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Frequently asked questions regarding social rehabilitation

 

Who are entitled to receive social rehabilitation services?

The social rehabilitation service is meant for disabled persons or persons with partial or no work ability, who require assistance with enhancing or retaining their quality of life in connection to difficulties in coping caused by their disability or special needs.

For example:

  • a person cannot individually cope at home,
  • a person cannot orientate in the city after loss of sight, resulting in them staying indoors,
  • a person cannot communicate with other individuals as they cannot use necessary technical aids or cannot emotionally cope due to changes.

The service is not purely meant for relieving physical disorders. For example, if a person is experiencing back pain, they actually need medical rehabilitation that can be received through a family physician or medical specialist, without having to apply for disability or evaluation of work ability.

 

What changes were made to the social rehabilitation system in 2016?

The rehabilitation service was divided into social and work rehabilitation.

Work rehabilitation is meant for persons of working age with decreased work ability or persons who have a disability or permanent incapacity for work or partial work ability or who have been declared incapacitated for work on the basis of previous procedure. Work rehabilitation services are meant for persons from the age of 16 until retirement age and provided by Eesti Töötukassa (link). In order to use the service, a person must be active in the professional field – occupy a position, be seeking for a job or studying.

Social rehabilitation is meant for all disabled persons and persons with partial or no work capacity who need assistance in their everyday lives with restrictions arising from their disabilities or special needs and the social rehabilitation service is provided by the Social Insurance Board.

The organisation and content of the social rehabilitation service was also changed. For adults, the evaluation of rehabilitation needs was added, by its nature being an interview with a case manager of the Social Insurance Board with the aim to determine if and which services are needed by the individual. Current experience shows that a large number of people have received services without considering if the content and aim of a specific service support the needs of a person. Evaluation allows us to approach every person on an individual level and assure that they receive the help they need, either by the means of rehabilitation or any other services.

The list of new services also includes the services of a peer counsellor, a doctor and a nurse.

A peer counsellor is a person with a similar disability or experience of special needs, who has received a training required to provide assistance and been prepared for working in a rehabilitation facility. Their role in the rehabilitation environment is to provide counsel and support as a person with a similar disability, health condition, experience or special need. By relying on their personal experience, a peer counsellor can exchange experiences and knowledge with a person receiving services and provide emotional, social and practical support.

A nurse and a doctor mainly play supportive roles, in order to avoid damaging a person's health. The additional role of a nurse is to inform persons on how to take care of themselves and their health, provide counselling and increasing awareness on preventing illnesses. In the context of the rehabilitation service, the role of a doctor or a nurse is not to establish a diagnosis or treatment or refer the person to further analyses.

If, until now, target groups of the service had been divided into minors and adults, then from the year 2016 they are being divided on the grounds of working age. This means that persons between the age of 0-15 receive the service on one basis and those from 16 years of age and older on another. The evaluation of rehabilitation needs is carried out for persons at 16 years of age and older.

New additions include provision of services on the basis of programmes and plans of action (previously, a person was required to have a rehabilitation plan to receive the service).

 

What is the difference of a rehabilitation program, a plan of action and a rehabilitation plan?

A program is an activity package put together for a group of persons with similar issues and objectives. If a suitable program exists, a person can skip the step of preparing a rehabilitation plan and receive necessary services faster. Programs are used for the provision of services to one specific target group with similar rehabilitation needs. For example, a program for persons with mobility disability with the focus of coping independently at home – this requires the services of an occupational therapist or a physiotherapist, the evaluation of home environment and need for technical aids, acquisition of technical aids and respective training and the assistance provided by a social worker. Programs have been prepared beforehand in rehabilitation facilities, in order to ensure that all activities included in the program would help to achieve the set objective, e.g. achieve independent coping at home. Programs may include services meant for individuals and for groups. For example, group activities are used for introducing different services and opportunities, acquiring and exchanging different experiences and learning from each other.

A plan of action is a new document that since year 2016 can be drawn up by a case manager of the Social Insurance Board responsible for evaluating the service need of a person. The case manager will evaluate the individual's need for social rehabilitation and if it becomes clear during the conversation that the objective of rehabilitation and services can be agreed upon during the meeting, the case manager can formalise a plan of action to ensure the achievement of established objectives. If a suitable plan exists, a person can skip the step of preparing a rehabilitation plan and receive necessary services faster. If a person has more complex needs, it is not possible to put together an action plan nor are there any suitable programs, the case manager will transfer the person together with already collected information to a rehabilitation team, who will assist them with preparing a rehabilitation plan.

A rehabilitation plan has been prepared for one specific person and includes the evaluation summary together with a plan of action, specifying what the person aims to achieve by using the services. For example, a child with mental disorder learns to tell time, orientate in the city and take care of their personal hygiene, which in turn allows them to independently participate in the activities of a day-care centre and be a part of a collective. Or, it will be established in a plan of rehabilitation that within the following three months, the person will receive the services of a special education teacher and social workers, in order to achieve the agreed objective, and if the progress is slow and there's a lack of motivation, a psychologist will also be included.

 

In which cases will a case manager visit me at home?

In general, the evaluation of social rehabilitations needs takes place in a regional office of the Social Insurance Board. In justified cases, for example, when attending the appointment has been made difficult to a significant degree by a person's mobility impairment or other special need, it is possible that the appointment with a case manager will take place at the individual's home or in a healthcare or social welfare facility. If the evaluation of rehabilitation needs takes place at the person's home, the case manager may previously contact a social worker of a local authority.

If a person has a special need that prevents them from coming to the evaluation of rehabilitation needs at the Social Insurance Board, they can specify such circumstances in their application for receiving the rehabilitation service and agree upon the specific meeting location with the case manager.

 

If I submitted an application for social rehabilitation before the year 2016, if and how will the changes that took effect on January 1st, 2016 affect me?

If an application has been submitted before year 2016, further actions depend on the progress of the application process. Different possibilities have been listed below.

1. If an application has been submitted and there is a current rehabilitation plan and a decision (letter of referral) and a rehabilitation facility is already providing one or another service, the receipt of the service will continue and the person will not have any additional obligations. The provision of the service will continue until the expiration of the rehabilitation plan (not for longer than 31st of December, 2018) but not for longer than two years. In case of a continuous need for service, one must submit a new application to the Social Insurance Board after the expiration of their rehabilitation plan. Persons of the age of 16 and older must also undergo the assessment of rehabilitation needs.

2. If an application has been submitted and there is a current rehabilitation plan and a decision (letter of referral) but a person is still in the waiting list of a rehabilitation facility, the Social Insurance Board will make a continuation decision and  the person will not have any additional obligations. The provision of the service will continue until the expiration of the rehabilitation plan (but not for longer than 31st of December, 2018) but not for longer than two years. In case of a continuous need for service, one must submit a new application to the Social Insurance Board after the expiration of their rehabilitation plan. Persons of the age of 16 and older must also undergo the assessment of rehabilitation needs.

3. If an application has been submitted, there is a decision (letter of referral) and a person is in the waiting list of a rehabilitation facility but has no current rehabilitation plan, a case manager of the Social Insurance Board shall contact a person at 16 years of age and older and agree with them upon the time and location for the evaluation of their service need.

Children at 16-17 years of age, who applied for the service before the year 2016 but have not yet received a rehabilitation plan, may make an appointment for putting together a rehabilitation plan or use the services on the basis of terms and service limits established for children until the expiration of their plan or until the end of the calendar year when they turn 18 (but not for longer than 31st of December, 2018).

NB!
If a current rehabilitation plan has been prepared before January 1st, 2016, a disabled person must meet the terms of entitlement that were effective during the preparation of the plan. Respective to the legislation effective until January 1st, 2016, a person either had to have a disability or at least 40% loss of capacity for work and a mental disorder.

Example: a person with a current rehabilitation plan had the right for a rehabilitation plan on the grounds of having a mental disorder and at least 40% loss of capacity for work. If the person's loss of capacity for work has been less than 40 per cent from January 1st, 2016, but they still have a disability, they still have the right to receive social rehabilitation services on the grounds of their current plan.

 

In the case of a current rehabilitation plan and if the service provision continues after 1.01.2016, nothing changes for the individual. The Social Insurance Board will extend the right to receive the service with their continuation decision and services shall be provided on the former basis until the expiration of the plan, but not for longer than 2 years (for the maximum until 31st of December, 2018).

 

What is the reason behind the evaluation of rehabilitation needs and what does it mean for individuals applying for the service?

  • Before January 1st, 2016, referral to rehabilitation services was not always based on a person's needs, as is established by one of the contemporary welfare principles. All persons who applied for receiving the service were transferred to a rehabilitation facility, where they received a rehabilitation plan. Both the time and money of the disabled person and rehabilitation specialists was invested into that. At the same time, it often became apparent that the person didn't really need the rehabilitation service but other services, for example, medical rehabilitation. Therefore, the evaluation of rehabilitation needs helps us to determine who actually needs the social rehabilitation service and who needs medical rehabilitation or other services. What is most important is to help the person on the right track. At the same time, the state can invest more into service provision instead of preparing unnecessary plans and approach everyone based on needs.
  • During the evaluation of rehabilitation needs a person will receive a lot of new information. The case manager will explain the aim of the rehabilitation service, which specialists will be providing the service, what are the service volumes and the person's own role. In addition, the case manager will assist with finding a suitable rehabilitation facility. In the old system, a common problem was that people did not know the content of the social rehabilitation service or how to find a suitable service provider.
  • The case manager will also explain different options for applying for other services.  For example, what are social services, special care and health services, etc. provided by local authorities. If necessary, they will also support the person with accessing other services. Quite often, people are not aware of services available and how to apply for them, therefore being left without assistance.
  • Before, persons with special needs often didn't have the opportunity to just discuss their situation with a specialist. Persons who have participated in the evaluation of rehabilitation needs highly value the fact that they have been able to just talk about their situation.
  • The evaluation of rehabilitation needs also provides information for the state on what are the needs of disabled persons, which service volumes should be increased and which services should be developed beforehand. 
 

What does the evaluation of rehabilitation needs mean for a disabled person?

A person does not have to fill out a long application form or report to undergo the evaluation of their rehabilitation needs – it will take place in the form of a conversation. A case manager will investigate, which difficulties the person is experiencing in major areas of life, e.g. while communicating with other persons, moving around, taking care of themselves, working and in their domestic and recreational activities. The person can answer questions and explain their difficulties. If necessary, they may include a family member or a support person who is familiar with the situation and can help with answering the questions.

  • The minimum time required for the evaluation of rehabilitation needs is an hour and a half.
  • Establishing the person's needs form the basis of further provision of services and assistance.

 

 

What should I do if, as a result of evaluation, I have received a negative decision on my need for rehabilitation services?

A case manager will approach every person on an individual basis, evaluating their personal challenges, what sort of assistance they need and what are their future goals. If, as a result of the conversation, the case manager and the person reach a common conclusion that the person does not need social rehabilitation, then of course the social rehabilitation service will not be provided. At the same time, the case manager will recommend other services and, if necessary, assists the person with accessing said services, for example, by consulting with a family physician, social worker of a local authority, etc. This means that even if the case manager has made a negative decision in regards to social rehabilitation, they will still make suggestions on further steps and the person can receive necessary assistance by following said suggestions.

If you think that the negative decision is not justified, you can file a challenge with the Social Insurance Board. The challenge must be filed within 30 days from receiving the decision.

 

If I have a current rehabilitation plan that was prepared before the year 2016 and I am turning 16 this year, will I be able to use services on the basis of the terms for the target group of children or persons of working age?

In case of a current rehabilitation plan, the age change does not matter and the person may still receive services on the basis of terms for the target group of children. In such case, it is important that at least one legal justification for entitlement (e.g. a disability or, in case of a person of working age with a mental disorder, at least 40% loss of capacity for work) that was effective at the time of preparation of the rehabilitation plan is still present.

If a person with a current rehabilitation plan does not meet any legal grounds for entitlement that were effective at the time of preparation of the rehabilitation plan, they cannot receive any further services on the grounds of their current rehabilitation plan. In such case, the person shall have the following options:

  • if the person is studying, working or seeking employment they may contact Töötukassa that will assist them with accessing necessary services;
  • if the person is not studying, working or seeking employment they may contact the Social Insurance Board, where a case manager will evaluate their need for the social rehabilitation service and in case of such need, the person will receive the social rehabilitation service on the basis of terms for the target group of persons of working age.

Persons of 16 years of age and older will not receive a new plan after the expiration of their current plan. Depending on if a person is professionally active or not, they can either contact Töötukassa for the evaluation of work rehabilitation needs or submit an application for social rehabilitation services to the Social Insurance Board that will be followed by the evaluation of rehabilitation needs by a case manager. 

 

Why cannot I receive massage services or medical bath treatments as part of social rehabilitation? How can I receive those?

Social rehabilitation is a welfare service and therefore does not include massages and medical bath treatments. The objective of social rehabilitation is to support a person's coping in their everyday environment, for example, school, home, in their recreational activities, etc. In addition, the rehabilitation service requires active participation of a person, meaning passive procedures like massages and medical bath treatments are not included in the service.

If a person has health issues, for example back pain, they should contact a general physician or medical specialist who can transfer the person to medical rehabilitation on the basis of the need arising from a health condition. In specific cases, medical rehabilitation may include massages and medical bath treatments that will be compensated for by the Health Insurance Fund, but they will not be provided without specific indications.

 

Do I need a rehabilitation plan to receive childcare or support person services or other services provided by the local government?

No rehabilitation plan is required. Until the end of 2016, it was required that the need for childcare services was to be specified in a rehabilitation plan but, from 1.01.2017, the Social Welfare Act includes no such requirement.

Respective to § 452 subs. 2 of the Social Welfare Act, in the case of children with a severe or profound disability, a local authority shall assess the need for childcare service separately for each child. The same also applies to support person-, social transportation- or other services provided by a local authority. If you already have a plan, a local authority can rely on it in their evaluation but a local authority cannot refuse from making a decision if a person doesn't have a rehabilitation plan.

 

Is it required to reapply for rehabilitation if a child for whom a rehabilitation plan was prepared with the purpose of establishment of disability is awarded a disability?

There is no need for submitting an application for rehabilitation if the child has a current decision for transferral to the rehabilitation service.

From 01.07.2017, preparation of a rehabilitation before the establishment of disability is not required for children applying for the establishment of disability for the first time. After the establishment of disability for the first time, we will make a decision of referral to the rehabilitation service for the child without an application that a parent can use in order to contact the most suitable service provider of their choosing.

If there is a need for changing the service provider, a free-form but reasoned application for changing the service provider, not for receiving the rehabilitation service, must be submitted to us. It is important to pay attention to what kind of application is being submitted, as in the case of an application for changing the rehabilitation facility, we can immediately transfer the person and they can continue receiving the service, while when submitting a new rehabilitation application, they might be put in a waiting list.