical and labor process
5. the right to a medical and social examination carried out for medical reasons
6. have the right to be freely visited by lawyers, notaries, representatives of public associations, legal representatives, relatives and clergy.
7. have the right to free legal assistance in accordance with the Federal Law on free legal assistance in the Russian Federation of November 21, 2011.
8. the right to provide them with premises for the performance of religious rites for believers of all faiths.
9. the right to retain the residential premises they occupy under a rental or lease agreement for 6 months from the date of admission to social services, if these are state/municipal property houses. If family members remain in the premises, it is retained for the entire period.
10. participation in public commissions to protect the rights of citizens.
11. Disabled children in inpatient social service institutions have the right to receive education and vocational training.
12. Physically disabled children and mentally disabled children are placed in different social service institutions.
Elderly citizens and disabled people in inpatient social service institutions are given the right to be hired in accordance with their health status, and if an employment contract has been concluded with them, they have the right to a vacation of 30 calendar days.
Urgent social services carried out for the purpose of providing emergency assistance of a one-time nature if they are in dire need of social support. Urgent social services include:
1. one-time provision of hot meals or food packages
2. provision of clothing, shoes and other essential goods
3. one-time provision of financial assistance
4. assistance in obtaining temporary housing
5. organization of legal assistance for the purpose of their protection
6. organization of emergency medical and psychological assistance with the involvement of psychologists and clergy.
Social advisory assistance is aimed at adaptation of the elderly and disabled, at easing social tension, creating favorable conditions in the family, ensuring interaction between the individual, family, society and the state. Social advisory assistance includes:
1. identification of persons in need of this assistance
2. prevention of socio-psychological deviations
3. work with families in which these citizens live
4. organization of leisure time,
5. consultation in training, career guidance and employment.
6. legal assistance within the competence of social authorities. service.
7. ensuring coordination of the activities of public associations and social service institutions.
Network of inpatient facilities social services in Russia are represented by 1,400 institutions, the vast majority of which (1,222, or 87.3% of their total number) serve elderly citizens, including 685 (56.0% of the total number of institutions) boarding homes for the elderly and disabled (total type), including 40 special institutions for the elderly and disabled people who have returned from places of serving their sentences; 442 (36.2%) psychoneurological boarding schools; 71 (5.8%) boarding houses of mercy for the elderly and disabled; 24 (2.0%) gerontological (gerontopsychiatric) centers.
Over 200 thousand people currently live in inpatient social service institutions. This number includes disabled children and people of working age who need constant care and medical care. There were 150-160 thousand people living in the elderly, which is just over 0.5% of the total number of older citizens.
Over the past five years, the number of places in all inpatient social service institutions has increased by only 3.5%, in general boarding homes - by 8.4%. In psychoneurological boarding schools, there was a decrease in the total bed capacity of 3.6%. The number of people living in these institutions changed in approximately the same proportions: 1.1 and 11.8% more and 0.4% less, respectively.
The dynamics of development of both the network of stationary social service institutions and their main types did not make it possible to fully satisfy the needs of older citizens for stationary social services, to eliminate the waiting list for placement in boarding homes, which in general increased by 2.5 times over 10 years, general type boarding houses - by 6.1 times, in psychoneurological boarding schools - by 2.1 times.
Thus, despite the increase in the number of inpatient social service institutions and the number of residents living in them, the scale of the need for relevant services increased at a faster pace and the volume of unsatisfied demand increased.
As positive aspects of the dynamics of development of stationary social service institutions, one should indicate the improvement of living conditions in them by reducing the average number of inhabitants and increasing the area of bedrooms per bed almost to sanitary standards. The average capacity of a general boarding house over 13 years decreased from 293 to 138 places (more than twice), a psychoneurological boarding school - from 310 to 297 places. The average area of living rooms increased to 6.91 and 5.91 m2, respectively. The given indicators reflect the trend of disaggregation of existing inpatient social service institutions and increasing the comfort of living in them. The noted dynamics are largely due to the expansion of the network of low-capacity boarding houses.
Over the past decade, specialized social service institutions have developed - gerontological centers and boarding houses of mercy for the elderly and disabled. They develop and test technologies and methods that correspond to the modern level of providing social services to the elderly and disabled. However, the pace of development of such institutions does not fully meet objective social needs.
In most regions of the country there are no gerontological centers yet, which is mainly due to existing contradictions in the legal and methodological support for the activities of these institutions. Until 2003, the Russian Ministry of Labor recognized only institutions with permanent residence facilities as gerontological centers. At the same time, Federal Law No. 195-FZ of December 10, 1995 “On the Fundamentals of Social Services for the Population in the Russian Federation” (Article 17) does not include gerontological centers in the list of inpatient social service institutions (subclause 12, clause 1) and highlighted as an independent type of social service (subclause 13, clause 1). In reality, various gerontological centers with differentiated types and forms of social services exist and operate successfully.
For example, Krasnoyarsk regional gerontological center "Uyut", created on the basis of a sanatorium-preventorium, it provides rehabilitation and health-improving services to veterans using a form of semi-stationary service.
A similar approach is practiced along with scientific, organizational and methodological activities and was created in 1994 among the first Novosibirsk Regional Gerontological Center.
The functions of charity houses have largely taken over Gerontological Center "Ekaterinodar" (Krasnodar) and gerontological center in Surgut Khanty-Mansiysk Autonomous Okrug.
In general, statistical reporting data indicate that gerontological centers to a greater extent perform the tasks of care, provision of medical services and palliative care, more likely to be characteristic of compassionate homes. In the current situation, people on bed rest and in need of constant care make up 46.6% of all residents in gerontological centers, and 35.0% in boarding homes specially designed to serve such a contingent.
Some gerontological centers, for example Gerontological Center "Peredelkino" (Moscow), Gerontological Center "Cherry" (Smolensk region), Gerontological Center "Sputnik" (Kurgan region), perform a number of functions that are not fully implemented by medical institutions, thereby satisfying the existing needs of older people for medical care. However, at the same time, the own functions and tasks of gerontological centers for which they are created may fade into the background.
Analysis of the activities of gerontological centers allows us to conclude that scientific, applied and methodological orientation should prevail in it. Such institutions are designed to contribute to the formation and implementation of scientifically based regional social policies regarding older people and people with disabilities. There is no need to open many gerontological centers. It is enough to have one such institution, under the jurisdiction of the regional social protection body, in each subject of the Russian Federation. The provision of routine social services, including care, should be provided by specially designated general boarding houses, psychoneurological boarding schools and houses of mercy.
So far, without serious methodological support from the federal center, the heads of territorial bodies of social protection of the population are in no hurry to create specialized institutions, preferring, if necessary, to open gerontological (usually gerontopsychiatric) departments and mercy departments in already existing inpatient social service institutions.
The social service system for elderly citizens and disabled people in the Russian Federation is a multicomponent structure, which includes social institutions and their divisions (services) that provide services to older people. Currently, it is customary to distinguish such forms of social services as stationary, semi-stationary, non-stationary social services and urgent social assistance.
For many years, the system of social services for older citizens was represented only by stationary social service institutions. It included boarding houses for the elderly and disabled people of general type and partially psychoneurological boarding schools. Psychoneurological boarding schools accommodate both disabled people of working age with corresponding pathologies, as well as older people in need of specialized psychiatric or psychoneurological care. State statistical reporting on psychoneurological boarding schools (form No. 3-social security) does not provide for the allocation of the number of persons over working age in their contingent. According to various estimates and research results, it can be judged that among those living in such institutions, there are up to 40~50% of elderly people with mental disorders.
From the late 80s - early 90s. last century, when in the country, against the background of the progressive aging of the population, the socio-economic situation of a significant part of the citizens, including the elderly, sharply worsened, there was an urgent need for a transition from the previous social security system to a new one - social protection system.
The experience of foreign countries has demonstrated the legitimacy of using, in order to ensure the full social functioning of the aging population, a system of non-stationary social services that are close to the permanent location of social networks familiar to older people and effectively promote the activity and healthy longevity of the older generation.
A favorable foundation for the implementation of this approach is the UN Principles adopted in relation to older people - “Making fuller lives for older people” (1991), as well as the recommendations of the Madrid International Plan of Action on Aging (2002). The age above the working age (old age, old age) is beginning to be considered by the world community as the third age (after childhood and maturity), which has its own merits. Elderly people can productively adapt to a change in their social status, and society is obliged to create the necessary conditions for this.
According to social gerontologists, one of the main factors for the successful social adaptation of older people is the preservation of their need for social activity, in developing a course for positive old age.
In solving the problem of creating conditions for the realization of the personal potential of older Russians, an important role is given to the development of the infrastructure of non-stationary social service institutions, which, along with the provision of medical, social, psychological, economic and other assistance, should provide support for leisure and other feasible socially oriented activities of older citizens, promote educational and educational work in their environment.
The formation of structures providing urgent social assistance and serving elderly people at home was promptly begun. Gradually they transformed into independent institutions - social service centers. Initially, the centers were created as social services providing home-based services, but social practice put forward new tasks and suggested appropriate forms of work. Semi-stationary social services began to be provided by day care departments, temporary residence departments, social rehabilitation departments and other structural units opened at social service centers.
The complexity of social services, the use of technologies and approaches that are necessary for a particular elderly person and available in the existing social conditions, have become characteristic features of the emerging system of social services for older people. All new services and their structural divisions were created as close as possible (in organizational and territorial terms) to older people. Unlike previous inpatient services, which were under the jurisdiction of regional social protection authorities, social service centers have both regional and municipal affiliation.
At the same time, the system of inpatient social services underwent transformations: the tasks of providing medical care and care were supplemented with the functions of preserving the social inclusion of older people, their active, active lifestyle; gerontological (gerontopsychiatric) centers and boarding houses of mercy for the elderly and disabled people in need of high-level social and medical services and palliative care began to be created.
Through the efforts of local communities, as well as enterprises, organizations and individuals, small-capacity stationary social institutions are created - mini-boarding schools (mini-boarding houses), in which up to 50 elderly citizens from among local residents or former employees of this organization live. Some of these institutions operate in a semi-stationary mode - they accept elderly people mainly for the winter period, and in the warm season the residents return home to their garden plots.
In the 1990s. In the system of social protection of the population, sanatorium-resort-type institutions appeared - social health (social rehabilitation) centers, which were created primarily for economic reasons (sanatorium-resort vouchers and travel to the place of treatment are quite expensive). These institutions accept elderly citizens referred by social protection authorities for social and medical services, the courses of which are designed to
24-30 days. In a number of regions, such forms of work as “sanatorium at home” and “outpatient sanatorium” are carried out, which provide for the provision of medicinal treatment, necessary procedures, delivery of food to the elderly, veterans and disabled people at their place of residence, or the provision of these services in a clinic or in social service center.
Currently, the social protection system also has special homes for single elderly citizens, social canteens, social shops, social pharmacies and “Social Taxi” services.
Stationary social service institutions for the elderly and disabled. The network of inpatient social service institutions in Russia is represented by over 1,400 institutions, the vast majority of which (1,222) serve elderly citizens, including 685 boarding homes for the elderly and disabled people (of a general type), including 40 special institutions for the elderly and disabled people returning from places of serving sentences; 442 psychoneurological boarding schools; 71 boarding houses of mercy for the elderly and disabled; 24 gerontological (gerontopsychiatric) centers.
Over ten years (since 2000), the number of inpatient social service institutions for the elderly and disabled has increased 1.3 times.
In general, among elderly people living in inpatient social service institutions there are more women (50.8%) than men. Noticeably more women live in gerontological centers (57.2%) and in charity homes (66.5%). In psychoneurological boarding schools, the proportion of women (40.7%) is significantly less. Apparently, women cope with social and everyday problems relatively easier against the backdrop of serious deterioration in health in old age and retain the ability to self-care longer.
A third of residents (33.9%) are on permanent bed rest in inpatient social service institutions. Since the life expectancy of older people in such institutions exceeds the average for this age category, many of them remain in a similar condition for several years, which worsens their quality of life and poses difficult challenges for the staff of boarding homes.
Currently, the law enshrines the right of every elderly person in need of constant care to receive inpatient social services. At the same time, there are no standards for the creation of boarding houses in certain areas. Institutions are located quite unevenly throughout the country and individual constituent entities of the Russian Federation.
The dynamics of development of both the network of stationary social service institutions and their main types did not allow us to fully satisfy the needs of older citizens for stationary social services, or to eliminate the waiting list for placement in boarding homes, which in general has almost doubled over 10 years.
Thus, despite the increase in the number of inpatient social service institutions and the number of residents living in them, the scale of the need for relevant services is growing at a faster pace and the volume of unmet demand has increased.
As positive aspects of the dynamics of development of stationary social service institutions, one should indicate the improvement of living conditions in them by reducing the average number of inhabitants and increasing the area of bedrooms per bed almost to sanitary standards. There has been a tendency to disaggregate existing inpatient social service institutions and improve the comfort of living in them. The noted dynamics are largely due to the expansion of the network of low-capacity boarding houses.
Over the past decade, specialized social service institutions have developed - gerontological centers and boarding houses of mercy for the elderly and disabled. They develop and test technologies and methods that correspond to the modern level of providing social services to the elderly and disabled. However, the pace of development of such institutions does not fully meet objective social needs.
In most regions of the country there are practically no gerontological centers, which is mainly due to existing contradictions in the legal and methodological support for the activities of these institutions. Until 2003, the Russian Ministry of Labor recognized only institutions with permanent residence facilities as gerontological centers. At the same time, the Federal Law “On the Fundamentals of Social Services for the Population in the Russian Federation” (Article 17) does not include gerontological centers in the range of inpatient social service institutions (subclause 12, clause 1) and distinguishes them as an independent type of social service (subclause 13 item 1). In reality, various gerontological centers with differentiated types and forms of social services exist and operate successfully.
For example, Krasnoyarsk regional gerontological center “Uyut”, created on the basis of a sanatorium-preventorium, it provides rehabilitation and health-improving services to veterans using a form of semi-stationary service.
A similar approach is practiced along with scientific, organizational and methodological activities and Novosibirsk Regional Gerontological Center.
The functions of charity houses have largely been taken over by Gerontological Center “Ekaterinodar”(Krasnodar) and gerontological center in Surgut Khanty-Mansiysk Autonomous Okrug.
Practice shows that gerontological centers to a greater extent perform tasks of care, provision of medical services and palliative care, more likely to be characteristic of compassionate homes. In the current situation, people on bed rest and in need of constant care make up almost half of all residents in gerontological centers, and over 30% in boarding homes specially designed to serve such a contingent.
Some gerontological centers, for example Gerontological Center “Peredelkino”(Moscow), Gerontological Center “Cherry”(Smolensk region), Gerontological Center “Sputnik”(Kurgan region), perform a number of functions that are not fully implemented by medical institutions, thereby satisfying the existing needs of older people for medical care. However, at the same time, the own functions and tasks of gerontological centers for which they are created may fade into the background.
Analysis of the activities of gerontological centers allows us to conclude that scientifically applied and methodological orientation should prevail in it. Such institutions are designed to contribute to the formation and implementation of scientifically based regional social policies regarding older people and people with disabilities. There is no need to open many gerontological centers. It is enough to have one such institution, under the jurisdiction of the regional social protection body, in each subject of the Russian Federation. The provision of routine social services, including care, should be provided by specially designated general boarding houses, psychoneurological boarding schools and houses of mercy.
So far, without serious methodological support from the federal center, the heads of territorial bodies of social protection of the population are in no hurry to create specialized institutions, preferring, if necessary, to open gerontological (usually gerontopsychiatric) departments and mercy departments in already existing inpatient social service institutions.
Non-stationary and semi-stationary forms of social services for the elderly and disabled. The vast majority of older people and disabled people prefer and receive social services in the forms of non-stationary (home-based) and semi-stationary social services, as well as urgent social assistance. The number of elderly people served outside of inpatient institutions is over 13 million people (about 45% of the country’s total elderly population). The number of older citizens living at home and receiving various types of services from social-gerontological services exceeds the number of elderly residents of inpatient social service institutions by almost 90 times.
The main type of non-stationary social protection services in the municipal sector are social service centers, implementing non-stationary, semi-stationary forms of social services for elderly and disabled citizens and urgent social assistance.
From 1995 to the present, the number of social service centers has increased almost 20 times. In modern conditions, there is a relatively low growth rate of the network of social service centers (less than 5% per year). The main reason is that municipalities lack the necessary financial resources and material resources. To a certain extent, for the same reason, existing social service centers began to be transformed into comprehensive social service centers for the population, providing a range of social services to all categories of low-income and socially vulnerable citizens.
In itself, the quantitative reduction in the network of social service centers is not necessarily an alarming phenomenon. Perhaps the institutions were opened without proper justification, and the population of the respective regions does not need their services. Perhaps the absence of centers or a reduction in their number when there is a need for their services is due to subjective reasons (the use of a social service model that differs from the generally accepted one, or the lack of necessary financial resources).
There are no calculations of the population’s need for the services of social service centers, there are only guidelines: each municipality must have at least one social service center for elderly and disabled citizens (or a comprehensive social service center for the population).
Accelerating the development of centers is possible only with high interest from government agencies and appropriate financial support from municipalities, which today seems unrealistic. But it is possible to change the guidelines when determining the need for social service centers from the municipality to the number of elderly people and disabled people in need of social services.
Home-based form of social service. This form, preferred by older people, is most effective in terms of the “resources-results” ratio. Home-based social services for the elderly and disabled are implemented through social service departments at home And specialized departments of social and medical care at home, which are most often structural divisions of social service centers. Where there are no such centers, departments operate as part of social protection authorities and, less often, within the structure of stationary social service institutions.
Specialized departments of social and medical care at home are developing quite quickly, providing differentiated medical and other services. The share of persons served by these departments in the total number of people served by all departments of home care for the elderly and disabled since the 90s. last century increased more than 4 times.
Despite the significant development of the network of the branches in question, the number of elderly people and disabled people who are registered and waiting their turn to receive home-based services is decreasing slowly.
A serious problem of social services at home remains the organization of the provision of social and socio-medical services to elderly people living in rural areas, especially in remote and sparsely populated villages. In the country as a whole, the share of clients of social service departments in rural areas is less than half, of clients of social and medical service departments - a little more than a third. These indicators correspond to the settlement structure (ratio of urban and rural population) of the Russian Federation; there is even some excess in services provided to the rural population. At the same time, services to the rural population are difficult to organize; they are the most labor-intensive. Social service institutions in rural areas have to provide heavy work - digging up gardens, delivering fuel.
Against the backdrop of the widespread closure of rural medical institutions, the most alarming situation seems to be the organization of home-based social and medical services for elderly villagers. A number of traditionally agricultural territories (Republic of Adygea, Udmurt Republic, Belgorod, Volgograd, Kaluga, Kostroma, Lipetsk regions), although there are departments of social and medical services, do not provide rural residents with this type of service.
Semi-stationary form of social service. This form is presented in social service centers by day care departments, temporary residence departments and social rehabilitation departments. At the same time, not all social service centers have these structural units.
In the mid-90s. last century, the network developed at a rapid pace temporary residence departments, since, given the large waiting list for state inpatient social service institutions, there was an urgent need to find an alternative option.
Over the past five years, the growth rate in the number day care departments decreased noticeably.
Against the backdrop of a decline in the development of day care departments and temporary residence departments, the activities of social rehabilitation departments. Although their growth rate is not very high, the number of clients they serve is growing quite significantly (doubling over the last ten years).
The average capacity of the units under consideration practically did not change and amounted to an average of 27 places for the year for day care departments, 21 places for temporary residence departments, and 17 places for social rehabilitation departments.
Urgent social assistance. The most massive form of social support for the population in modern conditions is urgent social services. The corresponding departments operate mainly in the structure of social service centers; there are such divisions (services) in the social protection authorities. It is difficult to obtain accurate information about the organizational basis on which this type of assistance is provided; separate statistical data does not exist.
According to operational data (there are no official statistics) obtained from a number of regions, up to 93% of recipients of urgent social assistance are elderly and disabled.
Social and health centers. Every year, social and health centers occupy an increasingly prominent place in the structure of gerontological services. The base for them most often becomes former sanatoriums, rest homes, boarding houses and pioneer camps, which for various reasons repurpose the direction of their activities.
There are 60 social and health centers operating in the country.
The undisputed leaders in the development of a network of social health centers are the Krasnodar Territory (9), the Moscow Region (7) and the Republic of Tatarstan (4). In many regions such centers have not yet been created. Basically, such institutions are concentrated in the Southern (19), Central and Volga (14 each) federal districts. There is not a single social and health center in the Far Eastern Federal District.
Social assistance for elderly people without a fixed place of residence. According to operational data from the regions, up to 30% of elderly people are registered among persons without a fixed place of residence and occupation. In this regard, social assistance institutions for this population group also deal with gerontological problems to some extent.
Currently, there are over 100 institutions for persons without a fixed place of residence and occupation in the country with more than 6 thousand beds. The number of persons served by institutions of these types increases quite noticeably from year to year.
Social services provided to older people and people with disabilities in such institutions are complex in nature - it is not enough to simply provide care, social services, treatment and social and medical services. Sometimes elderly people and disabled people with severe psychoneurological pathology do not remember their name or place of origin. It is necessary to restore the social and often legal status of clients, many of whom have lost their documents, do not have permanent housing and therefore have nowhere to send them. Persons of retirement age, as a rule, are registered for permanent residence in boarding homes or psychoneurological boarding schools. Some older citizens of this group are capable of social rehabilitation, restore their work skills or acquire new skills. Such people are provided with assistance in obtaining housing and work.
Special houses for lonely elderly people. Lonely elderly people can be helped through system of special houses, the organizational and legal status of which remains controversial. In state statistical reporting, special houses are taken into account together with non-stationary and semi-permanent structures. Moreover, they are rather not institutions, but a type of housing in which only older people live under agreed conditions. Social services can be created at special houses and even branches (departments) of social service centers can be located.
The number of people living in special residential buildings, despite the unstable development of their network, is slowly but steadily growing.
Most special homes for single elderly citizens are low-capacity homes (less than 25 residents). Most of them are located in rural areas, only 193 special houses (26.8%) are located in urban areas.
Small special houses do not have social services, but their residents, like older citizens living in other types of houses, can receive services from social and socio-medical services at home.
Not all subjects of the Russian Federation have special houses yet. Their absence to some extent, although not in all regions, is compensated by the allocation social apartments, the number of which is over 4 thousand, more than 5 thousand people live in them. More than a third of people living in social apartments receive social and socio-medical services at home.
Other forms of social assistance for the elderly. The activities of the social service system for older citizens and disabled people, with certain reservations, include: providing elderly people with free food and essential goods at affordable prices.
Share social canteens in the total number of public catering establishments engaged in organizing free meals is 19.6%. They serve about half a million people.
In the social protection system, the network is successfully developing social stores and departments. Over 800 thousand people are attached to them, which is almost one third of the people served by all specialized stores and departments (sections).
Most social canteens and social shops are part of the structure of social service centers or comprehensive social service centers for the population. The rest are managed by social protection authorities or social support funds for the population.
Statistical indicators of the activities of these structures are characterized by significant scattering, and in some regions, the information presented is incorrect.
Despite the increase in the number of citizens living in inpatient institutions and receiving services at home, the need of older people for social services is increasing.
The development of the social service system for the population in all its diversity of organizational forms and types of services provided reflects the desire to meet the various needs of older citizens and disabled people in need of care. The full satisfaction of justified social needs is hampered, first of all, by the lack of resources in the constituent entities of the Russian Federation and municipalities. In addition, a number of subjective reasons should be indicated (methodological and organizational inadequacy of some types of social services, lack of a consistent ideology, a unified approach to the implementation of social services).
- Tomilin M.A. The place and role of social services in modern conditions as one of the most important components of social protection of the population // Social services of the population. 2010. No. 12.S. 8-9.
One of the important effective mechanisms for solving and mitigating social problems of elderly citizens and people with disabilities in the context of modernization of Russian society is the organization of their social services. It should be noted that stable trends in increasing the proportion of older people in the population are becoming one of the factors of economic, political, social, spiritual and moral changes in Russian society. The constitutional proclamation of the Russian state as social, large-scale humanistic ideas of building a “society for people of all ages” turn the implementation of tasks to create conditions for improving the quality of life of older citizens into one of the key directions of state social policy. Social services are the activities of social services for social support, provision of social, social, medical, psychological, pedagogical, socio-legal services and material assistance, carrying out social adaptation and rehabilitation of citizens in difficult life situations. The totality of these services can be provided to elderly citizens and disabled people at home or in social service institutions, regardless of their form of ownership.
Elderly people and disabled people who have reached the established retirement age have the right to social services if they need permanent or temporary assistance due to partial or complete loss of the ability to independently satisfy their basic life needs due to existing limitations in the ability to self-care and movement.
Since the late 80s - early 90s of the last century, when in the country, against the background of radical transformations in all spheres of social life, the socio-economic situation of a significant part of citizens, including the elderly and disabled, sharply worsened, there was an urgent need for a transition from the old system of state social security to the new system of social protection. The demographic processes of progressive aging of the population also necessitated changes in policies regarding older people.
Evidence of the concern of a number of countries about the growing number of older people was the adoption by the UN World Assembly in Vienna in 1982 of the International Plan of Action on Aging, which prompted many countries to develop their own national policies and programs regarding the elderly. The Assembly resolution declared that “the aging should, as far as possible, be allowed to live productive, healthy, secure and satisfying lives in their own families and communities and be considered an integral part of society.” In the social security system of the population of the USSR, new accents also began to appear on the need to find forms of strengthening care, first of all, for single elderly citizens and the disabled, and to organize assistance for them at their place of residence.
Non-stationary types of social services for elderly citizens abroad began to actively develop in the second half of the 20th century.
The Swedish decentralization regime ensured that everyone had equal access to all social services. A 1982 law placed responsibility for social care for the elderly in the hands of the communes. Communes should provide a variety of services that promote the greatest possible autonomy for older people. Assistance in housekeeping includes cooking, cleaning, laundry, meeting individual needs, etc. At the same time, for people living far from the center, everything necessary for cleaning, technical assistance, as well as personal hygiene items and books are delivered by special transport. Additional transport services upon personal request help an elderly person maintain contact with friends and acquaintances. In the system of measures to provide medical services to elderly people who have lost their independence, preference is also given to keeping them at home.
The UK government policy towards elderly citizens and disabled people is also focused mainly on creating adequate conditions for their living at home, primarily through the widespread provision of non-stationary forms and types of social services. Social and medical care at home is considered here as an important mechanism for the implementation of all social policy in the country, allowing to resolve many problems of this category of people associated with loneliness and loss of interest in life, helping to maintain contacts with others and improve living conditions. At the same time, the organization of social services is entrusted to local governments, which provide both mandatory and additional services. Not only full-time employees, but also numerous volunteers from various public, religious, charitable, youth and other organizations participate in the implementation of social programs.
Very popular among the elderly and disabled in the UK are such forms of assistance as “social club”, “social cafe”, which are usually created by religious and public charitable organizations. The main areas of their work include organizing communication between clients, their leisure time, providing inexpensive meals, medical, legal, psychological consultations, and organizing hobby groups.
In France, two types of assistance to older people are most widespread - the provision of services by “home assistants” and nursing care at home. The domestic helper service is intended to provide services primarily of a domestic nature to persons experiencing difficulties in purchasing food, preparing food, and maintaining living quarters. For elderly people with a significant degree of loss of ability to self-care, a nursing care service is provided, the functions of which, in addition to regular home care, include the provision of pre-hospital medical care and hygienic services. For persons discharged from inpatient medical institutions and who do not require intensive treatment, a “hospital at home” can be organized. Services for such persons are provided by doctors and nurses together with a social worker who provides household services.
The fundamental principles of social services for the elderly in France include the following:
- 1. Personal dignity. An elderly person, whatever his age, state of health, degree of loss of independence and level of income, has the right to service, qualified treatment and treatment.
- 2. Freedom of choice. Every elderly person whose health condition requires special intervention should have the opportunity to choose the form of care and its duration.
- 3. Coordination of assistance. Providing assistance and service requires coordinated and effective efforts that are as close as possible to the needs of the individual.
- 4. Help is provided first of all to those in need.
The experience of foreign countries attracted attention and demonstrated the legitimacy of using, in order to ensure the full functioning of elderly citizens and people with disabilities, a system of non-stationary social services that are close to their place of permanent residence and contribute to the preservation of activity and healthy longevity of these persons.
Not all single elderly and disabled people in need could receive help in boarding homes and inpatient institutions, since there were not enough places and many waited in queues. The population's needs for social services increased, and state and municipal institutions were not able to provide them in a timely and high-quality manner, even to those individuals who, for various reasons, were left without relatives and friends. These people were most often under the tutelage of friendly and sensitive neighbors, acquaintances, and bosses who were ready to help them. But the elderly needed constant and systematic care, services of a wide variety of properties. There was a growing understanding that the implementation of such tasks could only be accomplished by workers and social services specially assigned to serve them.
The first document that expressed the new direction of state policy in this area and laid the normative basis for organizing work was the resolution of the Central Committee of the CPSU, the Council of Ministers of the USSR and the All-Russian Central Council of Trade Unions dated May 14, 1985 “On priority measures to improve the material well-being of low-income pensioners and families, strengthening care about lonely elderly citizens.”
The following priorities were identified:
- - establishment of additional payments to pensions at the expense of local budgets for single pensioners in dire need from among workers, employees and members of their families;
- - establishing a 50 percent discount on the cost of medicines purchased according to doctors’ prescriptions for pensioners receiving minimum pensions;
- - increasing care for labor veterans by associations, enterprises, organizations, expanding the practice of constructing boarding schools, including inter-collective farm and collective farm, using funds from social and cultural events and housing construction funds;
- - development of the construction of residential buildings for single elderly citizens with a complex of social services and premises for the work of pensioners;
- - ensuring registration of single disabled and elderly citizens who are especially in need of help, and organizing their social services with wide involvement for these purposes of consumer services, trade enterprises, public catering, foster care services, organizations of the Red Cross society, health care institutions, individual citizens employed in the household, students with appropriate remuneration for their work.
Thus, the country began to create a system of social assistance for single elderly people, disabled people and low-income pensioners, focused on the diversity of its forms and types. In many territories, complex targeted programs “Care” and “Duty” began to be developed and implemented, and the defining institutions were the nascent multifunctional social service centers, departments of social assistance to single people at home, special residential buildings with a range of social services.
The result of the implementation of this resolution was the opening of the first experimental social assistance departments at home under the social welfare departments of the district executive committees.
The activities of such departments to identify, organize accounting and social services for single elderly citizens and disabled people in need of outside help and care gradually developed. Local social welfare authorities took responsibility and began to implement measures to provide such people with necessary services at home, including the delivery of food, lunches, medicines and hygiene products, fuel, laundry and cleaning of residential premises. Lists of identified persons were also sent to enterprises and services of trade, public catering, housing and communal services, consumer services, and health care institutions to organize the necessary assistance at home. In some settlements, organizations of the Red Cross society and Komsomol youth groups took care of lonely elderly people and disabled people. Therapeutic and recreational activities were carried out according to individual plans. Day hospital departments and hospitals at home for the elderly developed everywhere; public health rooms appeared in residential neighborhoods in cities, which made it possible to carry out constant medical monitoring of the health status of the elderly. A network of geriatric offices in the health care system was developed.
A further step in the development of social services was the Decree of the Central Committee of the CPSU, the Council of Ministers and the All-Union Central Council of Trade Unions dated January 22, 1987 No. 95 “On measures to further improve services for the elderly and disabled.” The resolution consolidated the legal status of social assistance departments at home, and also provided for the creation of territorial social service centers that would make it possible to combine home-based and stationary forms of state support and assistance to single and disabled citizens into a single complex.
By order of the Ministry of Social Security of the RSFSR dated June 24, 1987, the Regulations on the territorial center for social services for pensioners, on the department of social assistance at home for single elderly and disabled citizens, as well as the staffing standards of these institutions were approved.
Significant success in serving single citizens at this stage was achieved in the Ulyanovsk region. A lot of organizational work was carried out here, the “Care” program was developed, measures were taken to provide single elderly citizens living in rural areas with various types of services - from the construction and repair of a residential building to the delivery of fuel and feed for livestock in their personal yard. Work on medical examinations and comprehensive medical examinations of single rural residents has intensified, enterprise bosses have been assigned to them, and many have been provided with new housing. For medical and social assistance to single disabled citizens, “nursing bureaus”, “patronage bureaus” were organized, and “mercy posts” were established.
In Ivanovo, Kuibyshev and other regions, a different model of service developed through boarding houses operating in the system of social security authorities. House employees once every 7-10 days, as part of an integrated team, went to single elderly citizens and brought them a set of food, clean linen, medicines, cleaned the premises, and provided medical care. Initially, social service centers were created on the basis of existing boarding houses, but gradually the structure of these institutions changed, and they began to function autonomously, in no way connected with boarding schools.
In 1992, ten years after the adoption of the Vienna Plan of Action on Ageing, a new program of international cooperation was prepared, UN principles on older people were developed and recommended for their inclusion in national programs. Much attention in these documents was paid to the organization of care and protection of disabled elderly citizens, ensuring access to medical care, social, legal and other services that allow maintaining an optimal level of well-being, dignity and independence. It was especially emphasized that older people should live at home as long as possible. Attention was drawn to the importance of forming an active subjective life position of the oldest person. Such approaches to the status of disabled elderly people have found recognition in many countries, including Russia.
Began in the early 90s. last century, economic reforms and large-scale liberalization of prices led to a sharp drop in the living standards of the population, a deterioration in the consumption structure, and an increase in socio-psychological tension in society. As the crisis grew, a set of measures was urgently needed to reduce the level of social instability. A general focus was taken on supporting the population through a system of social compensatory measures. Using funds from budgets at all levels, reserve funds for social protection of the population began to be urgently formed, and a targeted system of social assistance was developed for the most vulnerable groups of the population, including elderly disabled citizens.
The Decree of the President of the Russian Federation “On additional measures for social support of the population in 1992” provided for the streamlining and development of the local system of providing in-kind assistance (charity canteens, social shops, etc.), as well as the creation of social assistance departments at home and territorial centers of social services for the population of emergency social assistance services. Strengthening the targeting of social support to vulnerable groups of the population in order to limit poverty and provide basic guarantees in the field of medical and social services, education and cultural development was declared a priority task of state social policy.
In the Main Directions of Social Policy of the Government of the Russian Federation for 1997, it was noted that although the general situation in the country continues to remain tense, some positive symptoms have also appeared that characterize the processes of gradual adaptation of the population to market conditions.
At the end of 1994, about 10 thousand social assistance departments at home were already functioning in the country, over
1.5 million elderly and disabled people need home care; out of every 10 thousand pensioners, 250 people received such help. In 1995, 10,710 home service departments provided social assistance to 981.5 thousand single elderly and disabled people, 42.6% of whom lived in rural areas. Moreover, of the total number of departments, 57% were located in the structure of territorial centers and boarding houses.
The high demand of older citizens for medical services has necessitated the opening of specialized departments of social and medical services at home. The number of such branches in 1998-2001. increased from 632 to 1370, i.e. more than 2 times, and the persons served by them, respectively, from 41.6 thousand to 151.0 thousand people, or 3.6 times.
Thus, in the 90s of the last century, home-based social services for elderly and disabled people of this age were intensively formed and developed in the country. Almost 150 thousand full-time workers were employed in this area. In 1995, the number of emergency social assistance services was 1,585, in which 5.3 million people received various types of one-time support within one year.
All these processes developed in line with global trends and in accordance with the requirements of international legal acts on aging issues.
The key to understanding the direction of development of social services for older people in these years can be considered the norm of the European Social Charter of May 3, 1996 “to give older people the opportunity to freely choose their lifestyle and lead an independent existence in a familiar environment, as long as they are willing and able to do so.” This".
In the activities of social assistance services, a differentiated approach to the population of those served was strengthened, taking into account the diversity of their needs and demands. The regulatory and legal framework of the policy in this area began to require further improvement, development and approval of special norms for organizing work in changing conditions.
Adoption in the mid-90s of the XX century. a number of legislative acts, federal laws “On the fundamentals of social services for the population in the Russian Federation”, “On social services for elderly citizens and disabled people”, “On social protection of disabled people in the Russian Federation”, “On state social assistance”, “On veterans”, “On charitable activities and charitable organizations”, etc. was due to these reasons and characterizes the beginning of a new stage in the development of social services for the population.
Favorable opportunities for actually providing older citizens with high-quality social services were created by the approval in 1997 by the Government of the Russian Federation of the target program “Older Generation”, one of the most effective social programs, characterized by an innovative approach, comprehensiveness, and sustainable financing. The program was extended for 2002-2004. and new tasks were set for this period.
The main goal of the program was to create conditions for improving the quality of life of older citizens through the development of a network of social service institutions and improvement of their activities, ensuring the availability of medical care, educational, cultural, leisure and other services, promoting the active participation of older people in society.
The “Older Generation” target program has become an effective model of intersectoral cooperation, combining the efforts of a number of ministries and departments to strengthen, first of all, the material and technical base of social service institutions for elderly citizens and the disabled. Measures were taken everywhere to overhaul, reconstruct, disaggregate, technically re-equip facilities for the elderly, and equip them with means to facilitate care for the elderly.
During the implementation of the program, emphasis was placed on the need for a systematic solution to the problems of developing social services for older people, the application of uniform principles of network management and the consistent introduction of new organizational and legal forms of institutions, ensuring the accessibility of social services through mobile social services, the availability of specialists with a high status in all main indicators.
Taking into account the norms and requirements of the main international documents, ideas were actively developed about the need to perceive the older generation not only as recipients of assistance, but also as subjects capable of being active and participating in the social life of society.
A major role in the implementation of these ideas in social work with the elderly and disabled was played by social service centers, institutions of a new type, which first appeared, as already noted, in the late 80s of the last century.
Such institutions carry out all organizational and practical activities on the territory of a city or district to provide various types of social assistance to elderly citizens, disabled people, families with children, people without a fixed place of residence and other groups of the population in need of social support.
The center has in its structure various social service units, including day care departments for the elderly and disabled, social assistance at home, an emergency social assistance service, etc. Many centers have social canteens, shops, hairdressers, shoe and household appliance repair shops and other social services. The network of non-stationary social service institutions for elderly citizens and people with disabilities is developing dynamically, the total number of such centers in the country has now reached almost 2.3 thousand against 86 in 1992. The structure of the centers includes about 12 thousand social service departments at home, including employing 178.5 thousand social workers. They provide various social services to almost 1.5 million people a year, or 92.2% of elderly and disabled citizens registered for home-based services.
The main tasks of the center are as follows:
- - identification of the elderly, disabled, families with children and other persons in need of social support;
- - determination of specific types and forms of assistance;
- - differentiated accounting of all persons in need of social support, depending on the types and forms of assistance required, the frequency of its provision;
- - provision of various social services of a one-time or permanent nature;
- - analysis of the level of social services for the population of the city, district, development of long-term plans for the development of this area, introduction into practice of innovative technologies of assistance, depending on the nature of the needs of citizens and local conditions;
- - involvement of various government and non-governmental organizations, public structures in resolving issues of providing social, medical, social, psychological, legal assistance to elderly people and other people in need, coordinating their activities in this direction.
The provision of social services in such institutions can be provided on a full or partial payment basis or free of charge, depending on the client’s income level compared to the cost of living in the region. Funds from collecting fees for services are used to further develop social services and stimulate the work of social workers. Social service institutions are required to enter into agreements with citizens accepted for paid services, which determine the volume and types of services provided, terms, procedure and amount of payment.
Social services are provided free of charge to the following categories of clients:
- 1) single elderly citizens (single married couples) and disabled people receiving a pension in an amount below the subsistence level established for a given region;
- 2) elderly citizens and disabled people who have relatives who, due to remoteness of residence, low income, illness and other objective reasons, cannot provide them with assistance and care, provided that the amount of pension received by these citizens is lower than the subsistence level established for the given region ;
- 3) elderly citizens and disabled people living in families whose average per capita income is below the subsistence level established for a given region.
Social services are provided on a partial payment basis:
- 1) single elderly citizens (single married couples) and disabled people receiving a pension in the amount of 100 to 150% of the minimum subsistence level established for a given region;
- 2) elderly citizens and disabled people who have relatives who cannot, for objective reasons, provide them with help and care, provided that the amount of pension received by these citizens is from 100 to 150% of the minimum subsistence level established for the given region;
- 3) elderly citizens and disabled people living in families whose average per capita income is from 100 to 150% of the subsistence level established for a given region.
Social services on a full payment basis are provided to elderly citizens and disabled people living in families whose average per capita income exceeds the subsistence level established for a given region by 150%.
In accordance with Art. 15 of the Federal Law “On the Fundamentals of Social Services for the Population in the Russian Federation,” paid social services in the state system of social services are provided in the manner established by the state authorities of the constituent entities of the Russian Federation. When contacting social services, older people and people with disabilities have the right to:
- 1) to choose an institution and form of service;
- 2) respectful and humane attitude on the part of the institution’s employees;
- 3) information about your rights, obligations and conditions for the provision of social services;
- 4) confidentiality of personal information that became known to an employee of the institution during the provision of social services;
- 5) protection of their rights and legitimate interests, including in court;
- 6) refusal of social services.
Restrictions on the rights of elderly and senile citizens in the provision of social services to them are allowed in the manner prescribed by Federal Law No. 122-FZ of August 2, 1995 “On Social Services for Elderly and Disabled Citizens”, and may be expressed in the premises of these citizens without their consent to social service institutions in cases where they are deprived of care from relatives and other legal representatives and at the same time are unable to independently satisfy their vital needs (loss of the ability for self-care and (or) active movement) or are recognized as legally incompetent.
The issue of placing such people in inpatient social service institutions without their consent or without the consent of their legal representatives is decided by the court on the proposal of the social protection authorities.
Refusal from the services of social service institutions for elderly and senile citizens is made upon a written application from their legal representatives if they undertake to provide these persons with care and the necessary living conditions.
Elderly citizens and disabled people who are bacteria or virus carriers, or if they have chronic alcoholism, quarantine infectious diseases, active forms of tuberculosis, severe mental disorders, venereal and other diseases requiring treatment in specialized healthcare institutions, may be denied social benefits. home services.
Refusal to provide elderly citizens and disabled people with social services is confirmed by a joint conclusion of the social protection body and the medical advisory commission of the health care institution.
Social services for elderly and senile citizens provided in non-stationary conditions may be terminated if they violate the norms and rules established by social service management bodies when providing this type of service.
The widespread development of social service centers and the creation of social service departments at home within their structure expresses the priority direction of policy in this area - to enable older people to remain full members of society for as long as possible and live in familiar home conditions.
At a meeting with the Minister of Health and Social Development of the Russian Federation, President of the Russian Federation D. A. Medvedev in September 2010 noted: “Now the time has come to more actively engage in the implementation of the rights of older people, to think about how to stimulate labor activity, how to help them more successfully, take this topic as one of the state priorities... This should become a big and serious work.”
The structure of demand for social services is gradually changing and depends on a number of factors. Expensive services for constant outside care, social and medical services, and nursing services are becoming increasingly in demand. First of all, this is explained by the socio-demographic processes of changing the structure of the population over working age, the disability of society, the emergence of groups of people with special needs, such as:
- 1) elderly disabled people - there are about 5.3 million of them in the country;
- 2) persons over 70 years of age - approximately 12.5 million people;
- 3) centenarians - about 20 thousand people aged 100 years and older;
- 4) lonely, long-term ill elderly people;
- 5) elderly residents of remote rural settlements - about 4 million people.
Article 16 of the Federal Law “On Social Services for Elderly and Disabled Citizens” provides for the following forms of social services for such citizens:
- 1) social services at home, which is aimed at maximizing the possible extension of the stay of elderly and disabled people in their usual social environment in order to maintain their social status, as well as to protect their rights and legitimate interests;
- 2) semi-inpatient social services in day (night) departments of social service institutions, including social, medical and cultural services for the elderly and disabled, organizing their meals, recreation, ensuring their participation in feasible work activities and maintaining an active lifestyle;
- 3) inpatient social services in stationary social service institutions (boarding homes, boarding houses, houses of mercy, homes for veterans, etc.), involving the provision of comprehensive social and domestic assistance to elderly and disabled people who have partially or completely lost the ability to self-care and who, for health reasons, need constant outside care and supervision;
- 4) urgent social services, carried out for the purpose of providing emergency one-time assistance to elderly and disabled people in dire need of social support;
- 5) social advisory assistance for elderly and disabled people, aimed at their adaptation in society, easing social tension, creating favorable relationships in the family, as well as ensuring interaction between the individual, family, society and the state.
The diversity and complexity of social problems caused by the aging population require adequate measures to provide the elderly with a guaranteed minimum of social services, and the development of such forms of service that could contribute to the realization of personal potential in old age.
Social services for older citizens in modern conditions are based on the following principles:
- - the principle of state responsibility - implies constant activity to improve the social situation of older citizens in accordance with changes occurring in society, fulfillment of obligations to prevent poverty and deprivation associated with market economic transformations, forced migration, and emergency situations of various types;
- - the principle of equality of all citizens of the older generation - implies an equal right to protection and assistance in difficult life situations, to recognition of decisions regarding one’s life activities, regardless of social status, nationality, place of residence, political and religious beliefs;
- - the principle of continuity of state social policy and stability of measures in relation to older citizens to preserve social guarantees of support and take into account their interests as a special category of the population;
- - the principle of social partnership - involves the interaction of the state, society and individual citizens in the implementation of measures to ensure the social well-being of older people, constant cooperation with family, public associations, religious, charitable organizations and other social partners providing assistance and services to older people;
- - the principle of unity of policy, commonality of views, consolidation of funds allocated to solve the priority problems of older citizens at all levels of government;
- - the principle of ensuring equal opportunities in receiving social services and their accessibility for all older citizens.
Based on these principles, the main directions for further development of the system of social services for elderly and disabled people of this age can be identified as follows:
- - sustainable increase in the level of social services at home and in inpatient settings as a factor in improving the quality of life in old age;
- - development of a network of institutions and services for social purposes of new types, allowing to take into account regional characteristics of climatic, national-ethnic, demographic, religious nature, including mobile interdepartmental social services;
- - provision of social services on an individual basis, the use of effective innovative service models close to the needs of older people;
- - consistent differentiation of the approach to determining the amount of fees for services provided, taking into account the individual needs of clients and their social status;
- - concentrating the efforts of institutions on providing older people with high-quality social and medical services, including hospices at home;
- - strengthening targeted rehabilitation and physical education and health work aimed at improving health, preventing diseases and premature aging;
- - improving interaction with social partners, public associations, charitable, religious organizations, families and volunteers in the implementation of activities to provide social services to older citizens;
- - development and implementation of innovative technologies for family care for older people in their usual environment;
- - ensuring a high level of professional training, retraining and advanced training of specialists employed in the areas of social services for the population;
- - development and implementation of research programs to study the specific lifestyle and situation of older people, dissemination of best practices in organizing their social services.
Further improvement of state social policy in relation to older citizens involves the implementation of the following priorities:
- - strengthening the legal protection of these citizens through the adoption of special legislative norms that facilitate the implementation of constitutional guarantees of their social rights, expanding the network of the legal profession and creating social courts;
- - implementation of measures to maintain a guaranteed level of income, regardless of region of residence, belonging to a socio-economic category and other conditions;
- - improving health status, ensuring accessibility for all older citizens of medical and special geriatric care, continuity and interconnection of diagnosis, treatment, rehabilitation, medical and psychological support, payment of social benefits for care, rationalization of nutrition;
- - increasing the role of the family in caring for the elderly, economic, social and psychological support for families providing care for elderly relatives, especially families with low incomes and elderly couples;
- - providing older people with decent housing conditions in accordance with minimum state standards that meet physical capabilities and lifestyle specifics, through modernization, reconstruction and repair of houses and apartments, design and construction of new types of housing, creating conditions for active recreation;
- - creating favorable conditions for feasible employment of older people, preventing discrimination on the basis of age and ensuring equal access to vocational training and retraining programs;
- - stimulating social participation and initiatives of older citizens, promoting the activities of public associations and organized communities to implement interpersonal contacts, satisfy cultural and aesthetic needs and the desire for creative self-realization;
- - providing information on measures to improve their legal, economic and social status, the activities of government bodies to protect the rights of people of the older generation
One of the important facts for ensuring the effectiveness of social services for the elderly and disabled is the correct selection, training and placement of personnel. Until recently, the level of professional training of social workers providing home-based services to older people was regulated by the relevant tariff and qualification characteristics approved by resolutions of the Ministry of Labor of Russia dated October 12, 1994 No. 66, dated February 22, 1996 No. 12. They determined the job responsibilities of the employee and the amount of knowledge and skills required to provide social services guaranteed by the federal list to an elderly person at home.
In connection with the adoption of Decree of the Government of the Russian Federation of August 5, 2008 No. 583 “On the introduction of new systems of remuneration for employees of federal budgetary institutions and federal state bodies, as well as civilian personnel of military units, institutions and divisions of federal executive authorities, in which the law provides military and equivalent service, the remuneration of which is currently carried out on the basis of a unified tariff schedule for remuneration of employees of federal government institutions”, the norms of these acts have become invalid. Currently, remuneration systems for workers in this area are regulated by collective agreements, agreements, and local acts in accordance with the current legislation of the Russian Federation and its constituent entities. The abolition of the Unified Tariff Schedule made it possible to change the basic principles of setting wages depending on the quantity and quality of work performed, and to introduce incentive payments to the employee’s basic salary.
In conjunction with the processes of formation of the social service system, multi-level training of specialists for this field has been successfully developing in the country in recent decades. Social workers receive initial vocational education in vocational schools for various purposes. Secondary vocational educational institutions train mid-level specialists. And finally, the implementation of higher professional and additional postgraduate education programs in the specialty “social work” is carried out by higher educational institutions. The Russian State Social University has become the leader of domestic social education, heading the educational and methodological association, which currently has 236 state universities engaged in training specialists for this field.
The profession of a social worker has a pronounced humanistic orientation, and the professional competence of social service specialists is the most important factor in increasing the effectiveness of public policy towards older citizens. The concept of “competence” includes complex content that integrates basic professional, socio-legal, socio-psychological, socio-pedagogical, socio-gerontological and other characteristics. The competence of a specialist should be considered primarily as a set of knowledge, skills, abilities, qualities and personality traits necessary for professional activity in this field.
In a number of foreign countries, where the training of social work specialists has been carried out for many decades, certain criteria for their professional competence have been developed. The same problem is becoming relevant in Russia. At the same time, it should be noted that professionalism, as one of the leading components of social work, is also based on personal qualities, value orientations and interests of the social worker himself as a subject of assistance. The development of personal interest in the chosen profession, ideas about the basics of social work technology, its place in the system of social relations and the formation of motivational attitudes towards one’s activities contribute to the successful solution of social problems.
In the USA, for example, it is believed that the professional competence of a social worker combines the following components:
- 1) conceptual competence or understanding of the theoretical foundations of the profession;
- 2) instrumental competence is the possession of basic professional skills and abilities;
- 3) integrative competence is the ability to combine theoretical knowledge and practical skills in one’s professional activities;
- 4) analytical competence - the ability to analyze social processes, identify trends and patterns;
- 5) correctional competence - the ability to modify, adapt, adjust one’s actions to a changing situation;
- 6) evaluative competence or the ability to evaluate one’s professional actions, determine their effectiveness and efficiency.
Similar approaches in the process of training specialists in social work are being implemented in Russia, developing in close unity with the growing network of social institutions and relying on the norms of legislation in force in this area, state standards of social services for the population.
Social work specialists in modern conditions are in demand in government and non-governmental social services, organizations, labor collectives of industrial enterprises, associations, healthcare institutions, military units, and the penitentiary system. The needs of individual population groups, specific social situations, and the characteristics of people’s lives dictate the need to develop various modifications of social technology for providing assistance. The functional activity of a specialist in various areas of social practice can have a multivariate coloration.
In the qualification characteristics of specialists working in the field of social services for older people, the following qualities are especially significant: professional preparedness, erudition in the processes of socio-economic development of society, communication skills, emotional stability and readiness for psychological stress, tolerance, ability to make decisions and responsibility for them consequences, the ability to attract the attention of others to the results of one’s professional activities, and to interact with various social institutions of society. The basic characteristics remain a motivational and value-based attitude towards one’s profession, professional consciousness and self-awareness.
It should be noted that at present, a draft amendment to the Federal Law “On the Fundamentals of Social Services for the Population in the Russian Federation” has been submitted to the State Duma, which will meet the realities of modern life in Russian society and the changing socio-economic conditions. These changes are due primarily to the fact that the provisions of the current laws do not fully satisfy the needs of the population for high-quality social services.
There are regional differences in the scope of citizens' rights to social services, the levels of their implementation and accessibility. There have been long queues for receiving social services at home and in inpatient settings. In the constituent entities of the Russian Federation, the grounds for recognizing citizens as needing social services are defined differently. All these points require thorough legislative adjustments and unification of approaches to organizing the provision of services.
It is also envisaged to introduce a number of new basic concepts and terms, such as “state assignment for the provision of social services”, “individual need”, “social service provider” and some others. All this is aimed at strengthening the status of participants in social services for the population, including this area in the system of relations arising from the legal status of budgetary, autonomous and government institutions, placing state (municipal) orders, state support for socially oriented non-profit organizations, charitable and volunteer activities.
Expansion and specification of the list of powers of federal government bodies and government bodies of constituent entities of the Russian Federation in the field of social services for the population, defined by the bill, also reflect modern approaches, technologies and management solutions tested in practice in this area.
The adoption of these changes will certainly be a new step towards further improvement of the system of social assistance to the population.
Questions for self-control:
- 1. What is social services for the population?
- 2. How do you understand the activities of the social service system, what elements does this system include?
- 3. What forms of social services are available for older citizens?
- 4. What types of non-stationary services for older people are most popular in modern conditions?
- 5. What principles are social services for older citizens and disabled people based on?
- 6. What qualities should a specialist working with older people have?
Elderly and disabled people, left without the help of relatives, often cannot cope with ordinary household chores due to their age and poor health. Therefore, they are provided with social and medical services at home - by state budgetary institutions, municipalities, organizations and entrepreneurs. From this article you will learn what social services for the elderly and disabled at home are, who can count on such help, and how to receive the service.
Social services for the elderly and disabled at home: types of social services
Citizens who meet the legal requirements for recipients of social services at home can count on the following types of assistance:
- accompaniment to places of recreation, sanatoriums, medical institutions, state and municipal institutions;
- assistance in paying utility bills;
- assistance in organizing everyday life, arranging housing, carrying out cosmetic repairs, washing things, cleaning the house;
- water delivery, heating of the stove (if the beneficiary lives in a private house without central water supply and heating);
- cooking, organizing everyday life and leisure, going to the grocery store and pharmacy.
If a person cannot take care of himself independently, a social worker must help. The following services can also be provided depending on the citizen’s health status:
- joint visits to clinics;
- psychological support, assistance in sanatorium-resort treatment, hospitalization and in-patient care;
- assistance in carrying out social and medical rehabilitation, in passing the medical examination;
- assistance in obtaining medical services;
- implementation of medical procedures and manipulations, hygiene procedures;
- assistance in paperwork;
- legal and legal services;
- assistance in obtaining secondary and higher education (for people with disabilities).
Who has the right to social services for the elderly and disabled at home
The following categories of persons have the right to invite a social worker to your home:
- Citizens of retirement age (women over 55 years old and men over 60 years old).
- People with disabilities (disabled people of all three groups).
- People who are temporarily disabled and do not have assistants.
- Citizens who find themselves in a difficult situation due to alcohol or drug addiction of a family member.
- Some other categories of persons, for example, orphans without a place of residence.
Social services at home can be provided free of charge, on a partial payment basis or for payment in full.
| Payment for social services | Recipient categories |
| For free | Disabled people of the Second World War, war veterans, spouses and widows of combatants, former prisoners of concentration camps, former residents of besieged Leningrad, Heroes of the USSR and the Russian Federation, Heroes of socialist labor. Disabled people and pensioners who do not belong to special categories of citizens (federal beneficiaries), but have an income below 1.5 times the regional subsistence minimum. |
| Partial payment | Citizens who are not disabled or pensioners, but need the help of a social worker and have an income below 1.5 times the regional minimum wage (the size of the discount depends on social status). |
| Full price | In all other cases. |
How to register for social services for the elderly and disabled at home, in what cases the service may be refused
Important! To apply for social services at home, you must contact the regional office of social protection authorities.
Before an application for assistance is approved, social service employees must check the documents in order to assess the degree of need of the citizen to receive help from a social worker (since there are many people who want it, but there are usually not enough resources), and check the living conditions of the person applying. The law provides for the following cases when an applicant may be denied social services:
- If there are contraindications to social assistance. This refers to the presence of factors that could jeopardize the life and health of a social worker:
- presence of severe mental disorders,
- drug addiction,
- alcohol addiction,
- taking psychotropic drugs,
- presence of quarantine diseases,
- the presence of severe infectious pathologies;
- the presence of an open form of tuberculosis;
- the presence of any diseases requiring specialized treatment.
- The applicant's application to the State Police in a drunken or inappropriate state.
- High employment of the organization, lack of free social workers.
- The applicant is a person of no fixed abode.
When applying to social security authorities, you will need the following documents:
- conclusion of a medical and social examination on assignment of a disabled group;
- a certificate from a medical institution confirming the absence of diseases for which it is impossible to receive social assistance;
- pension certificate;
- certificate of family composition;
- certificate of income.
Expert opinion on the issue of social services for the elderly and disabled at home
Participants took part in last year’s seminar-meeting on issues of social services for elderly and disabled citizens, which was held at the Ministry of Social Development and Labor of the Kamchatka Territory Minister of Social Development and Labor I. Koirovich, Deputy Minister E. Merkulov, Head of the Social Services Department N. Burmistrova, heads of social protection bodies and heads of social services organizations for disabled and elderly citizens.
The economic, organizational, and legal foundations of social services, the rights and obligations of recipients and service providers, and the powers of government authorities established by Federal Law No. 442-FZ dated December 28, 2013 were discussed. The main attention was paid to the following issues:
- Citizens with an income below 1.5 monthly wages in the region have the right to receive free social assistance at home (previously, the pension had to be below 1 monthly wage);
- a detailed approach to the approval of a set of social services taking into account the needs of the citizen was introduced;
- citizens received the right to independently choose their social service provider;
- Now not only pensioners and disabled people can apply for social services at home, but also citizens who are temporarily disabled, faced with intra-family conflicts (related to drug addiction, alcoholism in relatives), who need help caring for a disabled child and have no place residence (if you are an orphan).
