In the Russian Federation, as throughout the world, there is a trend of population aging. According to the UN Population Division, in developed countries the proportion of older people will increase from 21 to 28% by 2050. In Russia, by 2010, the share of people of retirement age already exceeds one third.
In this regard, in modern conditions, institutions of social services for older people and interdepartmental work on organizing social support for this group of the population are becoming important. This is due not only to an increase in the proportion of older people in the population, but also to the solution of problems arising from this phenomenon: changes in the social status of a person in old age, cessation or limitation of work, transformation of value guidelines, the very way of life and communication, as well as the emergence of various difficulties both in social and everyday life and in psychological adaptation to new conditions, which dictates the need to develop and implement specific approaches, forms and methods of social work with pensioners and older people.
Social services for older people are carried out in accordance with the ethical principles of the International Labor Organization.
Personal dignity is the right to decent treatment, treatment, social assistance and support.
Freedom of choice - every elderly person has the right to choose between being kept at home and living in a shelter, temporary or permanent.
Coordination of assistance - assistance provided by various social bodies must be proactive, coordinated and consistent.
Individualization of assistance - assistance is provided, first of all, to the elderly citizen himself, taking into account his environment.
Eliminating the gap between sanitary and social care - given the priority nature of the health criterion, the level of financial assistance cannot depend on the standard of living and place of residence.
The regulatory framework for social work with older people in the Russian Federation is the Federal Law “On the Fundamentals of Social Services for the Population in the Russian Federation” (dated December 10, 1995), according to which the scope of social services provided to older people includes: social household, social-medical, psychological-pedagogical, social-legal services; material assistance and social adaptation and rehabilitation of older people.
At the initial stages of the development of the social assistance system for older people, social workers focused on solving such urgent problems as organizing food, medical services, housing, and material support in order to create normal living conditions for them.
At the present stage, the organization of assistance to older people, along with the solution of these traditional social problems, involves the development of social technologies, the introduction of which will help resolve issues related to psychological difficulties that arise in older people in the process of communication or due to loneliness, as well as socio-psychological problems - how older people perceive other age groups, what are their social problems, their relationships with people around them, the role and status of older people in the family and society, etc.
It should be noted that there are different categories of older people. Among them there are people:
Not in need of help;
Partially disabled;
In need of service;
Requiring constant care, etc.
As a rule, social assistance, rehabilitation, and correction programs are developed depending on the membership of a particular category of older people. This is also related to the use of various principles, methods, and techniques for working with clients.
The basic principles of working with older people are respect and interest in the client’s personality, emphasis on the need and usefulness of his experience and knowledge to the people around him. It is important to perceive an elderly person not only as an object, but also as a subject of social work. This should help find and develop their internal reserves that promote self-realization, self-support and self-defense. An important role is played by the professional competence of the social worker, which includes knowledge of the gerontological and psychological characteristics of age, taking into account the client’s belonging to a particular social group.
Help for the elderly is provided by social protection authorities through their departments, which identify and monitor, provide various types of social support, offer and provide paid services. Social services are provided by decision of social protection bodies in institutions subordinate to them or under agreements concluded by social protection bodies with social service institutions of other forms of ownership.
The following institutions perform the function of social protection and assistance:
Boarding houses;
Day and night departments;
Special homes for single elderly people;
Hospitals and departments for chronically ill patients;
Hospitals of various types;
Territorial social service centers;
Social assistance departments at home;
Gerontological centers, etc.
The basic scheme for the functioning of social services for the elderly can be presented as follows:
In the system of inpatient institutions of the Russian Federation, a relatively new element is special houses for the permanent residence of single elderly people and married couples who have retained full or partial ability for self-care in everyday life and need appropriate conditions for self-realization of basic life needs.
The approximate Regulations on a special house for such pensioners (approved by order of the Ministry of Social Protection of Russia dated April 14, 1994 No. 47) lists its functions:
Providing favorable conditions for living and self-service;
Providing permanent social, domestic and medical care to elderly residents;
Creating conditions for maintaining an active lifestyle, including feasible work activity.
From the point of view of architecture and layout, special houses must correspond to the age characteristics of the living population of citizens. Such a house consists of one - two-room apartments, includes a complex of social services: a medical office, a library and a room for club work, a dining room (buffet), points for ordering food products, handing over things to the laundry and dry cleaning, as well as premises for work, etc.
The special house is equipped with small-scale mechanization facilities that facilitate self-service for the elderly citizens living in it, and it also has a 24-hour control center, provided with internal communications with all residential premises and external telephone communications.
Medical care for citizens living in a special house is provided by relevant specialists from territorial treatment and preventive institutions.
Based on current legislation, citizens living in such houses are paid a full pension. They have the right to priority referral to inpatient institutions of social protection authorities.
The organization of special homes for single elderly people and elderly couples is one of the promising ways to solve a whole range of social problems of pensioners and senior citizens.
8.2. Social services for elderly and elderly people
Social service is a set of social services that are provided to elderly and senile citizens at home or in specialized state and municipal institutions. It includes social and domestic assistance, social and environmental influence and moral and psychological support.
The basic principles of activity in the field of social services for old people are as follows:
respect for human and civil rights;
provision of state guarantees;
ensuring equal opportunities in receiving social services and their accessibility for older people;
continuity of all types of social services;
orientation of social services to individual needs;
priority of measures for social adaptation of elderly citizens.
The state guarantees elderly and elderly people the opportunity to receive social services based on the principle of social justice, regardless of gender, race, nationality, language, origin, property and official status, place of residence, or attitude to religion.
By mid-1993, several models of social services had developed in the Russian Federation, which were legislated by the Law of the Russian Federation of August 2, 1995 “On social services for elderly citizens and the disabled.” According to this Law, the social service system is based on the use and development of all forms of ownership and consists of the state, municipal and non-state social service sectors.
Public sector social services consists of social service management bodies of the Russian Federation, social service bodies of the constituent entities of the Russian Federation, as well as social service institutions that are federally owned and owned by the constituent entities of the Russian Federation.
Municipal social service sector includes social service management bodies and municipal institutions providing social services.
Municipal social service centers are the main form of the municipal sector, they are created by local governments in their subordinate territories and are under their jurisdiction. Municipal social service centers carry out organizational, practical and coordination activities to provide various types of social services.
The tasks of the municipal social service center includes identifying old people in need of social support; provision of various social services of a one-time or permanent nature; analysis of social services for elderly people; involvement of various state and non-state structures in resolving issues of providing social, medical, social, psychological and legal assistance to elderly and elderly people.
An analysis of the main activities of municipal social service centers indicates that this model of social service, focused on working with elderly and elderly people, has become most widespread and recognized and is the most typical.
Non-state social service sector unites social service institutions whose activities are based on forms of ownership that are not state and municipal, as well as persons engaged in private activities in the field of social services. This includes public associations, professional associations, charitable and religious organizations whose activities are related to social services for old people. Federal and territorial lists of state-guaranteed social services have been developed.
The federal list of state-guaranteed social services is basic, determined by the Government of the Russian Federation and revised annually; At the same time, a reduction in the volume of social services guaranteed by the state is not allowed. Based on the federal list of social services, a territorial list is established, also guaranteed by the state. This list is approved by the executive authority of the constituent entity of the Russian Federation, taking into account the needs of the population living on the territory of this constituent entity of the Russian Federation.
The right to social services is available to women over 55 years of age and men over 60 years of age who need permanent or temporary assistance due to partial or complete loss of the ability to independently meet their life needs.
When receiving social services, elderly and old people have the right to:
respectful and humane attitude on the part of employees of social service institutions;
selection of an institution and form of social services in the manner established by the federal social protection body and social protection bodies of the constituent entities of the Russian Federation;
information about your rights, obligations and conditions for the provision of social services;
consent to social services;
refusal of social services;
confidentiality of personal information;
protection of your rights and legitimate interests, including in court;
obtaining information about the types and forms of social services; indications for receiving social services and the terms of their payment and other conditions for the provision of social services.
Social services for old people include stationary, semi-stationary and non-stationary forms.
To stationary forms of social services These include boarding houses for labor veterans and disabled people, boarding houses for WWII veterans, boarding houses for certain professional categories of the elderly (artists, etc.), special houses for single and childless couples with a range of social and welfare services; specialized boarding houses for former prisoners who have reached old age.
Towards semi-stationary forms of social services include day and night departments; rehabilitation centers; medical and social departments.
Towards non-stationary forms of social services include social services at home; urgent social services; social advisory assistance; socio-psychological assistance.
Social services for old people can be permanent or temporary depending on their wishes. It can be completely free, partially paid or paid.
Inpatient social services is aimed at providing comprehensive social and domestic assistance to elderly and senile citizens who have partially or completely lost the ability to self-care and who, for health reasons, need constant care and supervision. This service includes measures to create the most appropriate living conditions for age and health status, rehabilitation measures of a medical, social and therapeutic-labor nature, provision of care and medical assistance, organization of recreation and leisure for elderly and elderly people.
Boarding houses for labor veterans (nursing homes) are not a product of our time. For the first time, special houses for old people appeared in ancient times in China and India, and then in Byzantium and Arab countries. Around 370 AD, Bishop Basil opened the first department for the elderly in the hospital of Caesarea Cappadia. In the 6th century, Pope Pelagius established the first home for the elderly in Rome. From that time on, special premises and rooms for the elderly poor began to be opened in all monasteries. Large asylums for old sailors were first opened in London in 1454 and in Venice in 1474. The first law on state responsibility for poor and infirm old people was passed in England in 1601.
In Rus', the first mentions of the creation of almshouses are found in the reign of Prince Vladimir in 996. During the years of Mongol enslavement, the church and Orthodox monasteries were the builders of premises for almshouses and old charity. In 1551, during the reign of Ivan the Terrible, an Appeal was adopted to the Stoglavy Cathedral, where in Chapter 73 “On Alms” the task was set as urgent measures to identify “elderly and lepers” in all cities, to build almshouses for them, for men and women, to keep them there , providing food and clothing at the expense of the treasury.
During the reign of Alexei Mikhailovich, by his order, the Kondinsky Monastery was built 760 versts from Tobolsk specifically for the charity of the old, crippled, rootless and helpless.
Metropolitan Nikon at the same time opened 4 houses for the care of poor widows, orphans and the elderly in Novgorod. In 1722, Peter I issued an order to fill the vacant places in monasteries with retired soldiers. Service in the army in those days lasted more than 25 years and, it is clear that these retired soldiers were already elderly people. With this order, the king pursued the goal of providing shelter and food for old and wounded officials who had no means of subsistence.
In the 30s of the 19th century, “houses of hard work” were opened in Moscow, where the poor and old people lived. In the 60s of the same century, parish trustees were created, which were also involved in the construction of elderly shelters. Admission to these shelters was very strict - only lonely and frail old people. These same councils obliged relatives to take care of their parents in old age.
In 1892, there were 84 almshouses at Orthodox monasteries, of which 56 were at the expense of the state and monasteries, 28 - at the expense of individuals and societies.
In Soviet times, the stationary social service system was decisive in providing social assistance to old people. As a rule, old people who, due to their physical helplessness, were unable to maintain their usual way of life were admitted to boarding homes for the elderly and disabled. These boarding houses were practically hospitals for chronically ill and helpless old people. The main principle of organizing the activities of boarding homes was the provision of medical care; all work was based on the principle of hospital departments and was entrusted to medical personnel: doctor - nurse - nurse. The structure and activities of these social security institutions have remained without significant changes to this day.
At the beginning of 1994, there were 352 boarding houses for labor veterans in Russia; 37 - specialized boarding homes for old people who spent their entire adult lives in places of detention and remained in their old age without shelter, family, home, or loved ones.
Currently, 1061 inpatient social security institutions are open in the Russian Federation. The total number is 258,500 places, with a population of 234,450 people. Unfortunately, in our time there is not a single boarding house for the elderly that is fully supported by private individuals or any charitable societies.
Boarding houses for labor veterans are available everywhere, but most of them are in the Nizhny Novgorod region - 40; in Sverdlovskaya - 30. Until 1992, there was 1 paid boarding house in Moscow, accommodation in a single room cost 116 rubles per month, in a double room - 79 rubles. In 1992, the state was forced to take it over, leaving 30 paid places, but even these places there were no takers. In 1995, only 3 paid places were occupied. This fact especially clearly demonstrates the impoverishment of the residents of Moscow and all of Russia.
According to N.F. Dementieva and E.V. Ustinova, 38.8% of elderly people live in boarding houses for labor veterans; 56.9% - old age; 6.3% are long-livers. The overwhelming majority of very old people (63.2%) in inpatient institutions of the social security system is characteristic not only of Russia, but is observed in all countries.
The basic rule for applicants is that 75% of the pension goes to the Pension Fund, and 25% remains for the old people themselves. The cost of maintaining a boarding house is from 3.6 to 6 million rubles (excluding denomination).
Since 1954, all homes for the elderly and disabled had benefits, they could develop their own estates, have subsidiary farming in rural areas, and labor workshops. However, after social reforms were carried out, taxes were established even on these social service institutions, including road taxes. This led to the abandonment of labor workshops and subsidiary farms in many houses. Currently, boarding houses for labor veterans have only 3 protected items: food, employee salaries and partially medicines.
According to the Federal Law, in boarding houses for labor veterans, old people living have the right to:
providing them with living conditions that meet sanitary and hygienic requirements;
nursing, primary health care and dental care;
free specialized care, dental and prosthetic and orthopedic;
socio-medical rehabilitation and social adaptation;
voluntary participation in the medical and labor process, taking into account the state of health;
medical and social examination to establish or change the disability group;
free visits by their lawyer, notary, clergyman, relatives, representatives of legislative bodies and public associations;
provision of premises for religious ceremonies;
if necessary, referral for examination and treatment to state or municipal health care institutions.
If desired and necessary for work, residents of boarding houses for labor veterans can be hired for work available to them due to health reasons, under the terms of an employment contract. They have the right to annual paid leave of 30 calendar days.
Special residential buildings for old people is a completely new form of inpatient social service. It is intended for singles and married couples. These houses and their conditions are designed for old people who have retained full or partial ability for self-care in everyday life and who need to create easier conditions for the self-realization of their basic life needs.
The main goal of these social institutions is to provide favorable living conditions and self-service, provide social and medical assistance; creating conditions for an active lifestyle, including feasible work. The pensions of those living in these houses are paid in full, in addition, they receive a certain amount of additional payment. A prerequisite for admission to residence is for old people to transfer their home to the municipal housing stock of the city, region, etc. in which they live.
Specialized boarding homes for the elderly are intended for permanent residence of citizens who have partially or completely lost the ability to self-care and need constant outside care, from among those released from prison, especially dangerous repeat offenders and other persons for whom administrative supervision is established in accordance with current legislation. Elderly people who have previously been convicted or have been repeatedly brought to administrative responsibility for violating public order, who are involved in vagrancy and begging, and who are sent from internal affairs agencies are also sent here. Old people living in boarding houses for labor veterans and constantly violating the rules of living in them established by the Regulations on Social Service Institutions may, at their request or by a court decision made on the basis of the provision of documents by the administration of these institutions, be transferred to specialized boarding houses.
Old people enter a nursing home for various reasons, but the main one, without a doubt, is helplessness or fear of impending physical helplessness. Almost all old people suffer from various somatic diseases that are chronic and usually no longer amenable to active therapy.
At the same time, these old people carry with them various moral, social and family losses, which ultimately become the reason for voluntary or forced abandonment of their usual way of life. An old person makes the decision to move to a nursing home as a result of difficulties in self-care. Fear of even greater physical weakness, impending blindness and deafness contribute to such a decision.
The composition of nursing homes is very heterogeneous. And this is understandable. In a certain (every year decreasing) part, old people come here who are able to take care of themselves and have sufficient physical health. In another case, entering a nursing home is a manifestation of the altruism of an old person, a desire to free younger family members from the burdens associated with guardianship and care for a helpless elderly family member. In the third, this is a consequence of unfulfilled relationships with children or other relatives. However, this is always the result of the inability of old people to adapt to new living conditions in the family and in the familiar home environment. These old people choose social assistance and social services as a new way of life.
And yet, in any case, it is not easy for an old person to radically change his previous lifestyle by settling in a nursing home. 2/3 of old people move here extremely reluctantly, yielding to the pressure of external circumstances. The organization of these social institutions essentially copies the organization of medical institutions, which often leads to an undesirable and painful fixation on the purely painful side of senile infirmity. The results of a sociological study conducted in 1993 in Moscow showed that the overwhelming majority of those surveyed - 92.3% - had an extremely negative attitude towards the prospect of a possible move to a nursing home, including those living in communal apartments. The number of people wishing to move to a nursing home has decreased especially noticeably after the creation of social service departments at home. Currently, in various regions and cities, this queue is no more than 10-15 people, mostly people of particularly advanced age, completely helpless and often alone.
88% of those in nursing homes suffer from various mental pathologies; 62.9% had limited physical activity; 61.3% are unable to even partially take care of themselves. 25% of residents die every year.
Serious concern, especially in the last 5 years, has been the unsatisfactory budget financing of boarding houses for labor veterans and disabled people. For this reason, many nursing homes cannot carry out major renovations of their buildings or purchase shoes, clothing, and technological equipment for elderly citizens. Currently, the pace of construction of special houses is sharply decreasing due to limited funds from local budgets. An equally pressing problem is the staffing of nursing homes.
Semi-stationary social services includes social, medical and cultural services for elderly and elderly people, organizing their meals, recreation, ensuring their participation in feasible work activities and maintaining an active lifestyle.
Semi-stationary social services are accepted for elderly and senile citizens who need it, who have retained the ability for self-care and active movement, and who do not have medical contraindications for enrollment in social services.
Day care department Designed to support the active lifestyle of older people. Old people are enrolled in these departments, regardless of their marital status, who retain the ability for self-care and active movement, on the basis of a personal application and a certificate from a medical institution about the absence of contraindications for admission to social services.
The length of stay in the department is usually a month. Visitors to the department can, with voluntary consent, participate in occupational therapy in specially equipped workshops. Work activities are carried out under the guidance of an occupational therapy instructor and under the supervision of a medical professional. Meals in the department can be free or for a fee; by decision of the management of the social service center and the local administration, certain services can be provided for a fee (massage, manual therapy, cosmetic procedures, etc.). These departments are created to serve at least 30 people.
Medical and social department is intended for those who experience serious difficulties in organizing their lives and running their own households, but for one reason or another do not want to live in nursing homes. Special departments and wards have been opened on the basis of healthcare institutions, where frail old-age pensioners living alone, who have lost mobility and the ability to self-care, are hospitalized primarily. In this case, a referral to a medical and social bed is given by social service centers in agreement with the local doctor. In recent years, the experience of organizing wards for routine treatment of old people, where all types of medical procedures are carried out, has become increasingly widespread.
In medical and social departments and wards, lonely, frail old people are on full social security for a long time, and their pensions, as a rule, are received by their loved ones and relatives, who often do not even visit the old people. In many regions, attempts are being made to at least partially reimburse the costs of maintaining elderly and senile people. This is done with the personal consent of the old people by order of the local authorities. These funds are used to purchase clothes and shoes, organize additional meals, and part of the funds goes to improve the wards and departments.
Medical and social departments have become widespread in rural areas. In winter, old people live here, and in spring they return to their homes.
Mercy Trains is a new form of service for old people living in remote, sparsely populated areas by teams that include doctors of various specialties and employees of social protection agencies. These mercy trains make stops at small stations and sidings, during which members of the team visit local residents, including the elderly, at home, provide them with all types of medical care, as well as financial assistance, give out medicines, food packages, and industrial kits. goods, etc.
Non-stationary forms of social services created to provide social assistance and services to older people who prefer to remain in their familiar home environment. Among non-stationary forms of social services, first place should be given to social services at home.
This form of social service was first organized in 1987 and immediately received wide acceptance from old people. Currently, this is one of the main types of social services, the main goal of which is to maximally prolong the stay of old people in their usual habitat, support their personal and social status, and protect their rights and legitimate interests.
Basic social services provided at home:
catering and home delivery of food;
assistance in purchasing medicines, food and industrial goods of prime necessity;
assistance in obtaining medical care, escort to medical institutions, clinics, hospitals;
assistance in organizing legal assistance and other legal forms of assistance;
assistance in maintaining living conditions in accordance with hygienic requirements;
assistance in organizing funeral services and burying lonely dead;
organization of various social services depending on living conditions in a city or village;
assistance in preparing documents, including for establishing guardianship and trusteeship;
placement in inpatient social service institutions.
In addition to home-based social services provided for by the federal or territorial lists of state-guaranteed social services, older people may be provided with additional services on a full or partial payment basis.
Social assistance departments at home are organized at municipal social service centers or local social welfare authorities. Social services at home can be provided permanently or temporarily for up to 6 months. The department is created to serve at least 60 people in rural areas and at least 120 people in the city.
Social services at home are provided free of charge:
for lonely old people;
for those living in families whose per capita income is below the minimum level established for the given region;
for old people who have relatives who live separately.
As studies have shown, of all types of services, the most significant for old people are:
care during illness - 83.9%;
grocery delivery - 80.9%;
drug delivery - 72.9%;
laundry services - 56.4%.
The list of services provided by social workers at home is regulated by special regulations, in particular the Order of the Ministry of Social Security of the RSFSR dated July 24, 1987. By the beginning of 1993, 8,000 social service departments at home were created in the Russian Federation, and the total number of persons served reached more than 700,000 people.
Additional services services provided by the department of social services at home:
health monitoring;
provision of emergency first aid;
performing medical procedures as prescribed by the attending physician;
provision of sanitary and hygienic services;
feeding weakened patients.
Procedure and conditions for enrollment for home-based social services: an application addressed to the head of the social protection agency; the application is reviewed within a week; An examination of the applicant’s living conditions is carried out. Based on the results of the examination, an act is drawn up, information is requested on the amount of the pension, a conclusion on the state of health and the absence of medical contraindications, a decision is made on enrollment for permanent or temporary service, and the types of services required.
Removal from social services is carried out on the basis of an order from the director of the social service center at the request of an old person, upon expiration of the service period, in case of violation of contractual terms of payment for services, identification of medical contraindications, malicious violations of the rules of behavior by old people served by social workers.
Social and medical care for old people at home is carried out in relation to people in need of home-based social services who suffer from mental disorders in remission, tuberculosis, with the exception of the active form, and severe somatic diseases, including cancer.
The staff of social and medical services includes medical workers whose professional activities are regulated by the legislation of the Russian Federation on protecting the health of citizens.
Social advisory services (assistance) for elderly and senile citizens is aimed at their adaptation in society, easing social tension, creating favorable relationships in the family, as well as ensuring interaction between the individual, family, society and the state. Social advisory assistance for elderly people is focused on their psychological support, increased efforts in solving their own problems and provides for:
identification of persons in need of social advisory assistance;
prevention of various kinds of socio-psychological deviations;
working with families in which old people live, organizing their leisure time;
advisory assistance in training, vocational guidance and employment;
ensuring coordination of the activities of government agencies and public associations to solve the problems of older citizens;
legal assistance within the competence of social service authorities;
other activities to form healthy relationships and create a favorable social environment for old people.
Currently it is represented by 4 forms of social services:
stationary (existing in the country for decades);
semi-stationary;
not stationary (home-based); 4) urgent social. The stationary network is represented by 1314 institutions, of which:
618 - boarding homes for the elderly and disabled (general type);
440 - psychoneurological boarding schools;
64 - houses - boarding schools of mercy for the elderly and disabled;
14 - gerontological centers.
245 thousand people live in inpatient institutions of the social protection system, of which 140 thousand people are elderly people.
If the growth in the number of people living in boarding homes in recent years has been insignificant (fluctuating between 1-2 thousand people per year), then the expansion of the network of inpatient institutions has turned out to be a more noticeable phenomenon. The network of general boarding houses developed most actively (over 10 years, an increase of more than 2 times) with complete stagnation of the psychoneurological network (at the beginning of the year).
The expansion of the network of general boarding houses has made it possible to improve living conditions in them.
In recent years, there has been a tendency towards the disaggregation of existing boarding houses and the opening of small-capacity houses. As a result, the average capacity of a general boarding house is now 151 places (in 1992 - 293 places).
Another trend is the creation of specialized inpatient institutions - houses of mercy and gerontological centers, which, to a greater extent than general boarding houses, deal with the problems of medical care.
Despite the active development of the network of inpatient institutions, the number of people waiting in line to be placed in boarding homes is not decreasing (17.2 thousand people, including 10.0 thousand people in general boarding homes).
The semi-inpatient form includes the activities of structural units of social service centers (CSC), institutions providing assistance to persons without a fixed place of residence, as well as social and health centers. This group usually includes special homes for the lonely and the elderly, although they are not, in essence, social service institutions, but rather a type of housing.
The network of social service centers developed more dynamically than the stationary network. The first central service center was opened in Chelyabinsk in 1987. Now there are already 1875 of them.
In 2001, day care departments served 825.5 thousand elderly and disabled people, temporary residence departments - 54.4 thousand people.
In 2001, 57.4 thousand people passed through the system of 99 institutions for persons without a fixed place of residence, and in most cases these were the services of 38 homes
night stay - 23.1 thousand people and 21 social adaptation centers - 15.6 thousand people. Up to 30% of the population served by these institutions are elderly people.
A network of social and health centers is developing. There are 52 of them, and they were able to serve 55.9 thousand people in 2001.
21.7 thousand people live in 701 special homes for single elderly people. For the most part, these institutions are small, with up to 25 residents; there are 444 of them. In 21.8% of such houses there are social services.
The non-stationary (home-based) form of service for the elderly and disabled is implemented through departments of social services at home and specialized departments of social and medical services at home.
The annual growth rate of the network of specialized branches significantly (15-20 or more times) exceeds the rate of development of the network of non-specialized branches.
In 2001, these units served 1,255.3 thousand elderly and disabled people at home, of which 150.9 thousand people (12.0%) were provided with specialized departments of social and medical services.
Urgent social services are the most widespread form of social services. In 2001, more than 13 million people received urgent social assistance, of which, according to data from a number of regions, 92-93% were elderly and disabled people.
Despite the apparent improvement in the material well-being of Russian citizens, this service continues to actively develop and provide services to more and more people.
Question 74. Social services for older citizens and disabled people.
Social services for elderly citizens and disabled people
Regulated by the Federal Law of August 2, 1995 On Social Services for Elderly and Disabled Citizens. This type of social service is a set of social services that are provided to specified persons at home or in social service institutions, regardless of the form of ownership.
Activities in this area are based on the following principles:
1. Respect for human and civil rights
2. Providing state guarantees in the field of social services
3. Equality of opportunities to receive social services and their accessibility
4. Focus on the individual needs of these individuals
5. Priority of social adaptation measures
6. Continuity of all types of social services
7. Responsibility of state bodies. authorities and institutions, officials for ensuring the rights of these persons in the field of social services.
The right to social services has women over 55 years of age and men over 60 years of age, as well as disabled people (including disabled children) who need outside help temporarily or permanently due to the loss of the ability to independently satisfy their life needs (in whole or in part). ).
Social services for these persons are carried out by decision of the social protection authorities in institutions subordinate to them or under agreements concluded by the social protection authorities with commercial organizations providing social services.
When receiving social services, elderly disabled citizens have the following rights:
1. respectful and humane treatment on the part of employees of a social service institution
2. the choice of institution and form of social services. service
3. for information about their rights and obligations, as well as about the conditions for the provision of social services.
4. Consent or refusal of social services
5. confidentiality of personal information
6. to protect your rights and interests
Social services are provided with the voluntary consent of the individuals themselves, with the exception of:
1. persons under 14 years of age
2. persons recognized as incompetent in accordance with the law
In this case, consent is given by the legal representative. Consent is expressed in a written statement, on the basis of which the person is placed in a social service institution.
The Law of the Russian Federation of July 2, 1992 on psychiatric care and guarantees of the rights of citizens during its provision provides for the possibility of placing an elderly citizen or disabled person in a social service institution without their consent.
As a general rule, these persons can refuse social services, and social service workers must explain to them the negative consequences of the decision. In this case, persons formalize their refusal of social services in writing.
Elderly citizens and disabled people may be provided with living quarters in social housing stock. At the same time, at the request of the individuals themselves, their social services can be provided both on a permanent and temporary basis.
Social services at home is aimed at maximizing the possible extension of the stay of elderly citizens and disabled people in their familiar environment in order to maintain their social status. The list of state-guaranteed social services includes the following as home-based services:
1. catering, including home delivery of food
2. assistance in purchasing essential medicines, food and industrial goods.
3. assistance in obtaining medical care, including transfer to medical institutions.
4. maintaining living conditions in accordance with hygienic requirements
5. assistance in providing legal assistance and legal services
6. assistance in organizing funeral services.
7. If these persons live in residential premises without central heating and/or water supply, then the list of guaranteed services includes the provision of fuel or water.
In addition, these persons may be provided with other additional services on the condition of partial or full payment.
If elderly citizens or people with disabilities suffer from mental disorders, cancer, tuberculosis, sexually transmitted diseases, chronic alcoholism and other similar diseases that require treatment, they may be denied social services at home and referred to health care institutions.
Semi-stationary social services: includes social, medical and cultural services for elderly citizens and people with disabilities, organizing their meals, recreation, ensuring their feasible work activity and maintaining an active lifestyle. Semi-stationary social services accept persons who are capable of self-care and active movement and have no medical contraindications. Semi-stationary social services can be provided in day and night care homes. These social service institutions are created primarily for persons without a fixed place of residence. The night stay home accepts persons who apply both independently and those referred there by social services. protection or ATS. Some persons may be provided with these services (listed above) for inter-individual indications.
Inpatient social services is aimed at providing social and domestic assistance to citizens who have lost the ability to self-care or who need it for health reasons. This type of social service includes rehabilitation measures of a medical, social, therapeutic and labor nature, appropriate to age and health status, provision of care, medical assistance, organization of recreation and leisure. These persons have the following rights:
1. providing living conditions that meet sanitary and hygienic requirements
2. primary health care and dental care
3. socio-medical rehabilitation and social adaptation
4. voluntary participation in the medical and labor process
5. the right to a medical and social examination carried out for medical reasons
6. have the right to be freely visited by lawyers, notaries, representatives of public associations, legal representatives, relatives and clergy.
7. have the right to free legal assistance in accordance with the Federal Law on free legal assistance in the Russian Federation of November 21, 2011.
8. the right to provide them with premises for the performance of religious rites for believers of all faiths.
9. the right to retain the residential premises they occupy under a rental or lease agreement for 6 months from the date of admission to social services, if these are state/municipal property houses. If family members remain in the premises, it is retained for the entire period.
10. participation in public commissions to protect the rights of citizens.
11. Disabled children in inpatient social service institutions have the right to receive education and vocational training.
12. Disabled children with physical disabilities and disabled children suffering from mental disorders are placed in different social service institutions.
Elderly citizens and disabled people in inpatient social service institutions are given the right to be hired in accordance with their health status, and if an employment contract has been concluded with them, they have the right to a vacation of 30 calendar days.
Urgent social services carried out for the purpose of providing emergency assistance of a one-time nature if they are in dire need of social support. Urgent social services include:
1. one-time provision of hot meals or food packages
2. provision of clothing, shoes and other essential goods
3. one-time provision of financial assistance
4. assistance in obtaining temporary housing
5. organization of legal assistance for the purpose of their protection
6. organization of emergency medical and psychological assistance with the involvement of psychologists and clergy.
Social advisory assistance is aimed at adaptation of the elderly and disabled, at easing social tension, creating favorable conditions in the family, ensuring interaction between the individual, family, society and the state. Social advisory assistance includes:
1. identification of persons in need of this assistance
2. prevention of socio-psychological deviations
3. work with families in which these citizens live
4. organization of leisure time,
5. consultation in training, career guidance and employment.
6. legal assistance within the competence of social authorities. service.
7. ensuring coordination of the activities of public associations and social service institutions.
In accordance with the Constitution of the Russian Federation, citizens of the Russian Federation have the right to social security, including pensions, in old age.
A pension is a cash benefit received by citizens from public consumption funds for old age, loss of ability to work, length of service, or loss of a breadwinner, which is the basis for calculating a pension. Payments are made monthly upon reaching retirement age.
In accordance with the law, pensions are divided into state and non-state. The law establishes labor and social pensions. In connection with labor and other socially useful activities, pensions are awarded: old age (age), disability, loss of a breadwinner, and long service. Citizens who for some reason do not have the right to a pension in connection with labor and other socially useful activities are provided with a social pension.
The pension is granted for life. Pension provision in accordance with current legislation is carried out by state social security authorities.
Men have the right to an old-age pension upon reaching 60 years of age with at least 25 years of work experience, and women upon reaching 55 years of age with at least 20 years of work experience. Certain categories of citizens are granted pensions on preferential terms (that is, with a lower age and length of service).
Pension legislation ensures the right of citizens to choose one of the types of state pension. An exception is established only for persons who have become disabled as a result of a military injury, who can simultaneously receive two types of state pension: old age (or service) and a disability pension.
In modern conditions, institutions of social services for pensioners and interdepartmental work on organizing social support for older people are becoming important. This is due to an increase in the proportion of older people in the population, a change in the social status of a person in old age, the cessation or limitation of work activity, the transformation of value guidelines, the very way of life and communication, as well as the emergence of various difficulties, both in social and everyday life, and in psychological adaptation to new conditions. All this dictates the need to develop and implement specific approaches, forms and methods of social work with pensioners and older people.
Social services for older people are carried out in accordance with the ethical principles of the International Labor Organization:
Personal dignity is the right to decent treatment, treatment, social assistance and support.
Freedom of choice - every elderly person has the right to choose between being kept at home and living in a shelter, temporary or permanent.
Coordination of assistance - assistance provided by various social bodies must be proactive, coordinated and consistent.
Individualization of assistance - assistance is provided, first of all, to the elderly citizen himself, taking into account his environment.
Eliminating the gap between sanitary and social care - given the priority nature of the health criterion, the level of financial assistance cannot depend on the standard of living and place of residence.
The scope of social services provided to older people includes: social, social, medical, psychological, pedagogical, social and legal services; material assistance and social adaptation and rehabilitation of older people.
At the initial stages of the development of the social assistance system for older people, such urgent problems as the organization of nutrition, medical services, housing, and material support were solved in order to create standard living conditions for them.
At the present stage, the organization of assistance to older people, along with solving these traditional social problems, involves the development of social technologies, the introduction of which will help resolve issues related to psychological difficulties that arise in older people in the process of communication or from loneliness. It is also necessary to take into account how older people will perceive other age groups, what are the social problems of those who live to old age, their relationships with people around them, the role and status of older people in the family and society, and others.
As a rule, social assistance, rehabilitation, and correction programs are developed depending on the membership of a particular category of older people. This is also related to the use of various principles, methods, and techniques for working with clients.
The basic principles of working with older people are respect and interest in the client’s personality, emphasis on the need and usefulness of his experience and knowledge to the people around him. It is important to perceive an elderly person not only as an object, but also as a subject of social work. This should help find and develop their internal reserves that promote self-realization, self-support and self-defense. An important role is played by the professional competence of the social worker, which includes knowledge of the gerontological and psychological characteristics of age, taking into account the client’s belonging to a particular social group.
Assistance to the elderly is provided by social protection authorities through their departments, which identify and keep records, provide various types of social support, offer and provide paid services. Social services are provided by decision of social protection bodies in institutions subordinate to them or under agreements concluded by social protection bodies with social service institutions of other forms of ownership.
The following institutions also perform the function of social protection and assistance:
- - boarding houses;
- - day and night departments;
- - special homes for lonely elderly people;
- - hospitals and departments for chronic patients;
- - hospitals of various types;
- - territorial social service centers;
- - social assistance departments at home;
- - gerontological centers, etc.
The basic functional diagram of social services for the elderly can be presented as follows:
In the system of inpatient institutions of the Russian Federation, a relatively new element is special houses for the permanent residence of single elderly people and married couples who have retained full or partial ability for self-care in everyday life and need appropriate conditions for self-realization of basic life needs.
The approximate Regulations on a special house for such pensioners lists its functions:
- - providing favorable conditions for living and self-service;
- - provision of permanent social, domestic and medical assistance to living elderly citizens;
- - creating conditions for maintaining an active lifestyle, including feasible work activity.
Architectural and planning solutions for a special house must correspond to the age characteristics of the living population of citizens. Such a house consists of one - two-room apartments, includes a complex of social services: a medical office, a library and a room for club work, a dining room (buffet), points for ordering food products, handing over things to the laundry and dry cleaning, as well as premises for work and others.
The special house is equipped with small-scale mechanization equipment that facilitates the self-care of elderly citizens living in it. It should have a 24-hour control center, provided with internal communications with all residential premises and external telephone communications.
Medical care for citizens is provided by medical personnel of territorial treatment and preventive institutions.
Based on current legislation, citizens living in such houses are paid a full pension. They have the right to priority referral to inpatient institutions of social protection authorities.
The organization of special homes for single elderly people and elderly couples is one of the promising ways to solve a whole range of social problems of pensioners and senior citizens.
