The Austrian Long-term Care Insurance

In German

Legal and financial basis

The legal basis for the Austrian long-term care benefit is the Federal Act for long-term care benefit that was introduced in 1993. The expressed purpose of this legislation is as follows: “The long-term care benefit aims at compensating additional expenditure due to long-term care in the form of a flat-rate cash benefit to ensure as far as possible necessary attendance and support for persons with need for care and to improve their possibility to live an independent life according to their needs.” (§1)

Depending on the kind of entitlement the financial responsibility lies either with the Federal Government or the Länder (nine Austrian Provinces). If a person is entitled for long-term care benefit, there´s a legal right to receive it. Long-term care benefit is financed from contributions of employers and employees as well as from tax revenues.

In December 2002, 356,797 people received long-term care benefit, 85% of them received Federal long-term care benefit, 15% received long-term care benefit from the Länder.

Eligibility and needs

To receive long-term care benefit a person has to qualify as follows:

• a person must be in need of care due to a physical, a cognitive or a mental impairment that will last for at least six months
• the permanent need of care must amount to at least 50 hours per month

Long-term care benefit is organised in seven levels according to the need of care. The fol-lowing table shows this structure as well as the monthly amount paid and the number of people receiving long-term care benefit in December 2002.

Long-term care benefit must be applied for at the relevant Federal or Länder authority. If a person receives a pension from the Federal social security system, the relevant assurance is re-sponsible. If this is not the case, e.g. for children with disabilities, for employees with disabilities or those receiving social care benefit, it´s the relevant authority of the Länder that´s responsible.

The assessment of eligibility for long-term care benefit is based on a medical model. Offi-cially authorized doctors assess the applicant´s need of care with a given screen. Different needs are translated into time needed, e.g. for getting dressed and undressed 2x20 minutes per day are being calculated. Apart from support on the body, like personal hygiene, eating and dressing, there´s a catgory for attendance, like e.g. shopping and support for housekeeping. For mobility, a flat-rate of 10 hours per month is estimated. The classification to a certain level follows the amount of hours per month. Applicants do not have much influence on the assessment by doctors, but they can add reports to their application: the more medical the better. The decision on the level of long-term care can be appealed for at court. Appeal proceedings are usually time as well as energy consuming and costly. As the emphasis is on care, for those whose need of support is not in this areas, like e.g. men and women with learning disabilities, with psychiatric disorders or deaf people, it´s usually difficult to be classified according to their needs.

Coverage and accountability

The long-term care benefit does not aim at covering all needs of support for a person resp. at financing it. Additionally to the introduction of long-term care benefit, the Länder committed themselves to extend their social services comprehensively and to improve them qualitatively.

Recipients need not proof of how they use their long-term care benefit and therefor need not account for it.

Evaluation

The evaluation of the Austrian long-term care benefit needs to be differentiated, there are obviously advantages as well as disadvantages to it. It´s an advantage that people with disabilities receive cash benefits directly, regardless of their income or the reason of their disability, and that they have it at their own disposal without obligation to account for it.

The main problem is that how the long-term care benefit is put into action is based on a medical model, we characterize this as “bedside-table and bed”-mentality. This means that the life of disabled people is reduced to the space between bedside-table and bed.

The flat-rate benefit to meet personal needs is problematic, too. Based on our experience the following can be said: People who receive long-term care benefit up to level 4 can usually fi-nance their needs of personal support as they are defined in the regulation for long-term care pro-vision. Further needs for Personal Assistance, that would lead to a better quality of life and to more participation in society, are not covered. For those men and women who receice long-term care benefit from level 5 onward it´s even more problematic. They typically need assistance directly on the body several times a day and for them it´s not even possible to cover these basic needs with the money they receive. A report, that analysed the effects of the provision for long-term care, compared the time devoted to care per month with the monthly care requirements of the guide-lines for eligibility and it supports the way we see the situation: “The results confirm that a number of people who receive long-term care benefit in fact need intensive attendance every day. There´s an obvious gap between the actually given support ,…, and the kind of support, that according to the legislative body is objectively necessary,” (Badelt, et al., 1997, p. 68). People concerned are therefor either forced to have their assistance done by relatives whom they pay a compensation, or they have to organise their assistance illegaly by paying black wages. The latter can end up in a threat to the existence of the user as well as of the personal assistant. If neither of these strate-gies can be put into action, for people who need much support there´s just left the opportunity of moving to a residential care home with all its negative consequences.

The fact that the Länder have not fulfilled their duty to extend and improve the social ser-vices makes it impossible right from the start that people with disabilities buy the assistance they need. In large regions of Austria there are no organisations that offer personal assistance or even mobile attendance. Instead of building up such services the service providers raised their hourly rates enormously when the long-term care benefit was introduced. To complete the picture we want to add that the long-term care benefit has not been adjusted to inflation since 1996, but the service providers always raise their rates.

Experience obviously shows that the long-term care benefit, in spite of its basically positive characteristics, neither does justice to the diverse needs of people with different impairments nor to the objective of an independent and equalised way of living for disabled people. Improvements could be achieved if the long-term care benefit covered all costs that actually arise within regular employer-employee relationships for care resp. Personal Assistance. We question, though, if the long-term care benefit can be a satisfying basis for Personal Assistance. In our opinion there should be a separate law for Personal Assistance. This should on the one hand clearly define con-cepts and terms, on the other hand it should guarantee the funding of legal jobs for personal assi-tants as well as training and support for users.

Resources

BMSG. Pflegestatistik. im Internet:
http://www.bmsg.gv.at/cms/site/attachments/0/2/9/CH0356/CMS1078923314329/pflege.xls
(Stand 16. Aug. 2004), o.J.

Badelt, Christoph; Holzmann-Jenkins, Andrea; Matul, Andreas; Österle, August. Analyse der
Auswirkungen des Pflegevorsorgesystems. Wien: BMAGS, 1997.
http://www.bizeps.or.at/info/pa.html#recht

Identity

Mag. Dorothea Brozek, manager of the Vienna Association for Personal Assistance
user of Personal Assistance
Phone: ++43 (0)1 798 53 55
E-mail: d.brozek@wag.or.at