site.btaElderly in Bulgaria Lack Guaranteed Access to Quality, Affordable Health Care, Social Services

Bulgaria lacks guaranteed access for the elderly (65+) to quality, affordable healthcare, social services and integrated health and social services for long-term care in the community and at home, said Svetlana Gyoreva, expert on social activities and policies at Caritas Bulgaria. She was among the speakers at a round table discussion on access to long-term care for the elderly at home. 

According to data from the National Statistical Institute and the Ministry of Health, presented during the round table, at the end of 2022 people aged 65 and over accounted for 1,515,383 people or 23.5% of this country's population. According to the same data, during the period 2020-2034, the population aged 65+ is expected to continue increasing. The statistical forecast shows that in 2027 the share of the population aged 65+ in the total population of this country will amount to 24.5%, at the end of 2034 - 27.6%, and by the end of 2060 it will reach 31%.

According to data from the report presented at the round table, in a large number of small and remote settlements, the elderly do not have access to medical care, cannot rely on a personal doctor, pharmacy and other types of health care.

The authors of the report point out that the trend of population ageing and high morbidity among the elderly pose a challenge related to the growing demand and need for such services, while their supply is limited and not guaranteed.

According to the study, even in large cities with relatively good infrastructure, it is difficult and often impossible for the elderly to move on their own to hospitals and other types of public institutions; their low incomes do not allow them to receive quality health care and rehabilitation or a personal assistant. 

Due to the shortage of professional care at home, there is a growing tendency to rely on informal caregivers such as family, who care for their elderly relatives. It is the informal caregivers who are out of reach of any support from the institutions in Bulgaria, Svetlana Gyoreva said. 

According to the report, greater efforts and financial resources continue to be directed towards the development of residential forms of care, and there continues to be insufficient investment in ensuring the important preventive role of home care.

"In 2000, the Bulgarian Red Cross  started working in the field to create this model of home care. For the first centre we opened in Lozenets (a residential district in Sofia), we barely managed to find 35 people who had to be told what this was all about. There were concerns that a stranger would be coming into their home, etc. Now over 50,000 people in the country benefit from such a service," said Dr Nadezhda Todorovska, head of Social and Health Policy at the Bulgarian Red Cross. 

According to her, the model with digital services, allowing monitoring of a person's health indicators through a special bracelet and tracking by a communication centre 24 hours a day, has a huge effect on people. She cited data that digital health care comprises 20%-25% of total home care services. 

According to Dr Todorovska, Bulgaria needs to create a real working system of integrated health and social services that have a direct link to the general practitioner. 

She explained that it could be implemented in three ways: through the municipalities with the services they provide locally, the independent practices of nurses or other providers of integrated health-social services. 

"However, the Bulgarian situation is such that we cannot take a model from another country, we have to make our own system that works according to our possibilities, we cannot take an existing model," said Dr Todorovska.

She said there should be opportunities for mixed funding. The National Health Insurance Fund should be obliged to provide all its eligible users with the right to health care. The other funding option is from the municipal and state budgets and, last but not least, the programmes that still exist under the EU, which, however, oblige Bulgaria to take the next innovative step. 

"Telecare is constant care in the home that allows a person to feel cared for, even though they cannot see the visitor coming, but the device enables the person to keep their spirits up, and this allows people to overcome difficulties more easily," Dr Todorovska further explained.  

According to Daniela Ushatova, representative of the National Association of Municipalities in the Republic of Bulgaria, the development of integrated services depends on decentralization, and such development should happen at the municipal and local level. Some of the cheapest services are at-home care, she said, adding that there are over 513,000 domestic social patronage service and day centre users.