Analytics, Demography, Direct Speech, Economic History, Education and Science, Latvia

1. Introduction

In circumstances where financial resources are limited, and due to the growing changes in demographic structure, that is characterised by an ageing population, it is important to assess the possibilitiesin perspective of elderly people in the regions of Latvia, taking into account the capacity of state social care services. The highlighted question is: what will be the future possibilitiesto provide the care of elderly people in long-term social care facilities, taking into account the ageing population, the increase of life expectancy, the migration of labour from regions, and the country as a whole– thelow salaries in the social care sector, the disadvantaged recruitment of social care professionals and the different financial capabilities in local municipalities.

To answer this question the field of social services in Latvia is reviewed as the study object. The aim of the study is to find out, evaluate and to reflect the current situation and future trends of social care facility options for elderly people in the context of future globalisation, demography, migration and human resources, thus following tasks are set:

·        to review and analyse statistical data available at Central Statistical Bureau of Latvia (CSB) and Eurostat database;

·        to analyse the planning documents of the responsible ministries of the field;

·        to review and analyse available literature in the field of social care and related factors;

·        to define conclusions and make proposals on the studied subject.

As the basis of this study data and literature analysis is used as the method of research, including review of national planning documents – “Sustainable Development Strategy of Latvia until 2030”, “National Development Plan of Latvia for 2014–2020”, “Framework for Social Service Development 2014-2020”, “Regional Policy Guidelines 2013-2019”, “Framework for Professional Social Work Development 2014-2020”, “National Reform Programme of Latvia “Europe 2020”” and documents related to these planning documents, like evaluations, reviews, plans and other sources of literature.

Statistical data are taken from CSB and Eurostat databases, in addition an overview of studies and reports such as “Emigration from Latvia in the 21^st century by regional, urban and municipal breakdown” [12], “Results of the evaluation and analysis of the effectiveness of the activities by local municipalities in social service institutions and social workers” [37], “Collective monograph “Communities of Latvian emigrants: the diaspora of hope” [29], “Geographical labourmobility” [8], “The role of internal geographical mobility in the development of suburbanisation in Latvia” [3], “Dementia and neuropsychiatric symptoms in nursing home patients in Nord-Trøndelag” [50], “World Alzheimer Report 2015: The Global Impact of Dementia Alzheimer's disease international (ADI)” [53], “Public Health report. Dementia in Norway” [54].

2. Study results

Study results are summarized in four sub-sections: changes of demographic structure and population ageing, internal and external migration, social care, an overview of national planning documents, studies and other literature.

2.1. Changes of demographic structure and population ageing

According to Regional Policy Guidelines 2013-2019, changes of demographic structure is a significant global challenge, that will encounter all over Europe in the coming decades and put a pressure on funding for health and social care in the future [33]. The number of people in the age over 60 continues to increase in Europe as it is forseen by the European Commission [24].The number of people over the age of 65is increasingalso in Latvia, according to Eurostat figures, but the number of people in the agr of labour force is declining, and this trend will continue in the next few decades, according to European Central Statistics prognosis [52]. (see table 1)

Table 1 Changes of demographic structure [52]

It is predicted, that by year 2035 the number of people in the age group 15-64 will decrease by 12%, but in the age group over 64 it will increase by 15%, thus the dependency ratio will increase by 20% compared to year 2017 and on every 1000 people in the age of labour force there will be 726 unemployed people including 65% of people aged over 62 years.[19]

Previous trends indicate that the number of people aged over 65 has increased in Latvia. Between years 2007 and 2017, it has increased by 3691 people orin percentage of 1%. There is a higher increase in the number of people living in long-term social homes, which has increased by 1172 or 20% during the same period. [5] (see table 2)

Table 2 Number of elderly people living in long-term care facilities [6; 5]

In the relatively short period from year 2012 to 2017, life expectancy in Latvia has increased by approximately 0.5%. These data show not only an increase of the number of healthy years of population and medical progress, but also an ageing population and the expected growth of social service customers in the future. (see table 3) According to Eurostat, the estimated life expectancy in all EU Member States was 78.7 years in 2011 for women, 68.8 years for men, while in 2060 life expectancy would have increased to 87.2 for women and 81.1 for men. [22; 51]

Table 3 Expected life expectancy in Latvia [35]

The expected increase in life expectancy has a strong impact on the microeconomy andmacroeconomy, health and social care, neverthelessit is a positive factor. As the average age of the population increases, it is necessary to keep elderly people in the labour market for as long as possible, to engage them in lifelong learning, and to ensure the prevention and mitigation of special diseases specific to the elderly people, as well as to providethe people who have reached retirement-age with pensions, thatis a major challenge at national level. According to available data in year 2018 lifelong learning activities involve 7.5% of the population aged 25-64, representing only half of the target for year 2020. Comparatively in Scandinavian countries this figure is from 26% to 30% [40; 21; 20; 19].

2.2. Internal and external migration

The average age of the population in the regions is increasing due to internal and external migration. The highest proportion of emigration consists of young people, thus elderly people often remain without direct support from relatives, which in turn burdens social care services. Internal and external emigration also reduces the working population in the regions, leading to human resource shortages in different economic sectors. [8] Looking at regions, the age of permanent residents increases in the regions of Vidzeme, Kurzeme, Zemgale and Latgale, while in the regions of Riga and Pierigait has remainedstable over the last two years. (see table 4)

Table 4 The average age of the residents in regions of Latvia [36]

Data show the trend of internal migration by Latvian residents to the areas of Riga and Pieriga due to various factors and causes, but mainly these causes of migration are socio-economic and educational. The highest proportion of this migration is composed of labour force, including students and young families, thus the average age in other regions of Latvia is increasing [4; 29].

Overall changes in the demographic structure are also affected by external migration, which is one of the main factors forming the dynamics of Latvian residents, another undeniable factor is the relationship between birth and mortalityrates that leads to a demographic downturn in the country. In 2017 the birth rate in the country was 20.8 thousand children, while in year 2016 it was almost 22 thousand, mortality in 2017 exceeded the figures of the year 2016 by nearly 200 people. Overall, at the beginning of 2018, the number of Latvian residents decreased by 15.7 thousand people [16; 29]. (see table 5)

Table 5 Changes in population [17]

The long-term migration balance in the study period from year 2010 has been negative, nevertheless there are some improvements in the situation in the last statistically availableyear. (see table 6) This statistical indicator of the last year could have both incidental nature and in relation with a certain recovery of the economic situation of the country. The new Re-emigration Pilot Project developed by the Ministry of Environmental Protection and Regional Development of Latvia (MEPRD), that is likely to replace the unsuccessful Re-emigration Support Plan for 2013-2016, could also contribute in the return of people to Latvia. The new pilot project involves an individual approach to the needs of each person at local municipality level [32; 43].

Table 6 Migration [14]

The largest migration wave has hit Latvian cities in Zemgale, Vidzeme and Latgale regions, but less in Pieriga, Kurzemeregion and city of Riga. In total, fewer people emigrated from the rural territories, but there is a possibility, that due to internal migration emigrants in the beginning concentrated in large cities, which in turn is the starting point on the external emigration. [12; 29] (see table 7)

Table 7 Migration balance [15]

Given that the reasons for emigration are largely due to financial difficulties, opportunities for better salaries and better quality of life abroad, in the near future a relatively small number of Latvian emigrants are considering possibilityof re-emigration, at the same time emigration is continuing. In conclusion, the demographic downturn will continue as a consequence of migration, if the overall economic, social and political situation of the country does not improve significantly. [12; 29]

Emigration is higher than the natural increase of Latvian residents, in result Latvia has lost 277 thousand residents between years 2000 and 2018, in total 447 thousand people. Mostly the labour force is leaving, where the largest group is composed of young people, and the main reason is job opportunities abroad.

In some economic fields, there are signs of an ageing labour fource in Latvia. One of the most critical sectors where ageing trend has been observed is the social care sector, where the highest proportion of employees is over 50 years old. [19]

In general, external migration has a negative impact on the Latvian labour market, where demand for certain professionals is increasing annually, including social service providers. In the survey of the most demanded professions, the shortage of social care professionals is expected in 2018-2019 in all regions of Latvia. [7] The reason can also be found in relation to migration, because social sector specialists and carers have often chosen migration from Latvia because of the economic crisis. [28]

2.3. Social care

According to the CSB, the increase in adult care facilitiesof local municipalities and other organisations is evolving in a growing trend, while the most rapid rise is recorded in years 2016 and 2017. At the end of year 2017 there were 102 registered and approved care facilitiesthat may offer the service, it is 16 facilities more than in 2016. [45] (see table 8)According to data of the register of social service providers, there are already 126 service providers in December 2018.[47]

Table 8 Number of inhabitants and social care centres [45; 5]

Given the increasing number of people living in care facilities, which has increased by 942 persons from 2014, this was to be expected. Such a rapid statistical rise in the numbers of care facilities, compared to a certain stagnation of previous years, can be explained by the registration and approval of non-governmental organisations as service providers. On the basis of the Section 17 part (1) of the Law on Social Services and Social Assistance, the social service provider has an obligation to register its activity in the register of social service providers. In addition, local municipalities can notcontract any unregistered service provider in accordance with the general rules on social services in the municipality. [48]

Statistics show that there is also an increase in demand for homecare services due to the increase of residents in retirement-age. The number of social service clients increased by 4724 over a five-year statistical period, while the number of carers decreased by 387 during the period. This statistically increases the number of persons under care per care taker, thus the quality and efficiency of services suffers. (see table 9)

Table 9 Home care [46]

One of the factors that explain the shortage of human resources in the field is low salaries. It is important that, in different local municipalitieseven with the same population, the salaries of one level of social workers vary. In many social services, the salary of employees is not calculated on the basis of the results of work or the qualifications of the employee. In general, this leads to lack of motivation and frustration of employees. The second factor is the reluctance of professional social care graduates to work in a sector involving a variety of factors:salary, definition of working boundaries and competences, quality principles, professional growth opportunities, etc. [49; 41]

Table 10 Salaries in social care [9]

Statistics show that over seven years, the costs of social workers have increased on average by only 150,00 euro. (see table 10). Contrary to the 10% increase in the annual salary of social workers set out in the Framework for Professional Social Work Development 2014-2020, only half of local municipalities annually increase the salaries of social carersin the average amountof 3,3%. [18; 9; 1]

The spotlights mentioned above are a serious challenge not only for the field of social care, but for the country as a whole. Looking at policy planning documents, reports and assessments which, to some extent, highlight the anticipated demographic scene, there are reasonable grounds for believing that this problem is not assessed according to its importance.

2.4. Overview of national planning documents, studies and other literature

The responsible ministries of the field in the Republic of Latvia develop policy planning documents focused on sustainable development and improving the quality of life of citizens. [2]

Sustainable Development Strategy of Latvia until 2030 (Latvia 2030) is the main long-term development planning document, while the main medium-term planning document in the country is National Development Plan of Latvia for 2014–2020 (NDP2020). NDP2020 is a roadmap for national development and investment over a seven-year period. [25; 27] Latvia 2030 highlights depopulation and ageing as a problem that will affect regions of Latvia and notes that ageing dynamics in Latvia is the fastest in Europe, which correlates with the loss of employee productivity. Meanwhile, NDP2020, the main planning document elaborated in accordance with Latvia 2030, is focused on the economic breakthrough and one of its objectives is aimed at increasing birth rates and supporting re-emigration as well as reducing mortality. TheNDP2020 interim assessment report focuses on demographic challenges and migration policy. [30] According to the conclusions of interimassesment in contrary to the goal of Sustainable Development Strategy of Latvia until 2030, which aims to keep the age demographic dependency below 30%, Latvian population is ageing quite rapidly and has already reached 30.2% in 2016. This means that the strategy will not be reachedfor the ageing population, if any radical immigration measures are not taken. The document proposes to carry out an assessment of the budgetary framework programmes which have a direct impact on the ageing of the population and demography.

The National Reform Programme of Latvia (Europe 2020) looks at demographic trends in the programme of Latvia 2030 in the context of the level of employment and the shrinking labour force in the future. Policies have been identified to reduce poverty, including the development of highquality social and health care services and their accessibility to people at risk of poverty and social exclusion, by improving existing support systems and developing alternative social services in regions. [26] In the programme progress report 2018 of The National Reform Programme of Latvia (NRP) the main policiesare the fostering of birth rates, increasing the number of years of healthy life for the population, and also the project for deinstitutionalisation (DI) is mentioned in relation to social care institutions. [42]

The Ministry of Welfare has elaboratedFramework for Professional Social Work Development 2014-2020, that highlights demographic challenges such as migration, ageingpopulation, limited funds for state and local municipalities and labour shortages. The purpose of this document is to ensure the provision of social services suitable to the needs of the individual, to provide decent living conditions and high-quality services in social care facilities for persons in need of continuous supervision of specialists [31]. In order to reduce the burden of institutional services, the framework include also DI project. [10] However, it should be noted that the DI plan is focused only on persons with mental and functional disabilities, as well as orphans and the possibilities of these individuals to live in families outside the social rehabilitation facilities, thusthe persons in retirement age are not a part of the DI plan. [10]

In the context of the needs of people inretirement age, key problem is identified, namely, the lack of a sufficiently developed home care service for people of retirement age, although demand for long-term social care and social rehabilitation services in institutions is constantly increasing. [31] The framework also points out the direction of actions to address identified problems, and the solution is to extend home care services within existing municipal funds. Considering the growing number of dementia patients, a single daily care centre is expected to be established annually for patients with dementia or new patient places in existing care facilities. [31] The year 2017 interim report of the framework analyses the development of day care centres and finds that no new day-care centres for people with dementia were created in the period form year 2014 to 2016. This is based on a lack of demand and the limited financial resources of municipalities. [18]

However, the population with dementia will continue to grow in the future. On the basis of estimates, it will quadruple in the European countries by 2050. [53] Estimates show that around 80% of the inhabitantsin the long-term social care facilities have a dementia diagnosis and, as the number of elderly people increases, dementia incidence will increase in the future, with a consequent increased need for long-term social care facilities. [54] Although non-institutional services for elderly people will be increased and elderly people will continue to live in their homes for a longer period of time, around two thirds of these people will still need services in long-term social care centres in the end phases of dementia disease. [50]

On the basis of these studies, it can be concluded that the above-mentioned national documents do not adequately address the need of long-term social care facilities of elderly people and the future capacity of these facilities, thus there are reasonable grounds to believe that homecare will not be able to meet the needs of all elderly peopleon the basis of statistics, and the demand for services of long-term care facilities will be significant.

In August 2017 evaluation of the framework, the information report “Interim evaluation of the implementation of the Framework for Social Service Development 2014-2020 (2014-2016)” [18], was publishedin the Database of policy planning documents. This interim report provides evaluation of the results on the objectives and planned activities of the framework to promote the development of social care and social rehabilitation services at home. The results reflect information for three years (2014-2016).The results show that the number of home care services has increased, but the number of local municipalities providing this service has remained unaltered, with 80% of the total number of local municipalities. Other municipalities purchase this service and accordingly do not provide training for social home care providers. The number of homecare beneficiaries planned in the framework also does not correspond to the real situation, since it exceeds the percentage calculation in the framework by 23% in year 2017. [18] In relation with the provision of long-term social services, the interim report evaluates only state social care centres (SSCC) and the improvements made there, as well as the reduction of inhabitants to improve the living conditions in SSCC. The admission of new clients to the SSCC branchesis also suspended, if the premises are not in line with hygiene requirements.

Considering the demand for long-term social care and social rehabilitation services in institutions, it would be necessary to draw up a medium-term policy planning document directly targeting this audience. At this moment, such a plan does not exist.

In the project “Development of Professional Social Labour in Local Governments”of the Ministry of Welfare, a study “The results of the evaluation and analysis of the effectiveness of the activities of local municipal social services and social workers”was carried out between November 2016 and October 2017 [37]. The study includes an assessment of the effectiveness of the activities of social services and social workers, the study methodology is based on the results of in-depth interviews, questionnaires and surveys. [38]The study is comprehensive and covers many areas of social services in municipalities. By distinguishing the home care of elderly people and the provision of long-term social care services, care at home is seen as a priority in opinion of clients, and 94% of respondents say it is important, while the provision of long-term social care facilities is in the sixth position. On the other hand, the provided homecare service assessment by social service customers was found to be good at 63%, while the provision of long-term social care facilitiesat 46% of the total number of people surveyed. The authors of the study themselves, however, point out that respondents, are more positive than they actually thinkdue to caution, because they are depending on the social service evaluated. However, the final conclusion of this study, which includes the overall treatment of social services in the municipality, is very positive. The results go beyond the target value of the policy indicator “Satisfaction of the population with the support provided by the social service to the identified social problem” set out in the Framework for Professional Social Work Development 2014-2020, which is set at 75%. According to the results of the study, 78% of social services customers indicate that they are generally fully or rather satisfied with the servicesprovided. [44]

These satisfaction indicators may not be objectively taken into account by the authors of the study themselves because of the possible reasons for the bias of the respondents. Objectivity is also affected by the possibly limited availability of client information on the regulatory enactments regarding the requirements for social service providers, as well as hygiene requirements in social care institutions and the rest of their rights. [39; 13]

In the Framework for Professional Social Work Development 2014-2020a number of challenges in the field of social services was faced. For example,the number and qualifications of social work specialists employed in social services do not comply with the requirements specified in national regulatory enactments and social workers lack specific knowledge and skills in social working practices. There is no mechanism to ensure that social workers who are studying for State budget are attracted to the sector. There is insufficient link of education to working practice and a non-motivating and non-transparent system of salary calculations for social workers.

Interim evaluation of the implementation of the Framework for Professional Social Work Development 2014-2020 (2014-2017)” had to besubmitted by 1^st of November 2018, nevertheless the report was not published neither in the homepage of Ministry of Welfare, nor in the policy planning document database. [41]

Recommendations of the European Commission to improve the availability and quality of the healthcare system and more efficient use of funding during year 2016, progress is considered to be restricted. These recommendations include insufficient progress results in social assistance reform, health care and public sector reforms, including the problem of high co-payments, waiting lists for service availability, etc. [11]

Neither the opinion on long-term social care centresof Ombudsman are positive. In 2018, without prior information on the planned monitoring visits to the facilities, the employees of the Ombudsman's Office have identified a number of violations on human rights. Social care and rehabilitation services in these facilities do not comply and are not fully able to provide the requirements of Cabinet Regulation No. 338 “Requirements for social service providers”, as well as those of Cabinet Regulation No. 431 “Hygiene Requirements for Social Care Institutions”. [39; 13] During the monitoring visits, irregularities were identified in several long-term social care facilities in relation to the lack of access to information for customers, the non-compliance of required living space with the population. Irregularities in sanitary spaces, hygiene, catering and drinking water, air quality, as well as non-compliance of the number of employees and their qualifications with the obligations to be performed. [34]

These non-compliances with requirements have a serious argument for focusing in detail on social care, adapting infrastructure to the environment and creating quality of services in line with customers' needs.

3. SWOT analysis of long-term social care institutions for older people

The table below provides an analysis of SWOT in relation to long-term social care institutions for older people, showing the strengths and weaknesses of internal and external factors in this sector, as well as the existing opportunities and risks.

4. Conclusions and proposals

In this chapterauthor summarized conclusions based on the study and proposals to improve the social care field according to future demography challenges.

4.1. Conclusions

1.   Despite the challenges identified in the national policy planning documents and planning documents of the responsible ministries of the field in relation to population ageing and the increase in the number of elderly people in the future, this objective is not adequately addressed.

2.    With the expected increase in population life expectancy, demand for long-term social services in social care facilities will continue to grow, despite the intention to keep people in the labour market for as long as possible and to adapt health services to the category of elderly people.

3.   It is currently possible to provide home care services, nevertheless we may face challenges in terms of increased demand, lack of care workers and social workers in the sector in the future.

4.   Internal and external migration has an impact on the quality, supply and accessibility of social services and creates uncertainty in terms of the provision of human resources in the field and increasing average age of people in several regionsin the future.

5.    Although the level of patient satisfaction with the services provided by social care facilities is formally presented as satisfactory, it is reasonable to believe, that these satisfaction indicators are not objective.

6.    For a given moment, the infrastructure and quality of services of several social care facilities do not comply with the regulatory norms.

7.    Contrary to the expected indicators of the national planning documents, the current demographics and growing demand go beyond provisionally desideratum, but the activities to improve accessibility of services are not fully implemented.

4.2. Proposals

1.   In line with the growing demand for long-term social care and social rehabilitation facilities, it would be necessary to develop a medium-term policy planning document directly aimed at providing elderly people with access to these services in the future.

2.    Because of the prospective future demographic challenges, it is necessary to calculate the optimal number of long-term social care facilities and the number of residentsin each of them on the basis of studies carried out, that would include demographic trends, the specific characteristics of morbidity, quality of life, population density, average population age, mortality rate, life expectancy and public financial security in the region.

3.   The distribution of financial resources and grants to the social care field, regardless of the model for balancing finances of the local governments, in the context of regional development in the long term and the salaries of the workers must be reviewed, thereby attracting labour force, that will be vitally needed in the coming decades.

4.    Regular monitoring measures should be taken in long-term social care facilities to assess the quality and criteria of services and their compliance with the requirements and regulations in the field.

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