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Special care services

What is a special care service?

Special care services are targeted at people who, due to their mental health situation, need daily guidance, counselling, assistance, and supervision by a special care facilitator and who cannot be provided with the necessary assistance by other support measures of welfare services.

Special care services are social services for people with mental disorders, but not all of them always need special care services to ensure their daily livelihood, and maintain or improve their quality of life.

 

Who is the target group of a special care service?

You have the right to receive special care services from the age of 18.

  • As the queues for special care services can be long, you can queue up already from the age of 16 in order to quickly receive the necessary special care services as soon as you reach the age of majority.
  • As special care services, it is possible to receive
    •   support services while living at home
    •   a supported living and community living service
    •   a 24-hour special care service in the living space provided by the service provider.

Special care services are intended for people with a severe, profound or permanent mental disorder.

  • People with a severe mental disorder have a restless and extremely withdrawn attitude, they tend to tell incomprehensible or unrealistic stories, and their purposeful behaviour is significantly disturbed.
  • People with a profound mental disorder can be characterised by frequent unpredictable behaviour, which often disturbs the people around them, and they are unable to assess their situation, their speech is incomprehensible or verbal contact with them fails.
  • People with a permanent mental disorder suffer from a chronic mental disorder that lasts for years (or a lifetime) and it significantly impairs their independent coping with daily life.

 

Special care services are also available for people with a mental disorder who have

  • persistent negative symptoms and frequent worsening of the diagnosed disease,
  • experience no long-term stable periods in their health condition,
  • lack disease awareness and refuse to receive treatment,
  • as well as have needed involuntary treatment in the last five years, and there are also significant difficulties in coping with everyday life,
  • a significant deficiency or decrease in social abilities and a high incidence of other disorders (addiction disorders; mood disorders; personality disorders).

 

erihoolekanne psüühikahäirega inimestele

 

Special care services – when and how?

    The Estonian National Social Insurance Board assesses whether a person applying for special care requires a special care service or it is possible to assist this person by means of other social welfare support measures, including services provided by local governments. The assessment takes into account a person’s ability to cope, act and participate, as well as their state of health based on the purpose of the special care service.

    All special care services involve activating a person’s ability to cope and increasing their independence. A person must also make their own maximum contribution to their daily activities while receiving the service.

    A 24-hour special care service is intended for people with the most severe symptoms of mental disorders, for whom it is not possible to ensure assistance and support by means of other services established in the Social Welfare Act. Therefore, before referring to a service or extending the use of a service, the Estonian National Social Insurance Board always considers whether it is possible to provide a person with other social services that meet their needs. The aim is, on the one hand, to provide assistance as little as possible, but as much as necessary, and, on the other hand, to provide assistance that corresponds to a person’s actual ability to cope and act. For example, if the ability of participation and activity of an adult with a mental disorder has decreased to the extent that the main activities of the service involve their assistance and support only in self-hygiene and service, as well as normal daily activities. When due to biological age or other circumstances it is no longer possible to develop a person’s livelihood, other support measures specified in the Social Welfare Act, which are not special care services, must be considered as necessary services targeted at such a person.

    Types of special care services

    Daily life support service

    The service is intended for an adult with a mental disorder living at home who needs support and assistance in activities related to daily life.

    The purpose of the service is to ensure the best possible coping and development of a person and to support their participation in social life.

    What does the service provide? 

    • A person is guided in establishing or maintaining social relationships, as well as planning their time and arranging their leisure time. Also, the activities of support groups are carried out and support is provided in participating in such activities, as well as in using public services and acquiring education.
    • The person’s daily life and work skills are shaped and developed, and they are provided with an opportunity to practice working.
    • The person and their closest ones are counselled about the peculiarities of the person’s health and behaviour.

    When is the service provided? The service is provided as needed in a place suitable for the person in agreement with the service provider. It could be a day care centre, the person’s home or other place depending on the activities of the service. The activities of the service are carried out by the service provider according to the person’s needs.

    What do you have to pay for? You must pay for the meals provided during the service.

    Daily life support service for adults with a severe and profound disabilities with autism spectrum disorder

    The service is intended for an adult with a diagnosis of a severe or profound disability with autism spectrum disorder living at home who shows the signs of continuous and intense extremely harmful behaviour and, therefore, needs constant supervision. (Extremely harmful behaviour involves, for example, shouting, grunting, hitting other people, pushing, biting, pulling hair, injuring oneself, running away, breaking objects, tossing them, etc.)

    The purpose of the service is to provide a secure service environment. To ensure the best possible coping and development of a person and validation of skills by applying modern behavioural guidance techniques, thereby preventing and reducing the incidence of extremely harmful behaviour. To reduce the care burden of the closest ones and to support their work and participation in social life.

    What does the service provide?

    • A person is provided with constant supervision to notice changes in their behaviour and environmental triggers.
    • A person is guided in all activities of daily life, using clearly visualised information and codes of conduct.
    • Support is provided in using self-service skills, creating and maintaining social relationships, time planning, and arranging leisure time.
    • The closest ones and companions are counselled and the activities of support groups are supported.

    The service is provided to a maximum of six people by at least three trained employees. The employees must be able to use modern behavioural guidance techniques that reduce the incidence and intensity of extremely harmful behaviour.

    When is the service provided? The service is provided according to a person’s needs during the day in an environment designed by the service provider – at the day care centre. The service provider carries out the service activities according to the person’s needs. The right to use the service is at least 120 hours a month.

    What do you have to pay for? The person pays for meals while using the service.

    Daily life support service as a daily and weekly care service

    The service is intended for a person who has been diagnosed with other intellectual disability (diagnosis code F78) or unspecified intellectual disability (diagnosis code F79), a severe intellectual disability or a profound intellectual disability (diagnosis codes F72–F73), who has a great need for care, needs constant assistance in activities related to daily life, and who is not able to perform self-care activities. Therefore, in addition to regular daily support activities, they also need a lot of care, constant assistance or permanent guidance in daily activities by the facilitator. A person, who has a moderate intellectual disability (diagnosis code F71) and who needs a lot of supervision and assistance in daily activities, does not require a lot of care.

    The purpose of the service is to provide a person with the necessary assistance in daily life activities, enabling them to continue living in their home environment and to postpone placing them in a 24-hour social welfare institution. It also reduces the care burden of the closest ones and supports their work and participation in social life.

    What does the service provide?

    • A person is guided and assisted in self-care procedures, hygiene procedures and self-service (e.g. changing clothes, changing diapers and sanitary towels, washing, eating).
    • A person is also guided and assisted in establishing or maintaining social relationships, time planning, arranging leisure time and participating in hobbies. Also, the activities of support groups are carried out and support is provided in participating in such activities.
    • The service shapes and develops a person’s daily life skills according to their abilities. Job-like activities that correspond to a person’s abilities are also provided. If necessary, the service advises the closest ones of a person on the peculiarities of the person’s health and behaviour.

    According to the service period, the service provider also ensures meals and accommodation overnight on a daily basis.

    When is the service provided? The service is provided for up to 10 hours during the day and, if necessary, 24 hours a day. It is possible to use the service for up to 23 days (including 24 hours a day) in one month.

    What do you have to pay for? A person pays for the meals provided during the service and the necessary care equipment. Upon using the service 24 hours a day, it is also necessary to cover the accommodation expenses.

    Employment support service

    The service is intended for an adult with a mental disorder who needs constant support and guidance to find a job and while working.

    The purpose of the service is to guide and advise a person during the search for and employment of a suitable job corresponding to their abilities.

    What does the service provide?

    • A person is motivated to work, supported in finding a job that matches their abilities, based on the person’s interests. Also, a person is guided in the issues that arise from the performance of duties and employment during the job search, upon having or finding a job.
    • If necessary, the employer is guided and advised on the situations and peculiarities that may arise during the recruitment and employment of this person.
    • The preparations of a person for starting employment independently is also supported.

    When is the service provided? The service is provided as needed in a place suitable for the person in agreement with the service provider. It could be the person’s home or other place depending on the activities of the service. The activities of the service are carried out by the service provider according to the person’s needs.

    What do you have to pay for? The service does not include any expenses that a person must cover.

    NB: The employment support service provider must find a suitable job for the person referred to the service within at least one year after the start of the service provision. If a person referred to the employment support service has not accepted any jobs offered to them within one year, the provision of the service will be terminated.

    Assisted living service

    The service is intended for an adult with a mental disorder who is able to take care of themselves and, if guided, cope with the activities of daily life, but needs support while living independently.

    The purpose of the service is to provide a person with support to ensure the best possible coping by living independently.

    What does the service provide?

    • A person is guided in the organisation of their household, including the preparation of the budget, the organisation and use of services related to using the premises and their maintenance.
    • If a person lives in the premises of the service provider, the person is supported in finding an independent living space and they are prepared for independent life.
    • During the service, a person is assisted in agreeing and complying with the rules related to the living arrangements.

    When is the service provided? The service is provided as needed in a place suitable for the person in agreement with the service provider. It could be the person’s home, a day care centre or other place depending on the activities of the service. The service provider carries out the service activities according to the person’s needs.

    What do you have to pay for? When living in the premises belonging to the service provider, the expenses related to the use of the premises must be covered.

    Community living service

    The service is intended for an adult with a mental disorder who is able to take care of themselves and participate in household activities, but needs constant guidance during daily activities and support in making food, as well as a place to live.

    The purpose of the service is to maintain and develop a person’s daily life skills, so that they can cope with their daily life as independently as possible or with a little guidance in a family-like way of life.

    What does the service provide? As part of a community living service, people live together as a family, share a common living space, and the facilitator assists them in

    • time planning;
    • arranging leisure activities;
    • using public services;
    • finding learning opportunities and studying;
    • working or work-related activities.

    Given a person’s needs and ability to cope, hygiene items, clothes and bed linen are purchased and maintained in cooperation with them. Over-the-counter medicines and medical supplies are also provided, if necessary.

    When is the service provided? The service is used 24 hours a day, but at night the staff is not present in the service provision premises, but still available to a person (e.g. by phone).

    What do you have to pay for? A person pays for accommodation and meals.

    24-hour special care service

    The purpose of the service is to maintain and develop a person’s independent ability to cope and to ensure a safe living environment in the premises of the service provider.

    Who can use the service?

    An adult

    • who has been diagnosed with a severe or profound disability;
    • who has lost at least 80% of their ability to work or has been diagnosed with an incapacity for work;
    • who cannot be assisted by other social services and who does not use other special care services;
    • who needs help in taking care of themselves and does not cope with daily activities or needs a significant amount of constant assistance and guidance for this purpose.

    What does the service provide? The users of the 24-hour special care service live in the premises of the service provider that have been designed to look like home, and the facilitator assists and guides them in

    • creating, maintaining and developing social relationships;
    • time planning;
    • arranging leisure activities;
    • using public services;
    • finding learning opportunities and studying;
    • developing skills in everyday life by involving people in development activities;
    • a person is supported and assisted in self-care activities and in all daily activities needing assistance. During the service, a person is guaranteed to follow the treatment schedule;
    • if necessary, a person is provided with transport to reach health, social and other public services. The provision of care activities is also supported and the availability of an independent nursing service is ensured.

    Given a person’s needs and ability to cope, hygiene items, clothes and bed linen are purchased and maintained in cooperation with them. If necessary, the service provider also ensures over-the-counter medicines, medical supplies and incontinence articles, as well as skin protection and cleansing products.

    When is the service provided? The service is provided around the clock in the service provider’s premises.

    What do you have to pay for? A person pays for accommodation and meals.

    24-hour special care service for a person with autism spectrum disorder

    The purpose of the service is to maintain and develop a person’s independent ability to cope and to ensure a safe living environment in the premises of the service provider by applying modern behavioural guidance techniques, thereby reducing the incidence of extremely harmful behaviour.

    Who can use the service?

    An adult

    • who has been diagnosed with an autism spectrum disorder (or pervasive developmental disorder);
    • who has been diagnosed with a severe or profound disability;
    • who has lost at least 80% of their ability to work or has been diagnosed with an incapacity for work;
    • who shows the signs of continuous and intense extremely harmful behaviour and, therefore, needs constant supervision;
    • who needs help in taking care of themselves and does not cope with daily activities or needs a significant amount of constant assistance and guidance for this purpose;
    • who cannot be assisted by other social services and who does not use other special care services.

    What does the service provide? The service is provided in the service provider’s premises in a home-designed environment for a group of up to six people. The employees use modern behavioural guidance techniques that reduce the incidence and intensity of extremely harmful behaviour. During the service, a person is provided with constant supervision to notice changes in their behaviour and environmental triggers. The facilitator supports and guides the person with clearly visualised information and codes of conduct in the following activities:

    • creating, maintaining and developing social relationships;
    • time planning;
    • arranging leisure activities;
    • using health, social and other public services;
    • finding learning opportunities and studying;
    • developing daily life and employment skills, involving people in the relevant activities and enabling them to practice working;
    • everyday activities;
    • following a treatment schedule prescribed by the healthcare provider;
    • if necessary, a person is provided with transport to reach health, social and other public services. Support is also provided for self-care activities, if necessary. The service ensures the availability of an independent nursing service.

    Given a person’s needs and ability to cope, hygiene items, clothes and bed linen are purchased and maintained in cooperation with them. If necessary, the service provider ensures over-the-counter medicines, medical supplies and incontinence articles, as well as skin protection and cleansing products.

    When is the service provided? The service is provided around the clock in the service provider’s premises.

    What do you have to pay for? A person pays for accommodation and meals.

    24-hour special care service for a person with a profound multiple disability

    The purpose of the service is to maintain and develop a person’s independent livelihood and to ensure a safe living environment in the premises of the service provider.

    Who can use the service?

    An adult

    • who has a severe or profound intellectual disability and also a loss or deviation of structure or function based on which the disability has been determined;
    • who has been diagnosed with a profound disability;
    • who has lost at least 90% of their ability to work or has been diagnosed with an incapacity for work (at working age);
    • who needs help in taking care of themselves and does not cope with daily activities or needs a significant amount of constant assistance and guidance for this purpose;
    • who cannot be assisted with social services and who does not use other special care services.

    What does the service provide? The users of the 24-hour special care service live in the premises of the service provider that have been designed to look like home, and the facilitator assists and guides them in

    • creating, maintaining and developing social relationships;
    • time planning;
    • arranging leisure activities;
    • using public services;
    • finding learning opportunities and studying;
    • developing skills in everyday life by involving people in development activities;
    • a person is supported and assisted in self-care activities and in all daily activities needing assistance;
    • during the service, adherence to the treatment schedule prescribed to the person is ensured;
    • if necessary, a person is provided with transport to reach health, social and other public services. The provision of care activities is also supported and the availability of an independent nursing service is ensured.

    Given a person’s needs and ability to cope, hygiene items, clothes and bed linen are purchased and maintained in cooperation with them. If necessary, the service provider ensures over-the-counter medicines, medical supplies and incontinence articles, as well as skin protection and cleansing products.

    When is the service provided? The service is provided around the clock in the service provider’s premises.

    What do you have to pay for? A person pays for accommodation and meals.

    24-hour special care service for a person with unstable remission

    The purpose of the service is to maintain and develop a person’s independent livelihood and to ensure a safe living environment in the premises of the service provider.

    Who can use the service?

    An adult

    • who has a mental disorder with unstable remission;
    • who is of working age and who has lost at least 90% of their capacity for work or has been declared incapacitated for work on the basis of the Work Ability Allowance Act;
    • who is of retirement age and has been diagnosed with a profound disability;
    • who needs help in taking care of themselves and does not cope with daily activities or needs a significant amount of constant assistance and guidance for this purpose;
    • who cannot be assisted with other social services and who does not use other special care services.

    What does the service provide? The users of the 24-hour special care service live in the premises of the service provider that have been designed to look like home, and the facilitator assists and guides them in

    • creating, maintaining and developing social relationships;
    • time planning;
    • arranging leisure activities;
    • using public services;
    • finding learning opportunities and studying;
    • developing skills in everyday life by involving people in development activities;
    • a person is supported and assisted in self-care activities and in all daily activities needing assistance. During the service, adherence to the treatment schedule prescribed to the person is ensured;
    • if necessary, a person is provided with transport to reach health, social and other public services. The provision of care activities is also supported and the availability of an independent nursing service is ensured.

    Given a person’s needs and ability to cope, hygiene items, clothes and bed linen are purchased and maintained in cooperation with them. If necessary, the service provider ensures over-the-counter medicines, medical supplies and incontinence articles, as well as skin protection and cleansing products.

    When is the service provided? The service is provided around the clock in the service provider’s premises.

    What do you have to pay for? A person pays for accommodation and meals.

    Special care service based on a court ruling

    The purpose of the service is to reduce a person’s danger to themselves or to others and to obtain the person’s consent to use other assistance provided outside a closed social welfare institution.

    Who can use the service and how?

    • The service is intended for an adult with a mental disorder who, due to their state of health, is permanently unable to understand or control their behaviour and:
    • they are dangerous to themselves or others if they are not placed in a social welfare institution to receive a 24-hour special care service;
    • the use of previous services has not proven to be sufficient, or the use of other services is not possible.

    The court decides on the need for the service. The referral to the service can be initiated by a person’s guardian or the local authority of the person’s place of residence, who must submit a reasoned petition to the court.

    What does the service provide? The service is provided in a closed social welfare institution, where the service provider is responsible for ensuring safety and security. The service has 24-hour control and an overview of a person’s movement, location and activities. The escort is also guaranteed if the person needs to leave the premises or territory of the service provider.

    The facilitator assists and guides a person in

    • creating, maintaining and developing social relationships;
    • time planning;
    • arranging leisure activities;
    • using health, social, postal, financial and other services (public services);
    • finding learning opportunities and studying;
    • developing daily life and employment skills, involving people in the relevant activities and enabling them to practice working;
    • everyday activities;
    • following a treatment schedule prescribed by the healthcare provider;
    • if necessary, a person is provided with transport to reach health, social and other public services. The provision of care activities is also supported and the availability of an independent nursing service is ensured.

    Given a person’s needs and ability to cope, hygiene items, clothes and bed linen are purchased and maintained in cooperation with them. If necessary, the service provider ensures over-the-counter medicines, medical supplies and incontinence articles, as well as skin protection and cleansing products.

    When is the service provided? The service is provided 24 hours a day in the service provider’s premises.

    What do you have to pay for? A person pays for accommodation and meals.

    What do you have to pay for? A person pays for accommodation and meals

     

    Contact details of service coordinators

    Contact details of service coordinators can be found here (793.85 KB, PDF) 

    Please find the concluded contracts and annexes thereto for the provision of special care services in the document register of the Estonian National Social Insurance Board.

     

     

    Service referral

    An application for special care services is submitted to the Estonian National Social Insurance Board. The consultant of the Estonian National Social Insurance Board assesses the area of life in which a person needs assistance or support and decides whether a special care service is a suitable assistance measure. It can take up to 40 working days from the request for the service to the decision. In case of need for the service, the service consultant assists in selecting a suitable service provider and, if there is a vacancy, refers a person to the service.

    If there is no vacancy at the chosen service provider, the person will be added to a queue.

    For more detailed information and advice on special care services, please contact your service consultant.

    In order to receive the services, it is necessary for a person or their guardian to first submit an application for a special care service (28.93 KB, DOCX), which can be completed and sent

    A service activity schedule is prepared for each user of the special care service, indicating the goals and wishes of a person, as well as the activities for achieving them are written down with the person.

    The Estonian National Social Insurance Board makes a decision on providing special care services and a referral decision if:

    • the person meets the requirements necessary to receive the service;
    • there are funds in the state budget for the provision of the service;
    • the service provider chosen by a person has a vacancy;
    • the person agrees to cover their own contribution for meals and accommodation while receiving the community living service or 24-hour special care service.

     

     

    Queue of special care services

    Unfortunately, there is not always a vacancy with the chosen service provider or sufficient funds in the state budget to refer a person to the service. In this case, we add the person to a queue and issue a queue notification.

    Our queues are organised both by service and county. When submitting an application for a special care service, each person can indicate which county and service provider they prefer upon receipt of the service.

    In addition to the division of services and counties, we maintain a regular and priority queue for special care services. The priority queue includes people

    • who are staying in a substitute home;
    • who are undergoing coercive or involuntary treatment;
    • who, on the basis of a court ruling, receive a 24-hour special care service or a closed child care institution service and need a special care service after termination of the said services;
    • who receive services through pilot projects;
    • whose service needs have changed;
    • whose special care service provision is terminated due to the premature termination of the service provider’s activity licence or contract.

    Some services have long queues, as

    • there are significantly more people in need of the service than there are vacancies
    • a person has chosen a specific service provider who does not currently have a vacancy and they are not ready to choose another service provider  
    • a person wants to be in a queue in order to ensure that their place in the queue would be as favourable as possible if the need for the service arises

    As a result, a person who has a less favourable place in the queue may access the service earlier if they need the service immediately and they are ready to accept the first vacancy offered by the Estonian National Social Insurance Board.

    Information about the queues and service options can be obtained from a regional service consultant and from the attached special care queue table (509.83 KB, PDF), which is updated once a month. Information about the service vacancies is available in the  table of service vacancies (793.85 KB, PDF).

     

     

      View your place in the queue

      Here you can keep track of your place in the service queue. To this end, you need to enter the queue notification number* in the search field (e.g. J00021648)

       

       

      A queue notification is a document by which a person is informed that there is no vacancy for the service they need or at the service provider they have chosen. Until a vacancy appears, the person remains in a queue

      After the referral decision has been issued, a person must start with the service no later than within

      • three days of the agreed term for the daily life support service, employment support service and assisted living service;
      • seven days of the agreed term for the community living service and 24-hour special care service.

      If you want to change the social welfare institution after the referral decision has been issued, please submit an application to the service consultant. In case of a vacancy, the Estonian National Social Insurance Board will provide you with a new referral decision to the chosen service provider.

       

       

      Own contribution

      Own contribution is a fee paid by the service user to the service provider for expenses related to the accommodation and meals consumed during the service.

       Maximum own contribution

      • The maximum own contribution of a person referred to a community living service is EUR 251 per month;
      • the maximum own contribution of a person referred to a 24-hour special care service is EUR 251 per month if the 24-hour special care service is provided to more than twelve persons at a time in a single or each separate building of the social welfare institution;
      • the maximum own contribution of a person referred to a 24-hour special care service is EUR 295 per month if the 24-hour special care service is provided to up to twelve persons at a time in a single or each separate building of the social welfare institution, or up to ten persons in separate family-like groups, but not more than 30 persons in a single building.

      The maximum own contribution of persons referred to community living services and 24-hour special care services has been established by the 2020 State Budget Act.