Interest representation in elderly services - the case of Budapest, Hungary

1. Zoltán TÓTH,Head of Dep. • Budapest Municipality,Vice Mayor’s Departmentfor City Planning, Management and Social Policy • Lisboa – 2009.03.11. Interest representation in elderly services- the case of Budapest, Hungary

2. (I.) Social Trends in (a.) Hungary (b.) Budapest • The expected population number of Hungary is 8,000,000 citizen by the year 2050. • The expected number of the 60+ citizen might be another sort of the recent one, that is 2.4 million people. • The reduced child rate and the expanding elderly rate is a new challenge for us. This is why reforming and fitting the social and health care system to the increasing needs is a crucial task for us. • The unemployment rate might be the same as it is today. • The homeless rate shall stagnate. • The majority of those who are capable to workwould like to receive employment. • The number of household dues’ arrears (for gas, electricity, accommodation, etc.) has been trebled in the last 2 years in the central region of Hungary.

3. Number and income of the retired Number of retired (Hungary – own right) 60 % receive pension 30 % handicapped pensioners10 % bereaved pensioner Parameters of retirement pensions in 2007. The spending power of the Hungarian pensions reach 52% of the EU one. * Pensioners + Retired handicapped + advanced pension Resource: KSH. 2008.

4. (II.) Health characteristics of the elderly • The majority of the 65+ elderly believe that they have a very bad health status (according to their self-perception). • 70-79% of the old peoples’ expenditure goes for health purposes • 2/3 at the family doctor consultancy and 85% of the home visited patients are 60+ • 4/5 of the 70+ visit their family doctors regularly • 2/3 of the family doctors’ consulting hours are used by 70+ • Even the daily routines (activities, motions, housework) at home cause hardships for the 70+ These characteristics support the need of a complex national strategy.

5. Guiding principles of a possible HealthStrategy: • Sustain and repair self-sufficiency! • Health care system has to slow down ageing and to prevent and professionally treat elderly illnesses. • Healthy lifestyle dissemination has an effectto the quality of becoming old. • A special geriatric care system has to be developed • Integrated management and service contactis needed with the social branch. • Tools of self-help and self-care are needed.

6. (III.) Number of staff and other data of personal social services in Budapest • Local governments and NGOs maintain 152 local elderly care centres and clubsin Budapest as a part of the personal social services system. They serve 6,000 retired citizen. • 16local government run services (social rehabilitation by employment) are employing 2,197 (elderly) people with some kind of handicaps. • 300institution and organisation offer basic and special care for 20,000elderly citizen inBudapest. Resource: data provision of the Elderly Care Services in Budapest 2008.

7. Problems of Social Services • Unequal area coverage of the existing social services; • Unequal access to elderly services (services are related to local population numbers, and not to local problems); • Needs assessment is not a precondition of service development; • Undefined access criteria to elderly services; • Quality and quantity service minimum standards are not always defined; • Missing daily informationabout the various elderly services • State and professional control varies from county to county

8. Recent dysfunctions – areas for development • Lack of co-operation and harmony between health and social provision. • Elderly have more diverse needs than the recent service offers. • Recent services are ill-proportioned, there is no communication, information distribution is incidental. Financial background of the enlisting of services is both scare and wasteful at the same time. • Local governments are not very much interested in the solution of the complex elderly problems. • The continuously reduced number of staff in care organisations is a continuously growing professional and managerial hazard. • Low social prestige of the helping professions + their income is much less thanthe average + extra welfare provisions are minimal.

9. (IV.) Social welfare provision in Budapest • Service Provision Map of Budapest • Service Provision Matrix • Common development aims • ‘Bestpractices’ in the 23 districts • Limits of service provisions • New organisational and structural co-operations • Services based on each others results =complexity (e.g. debt consultancy), • ‘Iteration of the health system and the District Roundtables’.

10. Service responsibility of the City Government The Budapest Municipal Government … • … maintains 4 types of institutions: 1.) homes for the elderly 2.) psychiatric institutions 3.) homes for mentally handicapped 4.) homeless shelters (etc.) • … maintains 10% of the elderly services in Hungary • … offers specialised services = in 23 institutions, = on 65 sites (some of them are quite far away from the capital) = and 6,420 individual places.

12. Specialized elderly provision • 10 homes for the elderly in Budapest and5 in the rural areas = all serving 3,807 people. • The material conditions in some homes are not even fitted to the legal regulations = fitting is necessary. • On the other side 5 organisations, and sites offer much higher accommodation possibilities and services for 560 people. • The Municipal Government runs 9homes for the elderly with 382 flats, while the 23 district governments run 9homes with 500 flats.

13. Home for the Elderly: „Vámosmikola”

14. Costs of Welfare The Municipal Government gave the following amounts to its social welfare institutions: In the year 2006 : 158.4 m€ In the year 2007 : 52.7 m€ In the year 2008 : 58.7 m€ Number of clients: In the year 2006 : 8,375 pers. In the year 2007 : 8,352 pers. In the year 2008 : 8,510 pers. Operational costs per head: In the year 2006 : 7,811 €/person In the year 2007 : 7,167 €/person In the year 2008 : 7,938 €/person

15. Institutions run by the Budapest Municipal Government Homes for the Elderly Homes for Psychiatric Patients Homes for Mentally Handicapped Homeless services BMSZKI 1047 Bp. Baross u. 100. (137 fh.) 1046 Bp. Béla u. 18. (30 fh.) 1046 Bp. Csokonai u. 38. (56 fh.) 1173 Bp. Pesti út 117. (544 fh.) 2463 Tordas, Gesztenyés út 1. (200 fh.) – 30 km 2463 Tordas, Hangyasor 255/4. (60 fh.) 2463 Tordas, Somogyi B.u.35. (12 fh.) 9971 Szentgotthárd, Hunyadi u. 29. (720 fh.) – 243 km 9970 Szentgotthárd, Május 1. út 19. (14 fh.) 1134 Bp. Dózsa Gy. út 152. ÁSZ: 326 fh, ANY: 14 fh, CSÁO: 12 fh, ÉM: 150 fh. 1097 Bp. Külső mester u. 84. ÁSZ: 129 fh 1105 Bp. Bánya u. 37. ÁSZ: 64 fh. 1104 Bp. Vaspálya u. 56. ÁSZ: 66 fh 1105 Bp. Előd u. 9. ÉM:140 fh 1081 Bp. Alföldi u. 6-8. ÁSZ: 221 fh,. 1087 Bp. Könyves K. krt. 84. ÉM: 100 fh, NM:100 fh. 1102 Bp. Fehér köz 2. NM: 120 fh 1097 Bp. Táblás u. 31. ÉM: 80 fh. 1089 Bp. Kálvária u. 23. ÁSZ: 48 fh. 1119 Bp. Kocsis u. 26. ÁSZ: 150 fh, Mszáll: 200 fh. 1047 Bp. Rákosszeg park 4-6. CSÁO: 80 fh, Mszáll: 70 fh. 1091 Bp., Gyáli út 33. ÁSZ: 150 fh, Mszáll: 200 fh. 1102 Bp. Halom u. 31. (40 fh.) 1103 Bp. Óhegy u. 48. (73 fh.) 1213 Bp. Tapló u. 1. (60 fh.) 1103 Bp. Gergely u. 85. (160 fh.) 1064 Bp. Rózsa u. 67. (121 fh.) 1092 Bp. Knézits u. 14. (50 fh.) 6422 Tompa, Szabadföld út 47. (150 fh.) – 177 km 9919 Csákánydoroszló, Fő u. 11. (255 fh.) – 222 km 2100 Gödöllő, Dózsa Gy. út 65. (192 fh.) - 30 km 2100 Gödöllő, Dózsa Gy. út 65. 8048/2 hrsz( 50 fh.) - 30 km 2113 Erdőkertes Petőfi S u. 49. -52 fh) 1071 Bp. Dózsa Gy. út 82/b. (79 fh.) 1068 Bp. Benczúr u. 46. (50 fh.) 1161 Bp. Pálya u. 27. (39 fh.) Integrated institutions 8713 Kéthely, Magyari u. 35. (140 fh.) – 212 km 8713 Kéthely, Hunyadi u. 61-14fh 8713 Kéthely, Hunyadi u. 93-20 fh 8713 Kéthely, Ady E. u. 55. -40 fh IO 1201 Bp., Virág B. u. 36. (138 fh.) IO 1192 Bp. Mészáros L. u. 26. (50 fh.) PBO 1182 Bp. Ráday G. u. 3. (140 fh.) 2635 Vámosmikola, Ipolysági út 9-11. (150 fh.) – 75 km 2025 Visegrád, Mogyoróhegy út 10. (95 fh.) – 43 km 5701 Gyula, Vértanúk útja 1-5. (425 fh.) – 222 km 8331 Sümeg-Darvastó Foglalkoztató Intézet (255 fh.) – 166 km 8331 Sümeg-DarvastóLakóotthonok (24 fh.) 1112 Bp. Kamaraerdei út 16. (400 fh.) 1112 Bp. Rupphegyi út 7. (126 fh.) 1115 Bp. Bánk bán u. 12-20. (120 fh.) 9700 Szombathely, Bogáti út 72. (140 fh.) – 217 km ÉFO 8925 Búcsúszentlászló, Arany J. u. 17. (100 fh.) – 227 km PBO 8741 Zalaapáti, Deák F. u. 3. (191 fh.) – 187 km 9476 Zsira, Rákóczi F. u. 12. (186 fh.) – 201 km 9476 Zsira, Flórián u. 54. (8 fh.) 9476 Zsira, Fő u. 1. (10 fh.) 9476 Zsira, Peresznye külterület (76 fh.) 1125 Bp. Kútvölgyi út 20-22. (135 fh.) 1031 Bp. Ányos u. 3. (75 fh.) 1124 Bp. Mártonhegyi út 53-57. (56 fh.) 1121 Bp. Zugligeti út 58. (34 fh.) 8153 Polgárdi-Ipartelepek Somlyói u. 2. (165 fh.) – 80 km

16. ‘Voluntary’ elderly caretasks of the City • Depth management (service + training) • Housing costs support system • IT-development + district networks • Computer studies training • Professional experience exchanges and consultancy • Yearly grant system (district + civic) • Crime prevention and victim help • City-NGO co-operation • Collecting ‘Best practices’ • Information distribution about the district development plans

17. Home for the Elderly: „Polgárdi”

18. Partnership and co-operation • Budapest Social Charter – since 1997 • Social Policy Council of the Central Hungarian Region • Council of the District Representatives • Budapest Elderly Council – since1998 • Budapest Social Policy Roundtable • Association of the Retired in Budapest („NYUBUSZ”) Co-operation Agreement: • Financial support • Professional co-operation • Joint conferences and workshops • Crime prevention program • Civic interest representation

19. Self help – Self care – Voluntarism („NYUBUSZ” = NGO) • Studies on the living circumstances of the elderly • Knowledge distribution (health preservation) • Initiatives and experience dissemination • Direct forms of activity: • Cultural activity, haritage trust(Elderly Festival, AGE-conference), • Recreation and re-activation, • Interest representation (in Hungary and abroad) + legal aid service, • Training and education (IT, language), re-employment, • Traffic safety and crime prevention +consumer protection, • „Pensioners for the pensioners” (100 volunteer skilled workers), • „Granny service” + „Nursery-program”, • Funeral counselling service • Professional co-operation and partner relations

20. (V.) Civic organisations during the political changes • Local, informal networks (friends, co-workers); • Informal networks (based on common field and sphere of interest); • Formalization of the civic bodies; • Birth of umbrella organizations

21. ELDERLY COUNCIL - the consultative body of the city management • First ECs in 2003:(Budapest / county / local); • Starting the „Elderly-friendly local government” movement • Elderly as a political power; • Strong interest-representation capacity - e.g.: National Action Plan; K.I.N.CS., etc.;

22. Main areas of elderly policy • Secure the social safety net; • Preserve and improve healthconditions; • Forming the publicview about the elderly.

23. Why exactly the Elderly Council? • Common interests (see: the main arias of elderly policy); • The ‘society’ of the elders is not homogeneous; • Where it is possible to show up and clash interest - groups with low interest representation might manifest; • EC is a counsellingand opinion formulating body.

24. Experiences of the Elderly Councils • EC might be counselling body of the mayor or the County Government; • EC role: formulating the local elderly policy; • Trilateral composition: • local government (= responsibility) • professional (= activity) • civic (rainbow-like) activity (= civic control); • Planned&fixed in work-plans; • Summarising the experiences:National conference in Budapest

25. EC activities • Create local problem maps; • EC roles: in service development+ in creating new services (e.g.: learning, recreation, senior sports) • EC studies on living standards and lifestyles of the elderly; • EC role in the quality assurance of the elderly services; • Recent plan: Revival of the Budapest Elderly Council (Interest-representation + Service Providers+ Local Government Participants).

26. Where is the end of the tunnel?

27. Where is the end of the tunnel? • The social composition of the elderly population shall change dramatically; • Old people = political power and consumers at the same time + service customers; • Old people = promoters (volunteer) + promoted; • Social programs aim to improve the quality of life of the elderly + social care; • They have to face new challenges.

28. Elderly provision – in a European way Develop a NATIONAL ELDERLY STRATEGY: • Change the pension system + preserve the pensions’ real values; • Fight against elderly discrimination, unemployment and social exclusion; • Create the possible conditions of the ‘life long learning’ (LLL); • Work out the professional standards; • Convert the institutional structureand the two level service system; • Legislative change; • Finance reform of the provider system; • Harmonizing the social and health systems + new services; • Create the preconditions of self help, self care and voluntary activity.

29. Thankyouforyourattention!

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