14 - peatükk

Situation of persons with disabilities

Author: Mihkel Tõkke

In the beginning of 2017 there were 149,900 persons with disabilities in Estonia (11.4% of the population), which means an addition of nearly 3600 persons compared to the previous year.[1] Most of the persons with disabilities belong to an older age group (more than two thirds are at least 55 years old).

The Work Ability Reform, which was initiated in 2016 brought several changes to the discipline. Instead of incapacity for work as of 1 July 2016 the person’s preserved work ability is evaluated instead. Instead of a pension for incapacity for work the persons with diminished capacity for work are paid work ability allowance; labour market measures are actively developed in order to help persons with diminished capacity for work to get back to work. As a result of systemic rearrangements, the Estonian Unemployment Insurance Fund is now the body responsible for supporting persons of working age and persons with diminished capacity for work.[2] The task of the Estonian National Social Insurance Board is to detect the degree of disability and work with children, people of retirement age and persons with no work ability. The purpose of the changes is to support active life of persons with disabilities and their return to the labour market. Additionally, in the beginning of 2017 the obligation of providing support services to children with severe and profound disabilities along with compiling case plans was moved from the Estonian National Social Insurance Board to local authorities.

Political and institutional developments

In June of 2016 the Government approved the “Welfare Development Plan 2016–2023”, which gathers together strategic goals for labour, social protection, gender equality and equal treatment policies for 2016–2023.[3] One of the goals of the Development Plan is to develop provision and organisation of social services and improve accessibility and quality of the services.

At the end of 2015 Estonia submitted its first periodic report to the Convention on the Rights of Persons with Disabilities based on activities for 2012–2015.[4] Based on international practice the Estonian Chamber of Disabled People started putting together its own independent report on the situation of persons with disabilities in Estonia in 2016.

In 2015 the state continued modernisation of special welfare service places.[5] The developments are also based on the development plan for special welfare for 2014–2020.[6] The European Union, in order to implement the changes, is intending to reorganise the infrastructure of special welfare and improve the quality and accessibility of services from structural instruments for 2014 – 2023.[7] The plan is to reorganise 1200 special care home places, create at least 200 new places and replace large dorm-style special care homes with smaller ones containing up to 30 places. The process of changing the service places is called deinstitutionalisation. Then again, the viewpoint of service providers has not always matched that of service users, the persons close to them and the surrounding community’s.[8] [9] [10]

The reduction of caregivers’ care work load and the increase of the opportunities for them to participate in labour market has been paid vital attention to.[11] A care work load task force was established with the Government Office in December of 2015 with the intention of relieving the care work load of family caregivers. The goal of the task force was to chart out problems related to family caregiving and create solutions based on the needs of persons close to them.[12] The 2017 survey of International Bank for Reconstruction and Development on the situation of long-term caregiving in Estonia was one of the results of the task force’s activities.[13] The report recommends Estonia significantly increase funding for long-term caregiving in order to meet the demands stemming from aging of the population. The report also describes that organisation of long-term caregiving is fragmented between social and health sectors and places a disproportionately large care work load on the family members and persons close to them.[14] A recommended solution is to create common criteria for assigning caregiver’s allowance and develop support networks for family caregivers, as well as counselling, along with increased funding of the sector.

Information system SKAIS 2, which was supposed to be ready by the end of 2016 and was supposed to be used for exchanging data on social services and social benefits, has still not been completed and implemented.[15] Neither has been completed and implemented the electronic technical aid card, which means a person with a disability has to be “jogged” between various institutions and service providers when applying for a technical aid. Problems have also been caused by faulty data in e-health, which has been the reason why a person’s assessment of work ability has been wrong, or it hasn’t been possible at all. Faulty data means that a person has to wait for the decision on assessment of work ability and decision on disability for longer.

Legislative developments

The new Social Welfare Act stating conditions on how liability is distributed between the state and the local authority in providing social services came into force in 2016. Problems have been caused by different interpretations of the Local Government Organisation Act. This has also been drawn attention to by the Chancellor of Justice in her address of towns and rural municipalities.[16] The absence of sign language interpretation service from the list of local governments’ social services has also been pointed out as a problem; neither is it defined as a state service.[17]

In 2016 the rehabilitation system was split in two – the social rehabilitation and work rehabilitation. The goal of social rehabilitation is to achieve as independent living as possible along with education suitable for the person’s capabilities, acquiring of skills needed for work, and participation in community life. The goal of work rehabilitation is to increase the person’s work ability and support their activity on the labour market. However, there are problems with access to rehabilitation, as for example at the moment there are no service providers in Hiiumaa.[18]

The technical aid system was changed in the beginning of 2016, and instead of the country government and local authorities it is now being organised by the Estonian National Social Insurance Board. The change has been positive considering the fact that obtaining of a technical aid or the extent of aid is no longer influenced by the person’s place of residence, and the open market should lower the price of technical aids because of competition. At the same time the new system places on persons with disabilities and their family members a disproportionately great work load in obtaining information about and comparing the technical aids in order to make an informed decision. So far there is no comprehensive comparative information system in terms of descriptions, prices and providers.

As of beginning of 2017 the drawing up of rehabilitation plan for children is no longer the requirement for making a decision about disability, and as of July 2017 the decision-making regarding children applying for a disability for the first time became faster. Instead of the 88 days that was the time frame earlier (the average length of procedure) the Estonian National Social Insurance Board now announces the decision, if there is sufficient medical data, within 15 working days.[19]

The Estonian Ministry of Education and Research is planning on changing the organisation of studies for students with special educational needs. The purpose of the changes is to provide students a more comprehensive support in acquiring their education and to grant schools a wider knowledge of the needs of the students.[20]

In August of 2017 the Ministry of Social Affairs sent the amendments to the Equal Treatment Act to be approved; it would give the monitoring duty of the Convention on the Rights of Persons with Disabilities to the Gender Equality and Equal Treatment Commissioner. At the time of writing this chapter the draft has not yet passed on to the Government from the Ministry. Until now the obligation of monitoring taken with ratifying the Convention in 2012 has not been regulated on legislative level. Before, the minority groups had the right to turn to the Commissioner or the courts in cases of discrimination upon being hired, in employment and in vocational training, but upon passing of the draft the Commissioner and the courts are available in case of hindrances regarding access to education, receiving social benefits and services, health care or goods and services.[21]

Statistics and surveys 

In 2016 the survey on development of social services in rural areas was carried out; it discovered the need for development of social transport in all of the counties.[22] Social transport is considered the basic service, considering access to social services; it is also one of the services provided by local authorities that have had most problems with its quality.[23]

In February of 2017 the National Audit Office published a survey on state’s activity in preparing for the Work Ability Reform.[24] The survey pointed out that employers’ readiness in hiring persons with loss of work ability is low. 31% of employers were prepared to hire persons with loss of work ability, 44% saw no opportunity for doing that, and the rest did not have a viewpoint. The survey also pointed out that a great hindrance to success of the Work Ability Reform are the local authorities’ differing capabilities in providing social services supporting looking for work and going to work. The local authorities have a hard time finding support persons, although the need for them is ever-increasing.

The Estonian Centre for Applied Research Centar published a survey in 2017 on effectiveness of organisation of education for students with special educational needs and the associated methods.[25] The survey revealed that the opportunities of children with disabilities to receive support methods differ greatly in different regions and implementation of inclusive education organisation is hindered by attitudes of the community. The offered solutions included increasing the number of support specialists, guiding attitudes of the community and increasing regional cooperation in order to support students with special educational needs.

Good practices

An example of a good practice is the competition of universal design for student projects organised by Ministry of Social Affairs in 2016 – it was aimed at finding solutions to the living environment that surrounds us based on the principles of universal design.[26] On the other hand, the regulation on accessibility has still not come into force; disability associations often carry out monitoring of accessibility themselves.

In 2016 a pilot project was initiated which aimed to improve the living conditions of persons with disabilities. Piloting took place in Tallinn and adapting dwellings of persons with restricted activity was supported on 45 occasions.[27] In the following years the project will continue all over Estonia and by 2023 it is planned that 2000 dwellings will have been adapted.

In 2017 the government approved a draft that as of 1 January 2018 gives the parents of children with severe disability the right to apply for erasing of student loans, so far, this right was had by the parents of children with profound disability and persons with no work ability had this right.[28]

In April of 2017 the Estonian Chamber of Disabled People and the Ministry of Social Affairs signed a joint statement of intent with the goal of providing independent counselling for persons with diminished capacity for work. This service that came into effect in the second half of 2017 makes it possible to get counselling on issues regarding assessment of work ability and there is a specialist to help file challenges.[29]

The disability non-profit associations have issued various manuals. Estonian Association of the Blind put together a manual “Kui kohtad nägemispuudega inimest” (When you meet a person with a visual disability) and the NGO Kakora compiled “Käsiraamat ligipääsetavate ja mitmekülgsete kultuuriürituste korraldamiseks” (Manual for organising accessible and diverse cultural events).[30] The Estonian Chamber of Disabled People compiled the widely received book “Teekond erilise lapse kõrval” (The road alongside a special child), which is meant for persons close to children and young people with special needs.[31] The Estonian Association of the Deaf developed an international sign language e-dictionary, which can be used in Estonian as well as in English.[32]

Noteworthy public discussions

In the beginning of 2016, upon the initiation of the technical aid reform, 200 people received unexpectedly large bills for technical aids without any warning.[33] In 2017 the topic of technical aids continued in the public eye along with several scandals regarding the system of technical aids, where various partners of the Health Insurance Fund allegedly issued them fake invoices.[34] The Estonian National Social Insurance Board also detected possible cases of invoicing fraud in August of 2017.[35]

Similarly, in the social sphere much discussion was created by waiting lists for social rehabilitation, where the means for providing services ran out in the beginning of 2017 and the waiting lists grew very long. In addition to that the special welfare’s funding for creating new service places was frozen in the beginning of 2017 and a waiting list consisting of about a thousand persons allows access to service only if a current service user leaves.[36] The issue of waiting lists for medical specialists has received a lot of attention – this also acutely affects persons with disabilities. In 2017 there was also a lot of public discussions regarding challenges to decisions of the new Work Ability Reform, which have led to court cases. [37]

Recommendations

  • Establish minimum requirements for social services provided by local authorities and an effective review over their quality.
  • Analyse the effect of the Administrative Reform on organisation of the social welfare system and accessibility to services in various local authorities.
  • Provide specific activities for decreasing the care work load of long-term caregivers and developing support networks for family caregivers.
  • Give the Gender Equality and Equal Treatment Commissioner the role of monitoring the Convention on the Rights of Persons with Disabilities.
  • Increase support for employers and better connect the education of persons with disabilities with the expectations of the labour market in order to effectively start the Work Ability Reform.

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[1] Eesti Statistika Kvartalikiri [Quarterly journal of Statistics Estonia]. 2017. 2. Available at: https://www.stat.ee/valjaanne-2017_eesti-statistika-kvartalikiri-2-17

[2] Estonian Unemployment Insurance Fund’s home page. Töövõimereform [Work Ability Reform]. Available at: https://www.tootukassa.ee/toovoimereform

[3] Ministry of Social Affairs. Heaolu arengukava 2016–2023 [Welfare Development Plan 2016–2023]. 2016. Available at: https://www.sm.ee/et/heaolu-arengukava-2016-2023

[4] Estonia’s first report to the Convention on the Rights of Persons with Disabilities. 2015 Available at: https://www.sm.ee/sites/default/files/content-editors/puudega_inimesele/pik_aruanne_eesti_keeles.pdf

[5] Erihoolekandeasutuste reorganiseerimine [Reorganisation of special welfare institutions]. 2015. State Gazette I, 22 Available at: https://www.riigiteataja.ee/akt/115092015022

[6] Ministry of Social Affairs. Erihoolekande arengukava aastateks 2014–2020 [Development plan for special welfare for 2014–2020]. 2014. Available at: https://www.sm.ee/sites/default/files/content-editors/eesmargid_ja_tegevused/Sotsiaalhoolekanne/Puudega_inimetele/erihoolekande_arengukava_2014-2020.pdf

[7] Ministry of Social Affairs. Erihoolekande arengukava aastateks 2014–2020 [Development plan for special welfare for 2014–2020]. 2014. Available at: https://www.sm.ee/sites/default/files/content-editors/eesmargid_ja_tegevused/Sotsiaalhoolekanne/Puudega_inimetele/erihoolekande_arengukava_2014-2020.pdf

[8] Kangur, M. 2015. Psüühiliste erivajadustega inimeste peremaja kerkimist naabrusse Tartus veel peljatakse [Building family houses for people with mental special needs in Tartu is still feared]. Available at: http://www.err.ee/536400/psuuhiliste-erivajadustega-inimeste-peremaja-kerkimist-naabrusesse-tartus-veel-peljatakse

[9] Kaasik, M. 2016. Suured erihooldekodud kaovad, lähedased on reformi eel mures [Large special care homes to disappear, the people close to them worried ahead of the reform]. Available at: http://www.err.ee/578547/suured-erihooldekodud-kaovad-lahedased-on-reformi-eel-mures

[10] Pott, T. 2017. Erihooldekodu krundivalik pealinnas tekitab vaidlusi [Selection of building plot for special care home creates disputes in the capital]. Available at: http://www.err.ee/588342/erihooldekodu-krundivalik-pealinnas-tekitab-vaidlusi

[11] Ministry of Social Affairs. Heaolu arengukava 2016–2023 [Welfare Development Plan 2016–2023]. 2016. Available at: https://www.sm.ee/et/heaolu-arengukava-2016-2023

[12] Hoolduskoormuse rakkerühm [Care work load task force]. 2015. Available at: https://riigikantselei.ee/et/hoolduskoormus

[13] World Bank Group. Reducing the burden of care in Estonia. 2017. Available at: https://riigikantselei.ee/sites/default/files/content-editors/Failid/hoolduskoormus/estonia_ltc_report_final.pdf

[14] Government Office. Maailmapank soovitab Eestil märkimisväärselt suurendada pikaajalise hoolduse rahastamist [International Bank for Reconstruction and Development recommends Estonia significantly increase funding for long-term caregiving]. 2017. https://riigikantselei.ee/et/uudised/maailmapank-soovitab-eestil-markimisvaarselt-suurendada-pikaajalise-hoolduse-rahastamist

[15] National Audit Office. Riigi tegevus töövõimereformi ettevalmistamisel [State’s activity in preparing for the Work Ability Reform]. 2017. Available at: http://www.riigikontroll.ee/tabid/168/amid/557/ItemId/950/language/et-EE/Default.aspx

[16] Chancellor of Justice. Sotsiaalteenused kohalikus omavalitsuses [Social services in local authorities]. 2016. Available at: http://www.oiguskantsler.ee/sites/default/files/field_document2/sotsiaalteenused_kohalikus_omavalitsuses.pdf

[17] Sotsiaalhoolekande seadus [Social Welfare Act]. 2017. State Gazette I, 7.  Available at: https://www.riigiteataja.ee/akt/130122015005?leiaKehtiv

[18] Estonian National Social Insurance Board. Tegevuskohad [Places of activity]. 2016. Available at: https://www.sotsiaalkindlustusamet.ee/sites/default/files/tegevuskohad_070316.pdf

[19] Estonian Chamber of Disabled People. Esmakordselt puuet taotleva laste otsuste tegemise aeg muutub kiiremaks [Decision-making timeframe regarding children applying for a disability for the first time to become shorter.]. 2017. Available at: http://www.epikoda.ee/esmakordselt-puuet-taotleva-laste-otsuste-tegemise-aeg-muutub-kiiremaks/#more-10528

[20] Estonian Ministry of Education and Research. Hariduslike erivajadustega õpilaste õppekorralduse muutmine [Changing the organisation of studies for students with special educational needs]. 2017. Available at: https://www.hm.ee/sites/default/files/pgs_eelnou_tuge_vajavate_opilaste_infomaterjal.pdf

[21] Ministry of Social Affairs. Võrdse kohtlemise seadus tagab edaspidi kõigi diskrimineerimistunnuste alusel samaväärse kaitse [The Equal Treatment Act to guarantee equal protection based on all grounds for discrimination in the future]. 2017. Available at: http://www.sm.ee/et/uudised/vordse-kohtlemise-seadus-tagab-edaspidi-koigi-diskrimineerimistunnuste-alusel-samavaarse

[22] Analysis. Sotsiaalteenuste arendamine maakondades 2016–2020 [Development of social services in counties 2016–2020]. 2016. Available at: https://www.sm.ee/sites/default/files/content-editors/eesmargid_ja_tegevused/Sotsiaalteenuste_ja_-toetuste_andmeregister_STAR/Lisainfo/mak_analuus_toimetatud.pdf

[23] Ibid.

[24] National Audit Office. Riigi tegevus töövõimereformi ettevalmistamisel [State’s activity in preparing for the Work Ability Reform]. 2017. Available at: http://www.riigikontroll.ee/tabid/168/amid/557/ItemId/950/language/et-EE/Default.aspx

[25] The Estonian Centre for Applied Research Centar. 2017. Haridusliku erivajadusega õpilaste kaasava hariduskorralduse ja sellega seotud meetmete tõhusus [Effectiveness of organisation of education for students with special educational needs and the associated methods]. Available at: http://www.centar.ee/uus/wp-content/uploads/2017/01/P%C3%B5hiraport-final.pdf

[26] Ministry of Social Affairs. Algas universaalse disaini konkurss [The universal design competition has begun]. 2016. Available at: https://www.sm.ee/et/uudised/algas-universaalse-disaini-konkurss

[27] Tallinn. Kodukohanduse projekt [Project for adapting dwellings]. 2016. Available at: http://www.tallinn.ee/est/Kodukohanduse-pilootprojekt-2

[28] Ministry of Social Affairs. Raske puudega laste vanematel tekib õigus õppelaenu kustutamiseks [Parents of children with severe disability to have right to apply for erasing of student loans]. 2017. Available at: https://www.sm.ee/et/uudised/raske-puudega-laste-vanematel-tekib-oigus-oppelaenu-kustutamiseks

[29] Ministry of Social Affairs. Eesti Puuetega Inimeste Koda ning tervise- ja tööminister allkirjastasid ühiste kavatsuste protokolli [Estonian Chamber of Disabled People and the Ministry of Social Affairs signed a joint statement of intent]. 2017. Available at: https://www.sm.ee/et/uudised/eesti-puuetega-inimeste-koda-ning-tervise-ja-toominister-allkirjastasid-uhiste-kavatsuste

[30] NGO Kakora. Sündmusi kõigile! Käsiraamat ligipääsetava ja mitmekülgse kultuuriürituse korraldamiseks [Events for everyone! Manual for organising accessible and diverse cultural events]. 2017. Available at: http://www.kakora.sarasyl.com/et/Kultuur/K%E4siraamat.pdf

[31] Teekond erilise lapse kõrval. Käsiraamat puudega ja erivajadustega laste ning noorte lähedastele [The road alongside a special child. A manual for persons close to children and young people with special needs]. Habicht, A., Kask, H. 2016. Available at: http://www.epikoda.ee/wp-content/uploads/2012/03/Teekond-erilise-lapse-k%C3%B5rval.pdf-WEB.pdf

[32] International Sign online dictionary. 2017. Available at: https://rv-sonastik.ead.ee/

[33] Social Affairs Committee. Sotsiaalkomisjon leidis abivahendite reformi käivitamisel puudusi [Social Affairs Committee detected shortcomings in initiating the technical aids reform]. 2016. Available at: https://www.riigikogu.ee/pressiteated/sotsiaalkomisjon-et-et/sotsiaalkomisjon-leidis-abivahendite-reformi-kaivitamisel-puudusi/

[34] Postimees. Lakson, P. Haigekassalt väidetavalt raha välja petnud firma suhtes algatati kriminaalasi [Criminal proceedings initiated against the company that allegedly gained money from Health Insurance Fund by deceit]. 2017. Available at: http://www.postimees.ee/4055859/haigekassalt-vaidetavalt-raha-valja-petnud-firma-suhtes-algatati-kriminaalasi

[35] Raieste, A. Sotsiaalkindlustusamet uurib 32 000 euro ulatuses võimalikke arvepettusi [Estonian National Social Insurance Board is investigating possible invoicing fraud worth 32,000 euros]. 2017. Available at: http://www.err.ee/613786/sotsiaalkindlustusamet-uurib-32-000-euro-ulatuses-voimalikke-arvepettusi

[36] Estonian Chamber of Disabled People. Eesti Puuetega Inimeste Koda: Olukord sotsiaalvaldkonnas on kriitiline [Estonian Chamber of Disabled People: the situation in the social sphere is critical]. 2017. Available at: http://www.epikoda.ee/eesti-puuetega-inimeste-koda-olukord-sotsiaalvaldkonnas-on-kriitiline/

[37] Eesti Päevaleht. Ibrus, K. Värske töövõimereformi otsused on juba viinud esimeste kohtuasjadeni [The decisions of the new Work Ability Reform have already lead to first court cases]. 2017. Available at: http://epl.delfi.ee/news/eesti/varske-toovoimereformi-otsused-on-viinud-juba-esimeste-kohtuasjadeni?id=77685466

 


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  • Mihkel Tõkke lõpetas 2017. aasta kevadel Tartu Ülikooli magistriõpingud sotsiaaltöö ja sotsiaalpoliitika erialal. Oma lõputöö raames uuris ta Eesti puuetega inimeste kodade huvikaitse tegevusi puuetega inimeste esindamisel. Mihkel töötab juba üle kahe aasta Tallinna Puuetega Inimeste Koja tegevjuhina, enne seda oli ta samas organisatsioonis üle viie aasta vabatahtlik. Lisaks on ta Eesti Puuetega Inimeste Koja ÜRO puuetega inimeste õiguste konventsiooni variraporti projektijuht.

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