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Social rehabilitation

Social rehabilitation is a social service designed to support a person with a disability or reduced work capacity in coping with their everyday life.

Through social rehabilitation, the person and their family learn how to cope on a day-to-day basis with the special health needs arising from their state of health.

The social rehabilitation service is organised by the Estonian National Social Insurance Board. If the assessment of the need for service reveals that the person is in need of social rehabilitation service, the Estonian National Social Insurance Board shall assume the obligation of the person to pay the fee for the service, i.e. refers them to the service.

 

Description of the service

The aim of the social rehabilitation service is to teach and develop everyday skills, increase opportunities to participate in social life, support learning, and prepare the groundwork for working. 

The service is active in nature, and the person is able to perform all the activities that need to be done to achieve the goal on their own – for example, exercising or learning to dress using a technical aid. These skills are practised with the help and guidance of a rehabilitation specialist, and in addition, the specialist provides exercises and tasks to be performed at home independently or with the help of a family member/caregiver. As active participation on the part of a person is always a prerequisite for the effectiveness of rehabilitation services, passive procedures – such as massage, treatment bath, salt chamber, cold treatment, etc. – are not included among rehabilitation services.

Social rehabilitation is a complex service, one that is necessary if a person has several problems, the resolution of which is not possible by means of individual services (e.g. support person, rehabilitation, caregiver, or personal assistant), instead requiring the intervention of specialists from multiple specialties, i.e. rehabilitation team intervention.

To achieve the objectives, the following services will be provided, where necessary:

  • Occupational therapist service
  • Creative therapist service
  • Social worker service
  • Psychologist service
  • Special education teacher service
  • Speech and language therapist service
  • Physiotherapist service
  • Experience advisor service
  • Doctor services
  • Nurse services

    The services are provided both individually and to a family or group, with the exception of the services of a doctor, which is only provided individually. A detailed list of services and a description of their content, can be found here

    The service is time-limited, i.e. it is provided for the time necessary to achieve the set purpose. At the end of the rehabilitation period, the rehabilitation service provider will assess the need to continue the service. If it becomes evident that the service needs to be continued, a new application will need to be submitted to the Estonian National Social Insurance Board, followed by a new assessment of the need for service.

    NB!

    • The person must actively participate in the social rehabilitation service according to the action plan and rehabilitation plan drawn up by the rehabilitation service provider. If this is not done, the Estonian National Social Insurance Board may refuse to assume the obligation to pay the fee on the basis of clause 21 (1) 3) of the General Part of the Social Code Act.
    • Treatment, including rehabilitation, is not considered social rehabilitation. If you need treatment and rehabilitation, see your family physician or other doctor.
    • The service provided by a physiotherapist consists of assessing the person’s motor performance skills and the operating environment (e.g. school, home) and recommending adaptations to the environment, preparing and teaching physiotherapeutic programmes to promote independent coping, teaching the use of technical aids, teaching sustainable assistance techniques to family members. The service provided by a physiotherapist does not include passive activities, such as massages, baths, salt therapy chamber, cold therapy, etc.
    • The services of a doctor and nurse are consultative in nature and do not include activities related to treatment, such as establishing a diagnosis, preparing a treatment plan, writing a prescription, performing treatment procedures, issuing a referral to a medical specialist or for analyses, etc.

     

    • If you have any questions about the social rehabilitation service for children, you can get help from our chief rehabilitation specialists, whose contact details can be found here. (XLSX) (14.02 KB, XLSX) 
    • if you have questions about social rehabilitation and special care for people aged 16 and over, our services consultants will help to find a solution. We can help you choose the right service provider. We will also help address any concerns that were raised during the provision of the service.

     

     
    Please arrange an appropriate time in advance for meeting with a service consultant!
     

    See here the contact information for service consultants.

     

      For whom is the social rehabilitation service intended? 

      The assumption of the obligation to pay the fee for the service, i.e. referral to the service, can be applied for by:

      • disabled children under the age of 16
      • children under the age of 18 who have been identified by the local government as the children in need of assistance for the purposes of the Child Protection Act and given an assessment of their need for referral. A child declared to be in need of assistance does not need to have an identified disability.
      • persons of working age with partial work ability or a disability or a percentage of loss of capacity for work or with a category of disability who are not active in the field of work, i.e. who are not employed, are neither studying nor registered as unemployed at the Estonian Unemployment Insurance Fund
      • persons of working age with no work ability. They can apply for social rehabilitation services even if they are working, studying or registered as unemployed with the Estonian Unemployment Insurance Fund
      • early retirement pension recipients with a disability
      • recipients of an allowance for rescue staff awaiting old-age pension who have a disability
      • disabled persons of retirement age

      While all persons with disabilities can apply for social rehabilitation services, only those who have a need for rehabilitation services are eligible.

      Read more about the identification of a disability here.

       

      Organisation of social rehabilitation services

      Children

      1. The child has a previously determined degree of disability
      2. Submit the application for rehabilitation service to the Estonian National Social Insurance Board
      3. The Estonian National Social Insurance Board conducts a preliminary assessment of the need for a complex service and issues a referral decision if the need is established
      4. You can stay on the service waiting list for up to 1 year
      5. When your turn comes, the Estonian National Social Insurance Board will send you a notice that you can contact the service provider
      6. Contact a social rehabilitation service provider within 60 days and agree on the time of receipt of the service
      7. The service provider’s team, in cooperation with the family and the network, assesses the child’s rehabilitation needs and prepares a rehabilitation plan
      8. The child receives the service according to the rehabilitation plan
      9. The service provider evaluates the performance of the service with the parent/guardian and the child
      10. The parent/guardian confirms with the service provider those services that the child has received.

       

      Persons of working age

      1. You have a previously assessed extent of work ability or the determined degree of disability or percentage of loss of work ability
      2. Submit the application for rehabilitation service to the Estonian National Social Insurance Board
      3. The Estonian National Social Insurance Board checks your eligibility for the service and then assesses your rehabilitation needs
      4. The Estonian National Social Insurance Board issues a referral decision when the need for social rehabilitation is established
      5. You can stay on the service waiting list for up to 1 year
      6. When your turn comes, the Estonian National Social Insurance Board will send you a notice that you can contact the service provider
      7. Contact the service provider within 60 days and agree on a time to receive the service
      8. You will receive a service in accordance with the Estonian National Social Insurance Board’s action plan, rehabilitation plan or programme.
      9. The service provider assesses the performance of the service with you
      10. Give the service provider a confirmation of the services you have received

      Old-age pensioners

      1. You have a previously determined degree of disability
      2. Submit the application for rehabilitation service to the Estonian National Social Insurance Board
      3. The Estonian National Social Insurance Board assesses your rehabilitation needs
      4. The Estonian National Social Insurance Board issues a referral decision when the need for social rehabilitation is established
      5. You can be on the waiting list for up to 1 year
      6. When your turn comes, the Estonian National Social Insurance Board will send you a notice that you can contact the service provider
      7. Contact the service provider within 60 days and agree on a time to receive the service
      8. You will receive the service in accordance with the Estonian National Social Insurance Board's action plan, rehabilitation plan or programme.
      9. The service provider assesses the performance of the service with you
      10. Give the service provider a confirmation of the services you have received.

      Application

      You need to apply for the service. You can find the application form for social rehabilitation service here

      Before submitting an application, think again about whether the service is still necessary, i.e. whether you or your child have a number of coping restrictions due to the health condition that cannot be alleviated by other measures (e.g. learning support services at school/nursery school, rehabilitation, technical aids, etc.).

      The application can be submitted in several different ways. Use the one that suits you:

      An application for social rehabilitation service does not need to be submitted for a child in need up to the age of 18, who has been identified by the local government entity as being in need of assistance under the Child Protection Act and for whom the entity has assessed the need to refer the child to the social rehabilitation service.

      Persons suffering from a primary psychosis are also entitled to the service if the medical institution identifies a need for rehabilitation.

      Assessment of rehabilitation needs

      Child

      A rehabilitation needs assessment is carried out to ascertain whether or not a child with a disability needs rehabilitation services. The child’s rehabilitation needs are assessed by a service provider, who prepares a rehabilitation plan.

      If the child has a valid rehabilitation plan, he or she can receive the services on the basis thereof, if a referral is made to a service provider. Be sure to take the plan with you when you go to the service.

      The child’s rehabilitation needs are assessed by a team of rehabilitation service providers, including specialists from different disciplines. The team preparing the plan must include a social worker and a special education teacher, and other specialists will be involved according to the type of disability and the needs of the child.If the child does not have a valid rehabilitation plan, the first step is for the service provider to prepare one in cooperation with the child’s family and network. Networks can be a nursery school, a school, a family physician, a social worker from the local government, or other important network members in the child’s life.

      In order to prepare the plan, a least 3 specialists from the rehabilitation team will meet with the child and family and assess the child’s coping in different areas, as well as the parenting skills of the parents.

      During the assessment, the specialists will talk to the child and the family, and different tests may be administered and tasks given. On the basis of the assessments, the specialists will establish the need for different services and technical aids, make recommendations and prepare a rehabilitation plan. In cooperation with the child and the family, a rehabilitation objective will be set, which will be formulated in such a way that the results of its achievement can be measured at a later stage.

      The plan is signed by all the specialists involved in its preparation and the parent.

      If, as a result of the assessment, it is found that the child does not need social rehabilitation services in addition to the assistance of the educational institution or the local government, or that the child’s coping cannot be improved by the services, the rehabilitation plan will justify this and the action plan will not prescribe rehabilitation services.

      Persons of working age and old-age pensioners

      During the rehabilitation needs assessment, the services consultant will explain the purpose of the rehabilitation service, which specialists will provide the services, and what your role is. The consultant will also help you choose a rehabilitation service provider.

      We have experienced that people often do not know what services are available for a person with special needs at all and how to apply for them, and are therefore left unaided. That is why we will also explain to you the possibilities of applying for other services – such as local government social services, special care services, health services, etc.

      The assessment of the need for rehabilitation also provides the state with information about the needs of disabled people and what services need to be developed. The people who have carried out the assessment of the need for rehabilitation themselves greatly appreciate the fact that they have been given the opportunity to talk about their situation.

      Your rehabilitation needs will be assessed by a services consultant who will contact you to agree on a time and place to meet.

      As a general rule, the assessment of the need for rehabilitation is carried out in a customer service office of the Estonian National Social Insurance Board, where conditions enabling privacy and uninterrupted conversation have been created for this purpose. In justified cases, for example, if you find it significantly difficult to come to a meeting due to a disability-induced mobility barrier or other special need, it is possible that the services consultant will come to your home, health care or social care institution. Inform us in the application for rehabilitation services about special needs which preclude you from coming to the Estonian National Social Insurance Board to assess the need for rehabilitation, and tell the consultant if you agree to meet.

      Please allow up to 2 hours for the assessment. You can come with an escort – a family member, support person or friend who knows you and can help answer questions, or simply encourage you to talk about your problems.

      In the course of the conversation, we will ask you about the difficulties you have in the main areas of your life due to your health condition (cognition, mobility, self-care, communication, daily activities at home and at work/school, and participation in social life, etc.). If necessary, we will collect additional information from other people in your support network, such as your family members, local government social worker, family physician, or employer.

      Together, you will discuss whether you need a social rehabilitation service, or whether you need other help – for example, local government services, support services at school for basic education, rehabilitation, etc.

      If, as a result of the assessment, it becomes evident that you need a social rehabilitation service, we will find out whether there is a rehabilitation programme suitable for you or whether we will prepare an action plan that meets your needs. The assessment may indicate that you do not need rehabilitation services.

      In the following, we explain with examples why one person with the same disease or condition (joint disorders) needs rehabilitation services and the other does not.

      Example 1: A person has a chronic joint disease that has lasted for years, but has not worsened recently, and the person has not received surgical treatment. The person has been using rehabilitation services in spa-type facilities for many years, including acquiring gymnastics programmes prepared especially for them and receiving various counselling sessions. The person can handle everyday tasks because the home environment is adapted and the necessary technical aids are available. The reason why the person wants rehabilitation services is because he or she wants to receive therapeutic or spa treatments (massage, different types of baths, mud therapy, electrotherapy, paraffin therapy) that the person claims to have benefited from.

      In the case described, the person does not need a social rehabilitation service because the person is coping with everyday life and the rehabilitation service would not increase their coping. Procedures that a person considers necessary are not covered by social rehabilitation services.

      Example 2: a chronic joint disease of many years’ standing has continuously worsened, and surgery has recently been performed. The person is unable to carry on with their daily activities in the same way and therefore suffers from low mood and fear of coping. All this has led to a significant deterioration in coping. The person is also unaware of the possibilities of home adaptation and the various technical aids available to help them cope. Therefore, the person needs counselling, an assessment of the need for adaptations to technical aids and their home environment, training in different coping skills and the use of technical aids. This is provided by a comprehensive rehabilitation service, including a physiotherapist, an occupational therapist, a psychologist, and a social worker.


      In this case, the person is likely to need a social rehabilitation service, as the health condition severely limits their ability to cope with everyday life and rehabilitation services can help improve independent coping.

      NB!

      We assess the rehabilitation needs of each person individually, because people with the same illness or condition cope differently.

      The assessment is based on your ability to cope and your needs.

      We will send you the results of the assessment together with the decision.

       

       

      Deadline for proceedings

      • We will review the application for the child’s social rehabilitation service and make a decision to refer or refuse the service within 10 working days.
        •  NB! In the case of a child’s recurrent application for social rehabilitation services, the decision to refer or refuse the service is taken within 10 working days of the receipt of the child’s final documents from the service provider. 
      • We will review an application for social rehabilitation service for persons of working age and old-age pensioners and make a referral decision or a refusal decision within 40 working days. This time includes assessment of rehabilitation needs and making a decision. We will issue a decision within 10 working days of the assessment.

       

      Decision

      The validity of the referral decision is up to 2 years, with the start and end dates indicated in the decision. During the period of validity of the decision, there is no need to extend or renew it.

      The decision is accompanied by an annex indicating the amount per calendar year for which the services can be used, by service.

      We will send you the decision by the method of your choice, which you indicated in the application. We will send you a list of service providers with the referral decision.

       

       

      What should I do if I have received a negative decision on the options for using the services in the assessment?

      The services consultant will approach each person’s situation individually, assessing what the person’s difficulties are, what help they would need and what further recommendations they have. If the services consultant and the person agree during the course of a joint discussion that the person does not need social rehabilitation, then no rehabilitation services will of course be provided. At the same time, the services consultant will not fail to recommend other services and, if necessary, help you to reach them, for example, by consulting with your family physician, local government social worker, etc. This means that if the services consultant has made a negative decision on social rehabilitation, the consultant will still make a number of recommendations on what to do next, and the person will get the help they need by following these recommendations.

      If you think that the decision is inappropriate (for example, if you have received a decision refusing a referral), you can lodge a complaint with the Estonian National Social Insurance Board.

      You have 30 days after receiving the decision to lodge a complaint.

      We will resolve the complaint within 30 days of the date of the complaint. In cases where further investigation of the complaint is needed, we will extend the time limit for reviewing the complaint by up to 30 days. We will send a notice of extension to the person who made the request.

       

      Contacting a service provider

      Once you have received a referral decision, you have 60 days to make your selection from the received list of providers and register for the service.To do this, contact the service provider of your choice either by phone, e-mail or post, or appear in person and agree on a time to start the service.

      When registering, please provide the referral decision number, which is in the format K000... – the service provider can use this number to view the decision details in the information system.

      When you go to the service, take the referral decision with you or send it by e-mail.

       

      Service providers

      Factsheets containing information on the institutions providing rehabilitation services by target group

       

       

      Provision of service

      A provider of social rehabilitation services shall provide you with the service in accordance with the referral decision, either as a rehabilitation programme, or on the basis of an action plan or rehabilitation plan. If you receive the service on the basis of a rehabilitation plan, the service provider prepares a plan for you first. You will start receiving services once you have a plan.

      You can get the service for the period indicated in the decision. The expiry of a decision on disability or incapacity for work does not terminate the provision of the service; you may receive the service until the expiry of the decision on referral.

      For the services provided, the service provider will compile a data set indicating the date, the name and code of the service, the number of hours, the name and speciality of the specialist and the description of the content of the service for each service procedure. You have the right to ask your service provider, at any time, to provide you with the data set in order to review it.

      The service invoices must correspond to the data set. No later than before the final invoice is drawn up, the service provider will obtain your confirmation regarding services received.

      At the end of the service, the service provider will assess the impact of the service on your coping, i.e. describe the effectiveness of the service. The assessment describes the developments that have taken place as a result of the service, and the factors that have contributed to and hindered the achievement of the objective. The need for further rehabilitation services and other assistance needs will also be evaluated and recommended.

      The service provider you contacted, and from whom you agreed to receive the service, will arrange for all the rehabilitation services you need. The provider may, if necessary, involve other social rehabilitation service providers from another rehabilitation institution with which the Estonian National Social Insurance Board has a contract. 

      Change of service provider

      It is possible to change the service provider if there is a good reason to do so – for example, if you have changed your place of residence. If you need to change the service provider, please inform the provider of the need and provide us with a free form and reasoned application to change the service provider (DOCX) (12.16 KB, DOCX).

       

      Maximum cost of the service per calendar year

      Child

      up to EUR 2660 per year (the maximum cost of the service per calendar year, or the annual limit) until the end of the calendar year in which the disabled child turns 16 or the child in need of assistance, as assessed by the local government, turns 19.

      • The calculation of the money is individual – for example, a child with reduced mobility will have more money for physiotherapeutic services than a child who was not found to have reduced mobility when determining the severity of the disability. You can use the remaining services, if necessary, until the annual limit is reached.

      Person of working age and old-age pensioner

      can receive social rehabilitation services for a total of up to EUR 1275 per calendar year. If the service is provided as a programme, the limit is up to EUR 1800 per calendar year. 

      Working-age person with a mental disorder 

      is entitled to the annual limit of up to EUR 4300 per calendar year.

      Within the overall annual limit, there is a separate annual limit for the following services:

      • assessing and planning rehabilitation needs;
      • physiotherapist service.

      You can use the remaining services, if necessary, until the annual limit is reached.

       

      Reimbursement of travel and accommodation expenses

      Our task is to ensure that the right service is available for the right person. Therefore, in order to use the service budget efficiently, our aim is to provide the service in a rehabilitation facility close to the person’s home.

      However, in cases where there is no suitable service provider close to home, it may still be necessary to receive the service from a service provider further away, and in exceptional cases it is reasonable to provide the service with accommodation. When providing rehabilitation service with accommodation, one meal per day, usually breakfast, is included in the price of accommodation. Therefore, you need to take into account that you will need to pay for lunch and dinner yourself.

      The accommodation limit per calendar year is:

      • up to EUR 119.85 per recipient of the service (up to EUR 23.97 per day);
        • for the user of the service limit for a person of working age with a mental disability, the annual limit for accommodation is EUR 838.95.
      • up to EUR 91.09 for the person accompanying a child.

      Please note that we do not pay for accommodation only (e.g. if the services are paid for by the person themselves).

      The costs of travelling to a rehabilitation service shall be compensated to the recipients of the service who attend the service outside the local government where their home is located. We compensate for travel expenses related to the provision of rehabilitation services in the amount of EUR 0.10 per kilometre travelled, up to a maximum of EUR 41.55 per year. An application must be submitted to compensate for the expenses.

       

      • send the digitally signed application, by e-mail, to the following address info@sotsiaalkindlustusamet.ee;
      • send the application signed on paper by post to Paldiski mnt 80, 15092 Tallinn;
      • you can also apply at the Estonian National Social Insurance Board’s customer service offices in Estonia. You can find the addresses and opening hours of the customer service offices here.