May 2018

30 May 2018

DOCUMENT DE POZIŢIE

REFERITOR LA DEZVOLTAREA SECTORULUI DE ÎNGRIJIRI LA DOMICILIU

Propuneri în urma Conferinței naţionale"Realități, Experiențe și Provocări în Îngrijirile la Domiciliu”

din 15 mai 2018

Republica Moldova se confruntă cu fenomenul de îmbătrânire rapidă a populaţiei. Pentru a asigura cetățenilor vîrstnici  un trai decent şi, pe cât e posibil - independent în propriile case, în RM este necesar de a dezvolta serviciile integrate de îngrijire medico-socială la domiciliu.

Un rol important în dezvoltarea serviciilor respective aparţine organizaţiilor societăţii civile care oferă servicii medico-sociale, medicale și sociale la domiciliu. Uniunea Asociațiilor Obștești „Rețeaua organizațiilor necomerciale prestatoare de îngrijiri comunitare” a constatat că cererea de servicii integrate de îngrijire medico-socială la domiciliu depășește cu mult capacitatea de finanțare a statului. Modelul existent  de finanțare nu face faţă nevoii în creştere de astfel de  servicii.

În contextul îmbătrânirii accentuate a populaţiei din R Moldova, a migrației masive a persoanelor tinere care lasă în urmă vârstnici care au nevoie de îngrijire, cât și a faptului că un număr crescut de profesionişi din domeniul sănătăţii şi asistenței sociale zilnic părăsesc sectorul, se impune dezvoltarea de servicii de îngrijire, adaptate nevoilor individuale ale fiecărei persoane şi provocărilor existente.

În acest sens, pentru a reuşi să sprijinim dezvoltarea sectorului de îngrijiri la domiciliu, noi, Uniunea Asociațiilor Obștești „Rețeaua organizațiilor necomerciale prestatoare de îngrijiri comunitare”, compusă din 36 de prestatori de îngrijiri comunitare şi cei peste 100 de participanţii reuniţi în cadrul Conferinței naţionale "Realități, Experiențe și Provocări în Îngrijirile la Domiciliu”, organizată la Chişinău în data de 15 mai 2018, facem apel la toţi decidenţii politici, şi ne exprimăm susţinerea publică pentru următoarele deziderate: 

  1. Elaborarea şi asigurarea continuităţii tuturor politicilor pentru dezvoltarea serviciilor integrate de îngrijire la domiciliu, inclusiv ajustarea şi armonizarea cadrului normativ existent.
  2. Susţinerea şi promovarea, la nivel politic şi instituţional, a colaborării şi parteneriatului între autorităţile publice  locale şi centrale, şi sectorul neguvernamental, reprezentat de furnizorii activi în prestarea serviciilor de îngrijire la domiciliu.   
  3. Introducerea pe agenda publică şi în programele de guvernare a problematicii complexe a persoanelor vârstnice, inclusiv a măsurilor de intervenţie necesare în contextul tendinţei de îmbătrânire demografică accentuată. Dezvoltarea unei metodologii de evaluare a nevoilor de servicii sociale, la nivel de comunitate.
  4. Elaborarea și aprobarea de către MSMPS a unei politici sectoriale, care va oferi cadrul necesar pentru funcționarea și finanțarea sistemului de servicii sociale. Acest document ar trebui să prevadă aprobarea unui pachet minim de servicii sociale, finanțat direct din bugetul de stat. Totodată, Guvernul și Parlamentul ar trebui să prevadă creșterea ponderii procentuale din bugetului public național pentru ”sectorul social”, care este mult mai mică comparativ cu alte state europene.
  5. Asumarea de către MSMPS  a unui rol activ în inițierea elaborării unor metodologii de calcul al costurilor pe tipuri de servicii sociale și medico-sociale, cu implicarea prestatorilor de servicii în acest proces. Metodologiile de calcul al costurilor trebuie să se bazeze pe formulele clar definite, în baza unor elemente măsurabile, care va include costul fiecărei resurse necesare pentru prestarea serviciului. La elaborarea metodologiei de calcul al costului ar trebui să se țină cont de cheltuielile pentru pregătirea profesională a resurselor umane   implicate  în  serviciile respective. 
  6. Examinarea posibilității de majorare a cotei pentru îngrijirile medicale comunitare și la domiciliu din fondul de bază al asigurării obligatorii de asistență medicală. Elaborarea criteriilor de eligibilitate pentru contractarea prestatorilor de servicii de îngrijiri medicale comunitare și la domiciliu. Ajustarea mecanismului de contractare a prestatorilor de îngrijiri medicale comunitare și la domiciliu. Distribuirea echitabilă a fondurilor CNAM între prestatorii publici și privați.
  7. Aprobarea de către  Ministerul Finanţelor, în comun cu MSMPS a unui set de documente standard, care ar standardiza  şi stabili  condiţii unice de întocmire a documentelor de atribuire la achiziţia serviciilor sociale.  Avînd în vedere lacunele și impedimentele legislative existente, se impune o legislație specială pentru reglementarea parteneriatului public-privat (PPP) în domeniul contractării serviciilor sociale, care să fie în concordanță cu specificul domeniului protecției sociale. În acest context, este necesară modificarea cadrului legal existent, astfel încît să fie posibilă derogarea de la prevederile art. 7 din Legea nr. 179 din 10.07.2008 cu privire la parteneriatul public-privat și pct. 66-76 din Regulamentul privind procedurile standard și condițiile generale de selectare a partenerului privat, în cazul în care obiectul PPP este prestarea serviciilor sociale, iar partenerul privat este o organizație non-profit.
  8. Revizuirea Regulamentului-cadru al Serviciului Social de Îngrijire la Domiciliu, Standardelor minime de calitate, atât pentru îngrijirile sociale la domiciliu, cât şi pentru cele medicale. Elaborarea de standarde minime de calitate pentru servicii integrate socio-medicale.    
  9. Formarea para-asistenților medicali, cu întroducerea specialității date în clasificatorul profesiilor. Elaborarea programelor de formare continuă pentru personalul din domeniul serviciilor de îngrijiri la domiciliu pentru creşterea calităţii serviciilor prestate. Elaborarea unor modele-tip de Fişe de Post pentru personalul serviciului de îngrijire medico-socială la domiciliu , care să fie propuse prestatorilor de astfel  servicii . 
  10. Elaborarea categoriilor de dependenţă a beneficiarilor pentru  serviciul   de îngrijire medico-socială la domiciliu și pilotarea utilizării acestora.
  11. Elaborarea unor pârghii de responsabilizare a rudelor persoanelor vârstnice, care nu-şi asumă îngrijirea acestora.

Anexa la acest Document de Poziţie conţine ,,Studiul privind  serviciile  medicale și sociale de îngrijiri la domiciliu în Republica Moldova”,  realizat de către Centrul de Investigații și Consultanță Sociopolis, cu prezentarea constatărilor-cheie şi a recomandărilor.   

Chișinău

___________________________________________________________________________________________________________________________________________

10 May 2018

HOME-BASED MEDICAL AND SOCIAL CARE SERVICES ASSESSMENT IN THE REPUBLIC OF MOLDOVA

Prepared by: Centre of Investigations and Consultation “SocioPolis”

May 2018

EXECUTIVE SUMMARY

Republic of Moldova (RM) faces the phenomenon of rapid population aging. At the beginning of 2016 there were 592 600 persons aged over 60 year old, 13.3% of whom were over 80 years old.

Social services for the elderly, including Home Based Care (HBC) services, have been developed in the RM to ensure a decent and independent living for old people, to the possible extent. Social assistance is mainly provided through the social protection system and is under the responsibility of the Ministry of Health, Labour and Social Protection (MHLSP). The development and provision of social services at the community/municipality level is the responsibility of Local Public Authorities (LPAs). The main sources of funding social services are the transfers from the state budget to the LPA and the local taxes. This funding model is incompatible with the increased need for social services at the local level, resulting from the high level of ageing, poverty and migration.

The Moldovan legal framework on the organization of medical HBC services was approved in 2008 by the Ministry of Health (MH) and in 2010 by the Ministry of Labour, Social Protection and Family (MLSPF). The first medical HBC service provider was contracted by National Health Insurance Company (NHIC) in 2008. The medical HBC service providers need to be accredited before contracted by NHIC and access state funding. These funds are limited and cover only the insured people with advanced chronic diseases, people with low mobility and bed-ridden patients, based on doctors’ recommendation.

An important role in the development of HBC services is played by the network of Civil Society Organisations (CSOs) providing medico-social home care services. The network was created within the “Development of home care services 2011-2013” project implemented by the CSO “Homecare” in collaboration with Caritas Czech Republic. During 2011-2017, 36 CSOs and professional associations providing social, socio-medical, medical and palliative care have joined this network. In January 2017 the existing network has been reorganized. The founding members: CSO “Homecare”, CSO “Casmed”, the Charitable Foundation “Caritas Moldova”, CSO “Bethania”, CSO “Neoumanist”, CSO “Aripile Sperantei”, have established the Association of CSOs ”The Network of non-commercial organizations providing community care” (URONPIC). The observations made during the last few years by the URONPIC show that the demand for social and medical HBC far exceeds the state funding capacity, but comprehensive data of the real needs is not available.

In this context, several donor-driven service providers / projects initiated, in collaboration with the Centre of Investigations and Consultation “SocioPolis”, the Assessment of social and medical HBC services in the Republic of Moldova. The goal of the initiative was to provide a mapping of social and medical HBC services, including people’s demand for HBC services, to help Moldovan authorities develop evidence-based policies and contribute to the sustainable HBC service development.

 

The overall objective of the assessment is to assess the existing HBC service provision (private and public) as well as the need of the population in sustainable HBC services. National level data, which serve as reference in the field of social and medical care at home, was collected as part of the initiative.

The current assessment is mixing desk research with quantitative and qualitative research methods. Quantitative methods (questionnaire completed by providers) revealed the situation of HBC services and the need for this type of services. Qualitative methods (in-depth interviews) with beneficiaries of HBC services enabled an inclusive research of aspects related to HBC services, evaluation of the service, service needs, while those with LPA representatives revealed the real possibilities of their involvement in financing / co-financing of HBC services. The survey sample comprised 84 HBC service providers from 23 ATU. The qualitative research involved 2 target groups: 340 beneficiaries of HBC services and 23 LPA representatives. Financial data have been collected in order to establish the cost of the HBC provision. The method of cost calculation is based on transformation of resources (inputs) in products/services (outputs). The considered costing method associates the costs of resources with services delivery.

 

Types of home based care (HBC) services and their providers

Data from the Assessment of social and medical HBC services in the Republic of Moldova reveals the presence of three types of HBC services: social services, medical services and integrated services.

The social HBC service represents a public (established within territorial structures of social assistance (TUSA) or private service (created by foundations, private non-profit organizations, registered according to the law, dealing with social field activities). The overall purpose of the service is to provide quality social HBC services to ensure better quality of the beneficiaries’ life. Source of financing for social HBC services are local budgets, grants, local and international donations, beneficiary contributions.

Medical HBC service represents a public (medical institutions at the local level I) or private service, provided in accordance with the law, by a healthcare institution, irrespective of its type of ownership and legal form of organization (usually CSO, but can be also profit entities). The purpose of medical HBC services is to provide the patient with qualified, dignified and appropriate care according to his individual needs, in order to stimulate the rehabilitation, maintenance and/or rehabilitation of the health condition and reduce the negative effects of the disease. Source of financing are Compulsory Health Insurance Funds, grants, local and international donations, beneficiary contributions.

Integrated HBC services. There have no legal provisions regarding the integrated HBC services, neither standards. However, certain service providers (especially the CSOs, but also public institutions) operate with this notion. Integrated services are those services according to which the beneficiary receives, in line with his/her needs,  both social and medical HBC support. In other words, the same beneficiary receives the support from social worker and from medical assistant, but not always with common coordination of their efforts. Source of financing for such services are grants, local and international donations, beneficiary contributions.

 

Spending on HBC services

The registered expenses for social HBC services in year 2016 were 103.7 million MDL which is by 3.9 million more than in year 2015. The share of the spending for social HBC services is 93% out of the total actual budget (111.4 million MDL) reported for 2016 budget year.

Medical HBC services are financed from the main fund of NHIC and are called medical HBC. Community and medical HBC services have the lowest share of expenditures in the main fund. It is only 0.2% out of total and counted 8.7 million MDL in one year (7.7 million MDL exclusively for medical HBC services).

Official data do not include the CSOs’ spending. Those CSOs which do not have the contract with NHIC and local public authorities are not included in the total budget because there is no state reporting mechanism. Even if the private healthcare institutions (LLC or CSO) have the contract with NHIC and/or local public authorities they are not required to report the spending from their own sources.

The research data show that donor money in the sector exist, but not much. The problem lies in their reporting. The service providers do not report to LPAs and all their spending and achievements are not included in the official reporting documents. There are donors open to collaborate with LPAs in this sense (CSO ”CASMED” and CSOs under “CASMED” umbrella, CSO ”Homecare”, CSO “Neoumanist”, Charity Foundation “Caritas Moldova”, CSO “Concordia. Proiecte sociale”, CSO “Aripele Sperantei” etc.).

 

Characteristics of HBC providers

HBC service providers are different - public, private (including the profit entities (LLC)). Most providers are public providers that offer medical HBC services. They operate at community level and have the lowest number of beneficiaries (average - 20, minimum - 2, maximum - 107 (municipalities). The number of public providers of social HBC services is lower, but they provide services at the level of ATUs and have the highest number of beneficiaries (average - 636, minimum - 298, maximum - 2171). Private providers with CSO status are fewer, some of them provide social HBC services, some integrated HBC services, and some HBC medical services. Some CSOs provide services at the local level, others at the ATU or regional level and are CSOs that provide services at national level. Also, CSOs have the biggest variation in the number of beneficiaries (average - 472, minimum - 8, maximum - 2100).

The vast majority of HBC services offered are free of charge. Some CSOs promote the co-payment model (the beneficiary pays a symbolic sum; the most common is the co-payment model between beneficiaries, provider and LPA from level I). The analysis underlines that there is currently no normative framework on calculation of the fee for social HBC services, still, the evaluation study reveals that 3 TUSA (Falesti, Cimislia and Glodeni) provide social HBC services for charging a fee.

The models of HBC services are also different. The evaluation allowed differentiation based on 12 criteria of 4 social HBC models, 5 medical HBC models and 4 integrated HBC models. Integrated models respond to a broader variety of beneficiaries' needs, have the widest team of specialists, and are geared towards developing partnerships at community, ATU, region, or national level.

The research outcomes indicate on important voluntary work done by medical assistants which consist of the social support offered along with the required medical support. Also, TUSA social workers in charge with social HBC services, sometimes provide medical HBC services. In such situations, they are forced to overpass the regulatory framework, including professional standards that do not allow the social worker to provide medical services.

Lack of specialists is a major problem for a group of HBC providers. This is due the fact that young specialists are not being attracted by this sector. Most strikingly is the lack of medical assistants. All CSOs that provide medical HBC services or integrated HBC services mentioned difficulties in hiring nurses. Public service providers have mentioned this issue to a much lesser extent. The lack of medical staff is more felt in municipalities and some towns and less in rural areas. Half of TUSAs who participated in the evaluation have mentioned difficulties in hiring social workers. This situation is a result of the migration of skilled workers but also result of low wages, both in social protection and medical field. The other causes are: (i) high workload, (ii) high responsibilities, (iii) more attractive employment opportunities in other areas, (iv) specific requirements of provider (medical assistants with a driving license), (v) low professional training of social workers, etc.

 

Criteria for admission to HBC services

TUSA provide social HBC services according Government Decision no. 1034. Free of charge services are offered to elderly who have reached the standard retirement age and people with disabilities that are without support from children, extended family and other people (friends, relatives, neighbours). However, lack of children/support from children stipulated in the law is actually interpreted mainly as childless status.

All accredited public and private providers offer medical services to beneficiaries in accordance with the Regulation and Standards related to medical HBC set forth in the Orders of the MH no. 855 of 29.07.2013 and no. 851 of 29. 07.2017. The person has to meet a few criteria to benefit from services: (i) to have medical insurance, (ii) to have a recommendation from the family doctor / specialist, (iii) to reside on the territory served by the medical institution.

The admission to HBC within the CSOs is based on specific criteria set by donors. The basic request from donors is to include the most vulnerable in HBC service. Usually, individuals are accepted based on certificates from TUSA, LPA (wage/pension, family composition), or medical institution (referral from family doctor/specialized doctor from hospital/health centre) and have to be without an infectious or a mental illness. CSOs provide HBC services to people that do not benefit from such kind of services from public or private providers.

There are differences in the characteristics of the beneficiaries from one type of provider to another, determined by certain particularities of the institutions providing the service and by the normative documents. TUSA beneficiaries are more often single women from rural areas. The evaluation data indicates that medical HBC services are more gender balanced, targeted at people with disabilities and are particularly accessible to people from urban area. CSOs are oriented to those categories of beneficiaries that are not covered by public medical institutions and TUSA, thus increasing the number of men, people under the age of 65 and those with relatives as beneficiaries of HBC.

Currently, in the RM, the beneficiaries of medical, social or integrated HBC are not divided into any categories depending on their needs or abilities.

Offer and demand for HBC services

The analysis of HBC services from a geographic perspective reveals that single elderly and people with disabilities without support are the ones that are manly covered. Medical HBC services are distributed not–uniformly. Only half of public health institutions from the local level I were contracted by NHIC for the provision of medical HBC services. When speaking about the geographical coverage of medical HBC services, there are administrative territorial units (ATU) that have more providers and ATUs have only few or even none. The analysis of private provision (CSOs and LLC), is also not homogeneous. The distribution is frequently determined by LPA’s readiness to collaborate with CSOs in developing HBC.

Consequently, the HBC services are not available to all those who need them. HBC services are not accessible mainly because some persons who need them do not comply with the normative provisions for admission into such service. Also, HBC services, especially medical services, are not provided in all localities of the RM. Neither HBC services offered by CSOs are also available in all localities of the country. In many cases lonely old people abandoned by their children are disadvantaged and deprived of HBC services.

Assessment of social and medical HBC services in the Republic of Moldova has allowed to made estimations about people who might potentially need HBC services. The estimated number of people who need HBC social services is 33 915 people. Currently, social HBC services are offered for about 2/3 of those who need it. The estimated number of people in need of medical HBC services is 13 972 people, only 18 percent of the need is covered at the moment.

 

Beneficiaries' possibilities to pay for HBC services

The large majority of beneficiaries cannot afford and refuse services provided for a fee. Representatives of public and private providers, LPAs pointed out that the beneficiaries are not eager to pay for HBC services due to their poor financial situation and insufficient income. Only a very small circle of wealthy patients could accept services provided for a fee. The share of beneficiaries who are willing to come up with their own partial contribution to HBC services is still significant - each of the 5th current beneficiary of HBC services.

LPA's possibilities to develop HBC services

In-depth interviews with the mayors reveal that most of them have other priorities at the community level (roads, water supply, sewage, concert halls, street lighting, etc.) and the social protection of the population is lesser one. The income generated locally is low due to the small number of businesses. However, LPA could become one of HBC sources of funding. The assessment data show that some mayors agreed to come up with a contribution to develop HBC services and provide the elderly access to services with the help of the non-governmental sector: CSO “CASMED”, CSO “Homecare”, CSO “Neoumanist”, Charity Foundation “Caritas Moldova”, CSO “Concordia. Proiecte sociale” etc.

Evaluation of HBC by beneficiaries

Asked on what they like most about HBC, 47.9% of the beneficiaries said – everything, 29.4% - the fact that someone visits them, 18.0% - help in taking medication, 11.4% - socio-medical services, 11.4% – help in household chores, 10.0% - counselling, 8.1% - workers’ responsibility and professionalism, etc.

About 48.3% of beneficiaries believe that the HBC service cover their needs, compared to 51.7% who said – no. The majority of beneficiaries have very high expectations from these services, especially those that receive services from private providers that had financial resources from donors, as they know that services provided by the public providers cannot be improved. The uncovered needs specified by the beneficiaries include a wide range: medication, non-involvement in solving financial problems, need for free food, provision of firewood, need for a personal assistant, support in cooking, more services related to household cleaning, but also additional medical devices (wheelchair, tonometer, blood glucose meter) etc.

Difficulties in providing HBC services

Social HBC providers mentioned as difficulties: their dependence on external sources of financing, the lack of a functional mechanism for contracting social services by Central Public Administration (CPA) and by the LPA. This is especially true for private providers. The possibility of contracting social services from private providers constitutes an opportunity for development of social HBC services.

Obstacles currently hindering the development of medical HBC: (i) limited number of cases contracted by NHIC (ii) the amount of money allotted per visit/medical HBC is not enough for the procurement of single-use diapers, (iii) lack of transportation to visit patients, (iv) the list of approved medication is insufficient, etc. So, the representatives of medical HBS that participated in assessment mentioned that they want to provide the same services but within an increased cost and to larger number of individuals. The higher is the cost per visit, more the ability to contract more visits and ensure to development of medical HBC services.

On the collaboration of the medical HBC service providers with NHIC it was mentioned that it currently involves contracting, evaluation, monitoring, reporting and training. But there are also challenges: (i) limited and insufficient funding of medical HBC cases, (ii) small number of cases funded, (iii) lack of contracting requirements, but also lack of fairness, (iv) lack of training on evaluation and accreditation.

Volunteering is poorly developed in the RM in general, and particularly related to HBC delivery. Research data reveals the lack of volunteering activities in public institutions, both, medical and social (with a few exceptions). However, the large majority of CSOs (16 from 17) have developed volunteering component, engaging volunteers in providing HBC services. The number of volunteers varies from at least 1-2 persons to maximum 60 persons. Activities performed by HBC volunteers are: gardening, water supply, provision of firewood, delivery of warm lunches and food packs, organization of cultural activities, psychological counselling, medical assistance and needs evaluation. Volunteers play an important role in fundraising and HBC information activities, etc. Unfortunately, only a few of CSOs include volunteers in direct communication with the beneficiaries.

Resources used to deliver HBC services

The resources used for service delivery are relatively homogeneous within each model of providers. At the same time resources are different if we compare them from one model to another. There are several factors that dictate these differences. Private providers use more divers resources compared with public providers. Resources also differ by type of care (medical HBC, social HBC and integrate HBC) and how this service is provided (in-center or at-home delivery).

The biggest share of used resources is human resource; more than half of expenses across models cover work remuneration. Other important expenditures cover maintenance of a work space/premises (office or center) and transportation means as well as expenditures on medication.

One of the main differences in resource distribution among models is linked the availability of the existing physical social and medical infrastructure. Public providers have to cover less or no cost for maintaining an office/center. Private (including non-profit providers) spend an important amount on rent, utilities and repairs of work premises. Medical institution providers declared zero costs for such expenditures; therefore it is clear that the existing healthcare system is taking over some costs of delivery of HBC services. This puts the providers in a different financial position in the context of similar refunding mechanism from the state (the visit cost covered by NHIC).

The medical institutions have the least diversified resources used for HBC delivery. This is a result of the method of calculation of per visit cost covered by the NHIC. Biggest parts of the resources used by medical institutions are human resources (including related taxes), expenditures for medicine and materials. Most of medical institutions have only two types of expenditures (on personnel and drugs). Few medical institutions reported expenditures on maintenance of cars, hygiene products, office supplies and back fees. Very few medical institutions had expenditures for professional qualifications and work related travel.

TUSA have the most diversified expenditures for HBC service delivery. Work remuneration is the most important share of used resources. Another important component is rent/ maintenance and utilities for the work premises. Some resources are allocated to rent/ maintenance of cars, office supplies, telecommunication services, trainings and work related travel. Another particular expense for this model is rent/ maintenance of equipment and inventory. Very few TUSA can afford improving the work space, and very few buy hygiene products to be used by the beneficiaries and buy pharmaceutical products. Professional trainings are also not a priority when it comes to expenditures distribution.

The expenditures of non-profit entities don’t differ significantly by type of expenditure (compared with TUSA). At the same time, the share of certain expenditure in the total expenditures differ significantly by type. As mentioned, the major difference is dictated by the fact that private providers deliver services outside of an existing physical infrastructure. An important share of expenditures for private providers relate to paying the rent for a work space, utilities and maintenance of an office. Transportations cost are also bigger for this group, this is linked with the fact that these organization own cars which require maintenance and repairs. Transportation costs are higher also due to the fact that many villages have no medical assistant in place, and the medical assistants have to be transported from neighbouring villages. The non-profit organizations have particular expenditures liked with formulating and promoting public policies (consultancies for research, outside expertise, training materials etc.). Another exclusive group of expenditures are for representation (lawyer, notary).

         

The cost of HBC services delivery

The cost-analysis shows that the less expensive model is provision of medical HBC by a medical institution, with 2 300  MDL per beneficiary annually. The most expensive is the service provided by TUSA with 4 425 MDL per year. This is mainly explained by the frequency of delivered support comparing to other models. The non-profit organizations have balanced costs within the group, one beneficiary costs about 3 270 MDL per year. The pro profit delivery cost (private entities) is around 2 950 MDL per one beneficiary per year.

The most expensive type of support is integrated HBC service, on average one beneficiary’s annual costs of integrated support is 5 150 MDL, this is due to more intense use of resources for these services (medical resources as well as resources linked with social support). But the cost of the integrated support is less that cumulated costs for social support and medical support. This is explained by the fact that integrated support provided within one entity is cheaper due to lower administrative costs. This is an additional financial incentive to opt for integrated support offered by the same provider rather that medical support and social support offered by different providers.

          The minimal, optimal and high quality HBC services cost scenarious

A simplified approach to look at the minimal and optimum costs is considering the existing costs and their use or resources. The minimal calculated cost for service delivery could be considered 2 300 MDL per year per beneficiary for public entities and 2950.00 MDL per year per beneficiary for private provision. Optimum provision could be considered 4500.00 MDL both for public and private provision and high quality could be considered the integrated service which costs around 5 000 per year per beneficiary. An additional 5-7% to the costs presented above should be added on yearly basis for increasing qualifications of the personnel.

Assessment results reveal the shortcomings and achievements in the field of HBC in the RM. These results allow us to present the following recommendations, in order to improve the situation in this area.

Recommendations for MHLSP representatives

  • Development of a social services contracting mechanism to ensure the implementation and dissemination of the practice of contracting social services by CPA and LPA from private providers.
  • Elaboration of the normative framework for the development of integrated HBC services. Development of the intersectoral cooperation mechanism for public and private providers of medical and social HBC services (likewise those on child prevention of mortality and child violence, etc.). The mechanism should clearly established duties of each responsible party or developing a Case Management designed for the elderly, according to the Case Management addressed to families with children (National Model of Good Practice) currently operating in the RM.
  • Development by MHLSP and NHIC of the public policy of contracting medical HBC providers to cover the needs for services nationwide.
  • The MHLSP, together with NHIC can develop unit cost/prices method to reimburse for medical HBC services, based on “ABC” formula and/or “codes”. Such a method can be used both for residential facilities (hospitals, long-term care houses, hospices etc.) and for HBC services. A working group can be established to elaborate “code” prices for patients in different grades of dependency and health shape (long-term care, short-term post-operational care, patients in terminal stadium of life, etc.). A “code” prices for medical supplies; set special prices of medical workers working over working ours – take overtimes into accounts, etc.
  • A method to increase the cost (indexation) of the services should be also established in order to capture changes of consumer price index and ensuring sustainability and decent quality of service provision.
  • Elaboration of a methodology for assessing the needs of social services at community level in partnership with LPA and CSOs.
  • Elaboration of the job description models to outline the responsibilities of a medical assistant and a social worker in providing HBC services and to offer these models to HBC service providers.
  • The minimum quality standards should be revised for both social and medical HBC services from the perspective of realistic and sustainable support. The standards for integrated HBC services should be developed. A most important step is to correlate the minimum quality standards and regulations for HBC provision with the actual costs of resources needed to provide these services as per the requirements.

 

Recommendations for government authorities responsible for policy development in the field of protection and social assistance

  • The methodology for calculation social HBC should be developed and approved, establishing a range of social sub-services, the time that social worker has to dedicate to each service. The publication in Official Monitor will make it legal and available for LPAs and other potential service providers.
  • Establish an initial and continuous training system for social workers to improve the quality of provided HBC services.
  • Modification of the Social HBC Framework Regulation in order to improve the access of vulnerable people to HBC services and to provide services for elderly people who have children but they live far and their family situation is very difficult consequently they are unable to help their parents.
  • Accreditation process should start and include all providers of HBC service in order to establish and maintain a minimum quality benchmark.

Recommendations for government authorities responsible for policy development in healthcare

  • The methodology for calculation the visit cost for medical HBC service should be developed and approved. The publication in Official Monitor will make it legal and available for LPAs and other potential service providers.
  • Introducing in the Medical HBC Regulatory Framework the beneficiaries' dependency categories and developing a methodology for the cost of a medical HBC service visit based on these categories.
  • Organising the system training for paramedical assistants who will provide medical HBC services and exclude current situations when social workers provide medical services.
  • Development of tools and indicators for evaluation of medical HBC services. Elaboration and introduction of performance indicators for HBC providers, especially indicators related to the collaboration/partnerships of HBC providers.

Recommendations for LPAs

  • Introduction of the social services component in the policies and documents elaborated at local level and ensure their implementation, including by allocating the necessary financial resources.
  • Involvement of civil society in the development of a Local Action Plan for the development of volunteering.
  • Developing community-level volunteering for the provision of HBC services in collaboration with CSOs.
  • Implementation of good practices of co-financing and financing HBC services at community / ATU level.
  • Using the existing medical and social infrastructure per maximum for HBC service delivery. This refers to: support form primary healthcare facilities to private providers as well as public providers of social HBC, offer when possible work premised (buildings, part of buildings in existing policlinics or hospitals, building of socials sector) to private providers (non-profit), offer equipment and other support materials if available.
  • Involvement of CSOs in assessing community needs for social services.

Recommendations for HBC providers, especially the Network of Non-Commercial Organizations providing Community Care

  • Developing partnerships with LPAs for the purpose of providing HBC services, promoting good practice of public - private partnership.
  • Providing LPA support in assessing the needs of social services, especially HBC services.
  • Calculate the unit cost of services they provide and keep these calculations updated. The unit cost should be accessible and cumulated into one source. All costs should be made public, so beneficiaries will understand what actions/services are being provided and the intensity of provision. All relevant variables described in this study should be considered for financial planning, such as: beneficiary’s profile and especially the dependency degree, type of needed services, form of support etc.
  • Keep accurate financial documentation and provide an aggregated analysis regardless of source of financing.
  • Promotion of existing HBC services and how to access them.
  • Involvement in permanent communication with CPA and LPA for development of qualitative and sustainable HBC system in the RM.

_______________________________________________________________________________________________________________________________________

10 May 2018

CERERE DE OFERTĂ

 

10 mai 2018

Asociația Obștească ”Homecare” solicită oferta de preț pentru procurarea echipamentului medical în cadrul proiectului ” Supplying socially vulnerably patients with wheelchairs and other accessories for disabled.” realizat de Asociația Obștească ”Homecare” finanțat de către Ambasada Republicii Cehe

  1. Descrierea parametrilor tehnici ai echipamentului solicitat.

 

Denumirea echipamentului

Cantitatea / bucati

Descrierea tehnică

Carucior pentru invalizi mecanic

11

Caracteristici:

Tipul   de model economic al scaunului rulant manual:

  • Cadru din oțel carbon cromat durabil
  • Poate fi pliat la 29 cm  pentru depozitare și transport ușor.
  • Roți din față din PVC 
  • Roți din spate cu anvelope solide
  • Apăsați pentru a bloca frâna roții
  • Cotierele fixe și căptușite cu o piesă de protecție din oțel inoxidabil
  • Picioarele cu spumă" U "se răstoarnă
  • Tapițeria din căptușeală din PVC este durabilă și ușor de curățat

Specificații:

  • Lățime deschisă  65 cm 
  • Lățime îndoită 29- 30 cm 
  • Lățimea scaunului 40- 41 cm 
  • Greutate suportată, max110 kg 

Carucior pentru invalizi electric

1

Caracteristici:

  • Cărucior electric pentru persoane cu handicap
  • Confortabil, ofera o mare siguranta in utilizare
  • Construit pe cadru din otel vopsit
  • Spatar inclinabil, brate rabatabile reglabile in inaltime si tetiera, autonomie mare
  • Lumini de semnalizare. lumini spate si fata, indicatori de directie, iluminat de urgenta

Specificatii:

  • Marimea si tipul scaunuli:    20’’ A2
  • Marimea rotilor din fata:      330x110 mm (13’’X4’’)
  • Marimea rotilor din spate:    330x100 mm (13’’X5’’)
  • Greutatea   scaunului :          100-120KG
  • Amortizatia la roti :               la 4 roti
  • Latimea scaunului (locul de sezut) : 510mm
  • Inaltimea scaunului:               460mm
  • Adincimea scaunului:             480mm
  • Lungimea platformei p/u      picioare:  320mm
  • Dispozitiv electric de incarcare a acumulatorului :  DA
  • Modul electronic de control: DA

Baston pliabil reglabil

30

Caracteristici:

  • Plierea se face pe patru sectiuni
  • Realizat din tuburi de aluminiu
  • 5 nivele de ajustare pe inaltime folosind mecanismul de blocare ,,push-buton”,si o piulita de strangere pentru a evita coborarea bastonului
  • Vopsit cu vopsea pulbere in camp electrostatic
  • Rezistent la coroziune
  • Amortizor din cauciuc solid, interschimbabil cu o aderenta la sol mare

Specificatii:

  • Inaltime baston: 800mm – 900mm
  • Greutate netă: 350 g
  • Ajustare înălțime : 5 trepte
  • Sarcina maxima : 100 kg

 

Cadru de mers

10

Caracteristici:

  • Fabricat din aluminiu anodizat ușor și durabil care poate oferi utilizatorilor un ajutor stabil și sigur de mers pe jos
  • Minere antialunecare
  • Fiecare picior este prevăzut cu un știft de blocare a arcului pentru reglarea înălțimii pentru adulți sau adolescenți
  • Picioare dotate cu virfuri din cauciuc antialunecare
  • 8 nivele de ajustare a inaltimii (de la 77 cm pîna la 95 cm)

Specificatii:

  • Inaltime reglabila 75-93 cm
  • Latime 56 cm
  • Adancime  45cm
  • Greutate produs 2,3 kg
  • Greutate maxima utilizator 115kg
  • Compozitie/material aluminiu

 

Instalație sanitară portabilă

10

Caracteristici:

  • Rama de aluminiu acoperită cu pulbere durabilă 
  • Cuvă detașabilă din plastic cu capac
  • Cotiere fixe și spătar
  • Fiecare picior are un știft de blocare a arcului pentru reglarea înălțimii în 5 nivele
  • Fiecare picior are un vârf de cauciuc anti-alunecare

Specificatii:

  • Lățime generală 55 cm 
  • Inălțime totală  58-68 cm   (adjustabila in 5 nivele)
  • Adâncime totală 55 cm
  • Lățimea scaunului   45 cm 
  • Adâncimea scaunului  40 cm 
  • Înălțimea scaunului 43-53 cm  (adjustabila in 5 nivele)
  • Înălțimea spătarului  17 cm 
  • Greutate utilizator > 110 kg 
  1. Condiții de Livrare

Ofertanții pot depune o singură ofertă pentru toate  articolele  din cadrul prezentei cereri.

Oferta în limba română va fi depusă în conformitate cu termenii și condițiile de livrare și trebuie să fie însoțită de o copie a Certificatului de Înregistrare sau a Deciziei legale care să ateste că societatea este înregistrată ca persoană juridică, copie licenței emise de Camera de licențiere, documentația tehnică, catalog sau alte materiale informaționale ce atestă corespunderea produsului la specificațiile solicitate.

Termenii și Condițiile de Livrare din prezenta cerere de ofertă sunt parte integrantă a Contractului și necesită a fi completați, cererea de ofertă semnată  și returnată AO Homecare.

  1. Preţul:  Prețul poate fi indicat în Lei Moldovenești (MDL) și trebuie să includă prețul pentru transport, și alte costuri locale necesare livrării produselor  la următoarea destinație: Republica Moldova, Chișinău, str.Ștefan cel Mare nr.119, ap.26, Biroul central al Asociației Obștești HOMECARE.
  2. Evaluarea şi acordarea contractului: Ofertele considerate ca fiind adecvate din punctul de vedere al specificațiilor tehnice vor fi evaluate prin compararea prețurilor. Contractul va fi acordat în baza celui mai mic preț  economic avantajos.
  1. Criteriile de selecție :

1.Oferta prezentată în corespundere cu cererea de ofertă prezentată pe foaie cu antetul organizației, cu suma totală  nu depășește 325 000 MDL.

(a) în cazul în care există o diferență între sumele în cifre și litere, suma în litere va predomina;

(b) în cazul în care există o diferență între rata unitară și suma totală pe linie, care rezultă din înmulțirea ratei unitare cu cantitatea, rata unitară va predomina;

(c) în cazul în care ofertantul refuză să accepte corectarea, oferta sa va fi respinsă;

2.Prezența în anexă la ofertă a:

(a) Prezentarea certificatului de înregistrare;

(b) Prezentarea certificatului  despre lipsa restanțelor față  de buget;

(c) Datlor  generale despre ofertant;

(d) Indicarea termenului de garanție  a echipamentilui din  oferta de preț

  1. Valabilitatea ofertei: Oferta trebuie să fie valabilă timp de patruzeci și cinci (45) zile de la data limită pentru depunerea ofertelor.
  1. Condiții speciale:
  1. Disponibilitate în stoc.
  2. Ofertantul trebuie să examineze toate instrucțiunile, formularele, termenii și specificațiile din cererea de ofertă.
  3. Necomunicarea tuturor informațiilor sau documentelor solicitate prin cererea de ofertă poate duce la respingerea ofertei.
  4. Un ofertant potențial care necesită clarificări privind cererea de ofertă va contacta în scris AO Homecare  la adresa specificată în paragraful III. AO Homecare va răspunde în scris oricărei solicitări de clarificare, cu condiția primirii unei astfel de cereri Nu mai târziu de cinci (3) zile calendaristice înainte de data limită de primire a ofertelor.
  5.  În orice moment înainte de termenul limită pentru depunerea ofertelor, AO Homecare poate modifica cererea de oferte prin emiterea unui amendament. Orice act adițional emis va face parte din cererea de ofertă și va fi comunicat în scris tuturor celor care au obținut invitația de cotare direct de la AO Homecare.
  6.  Ofertantul va suporta toate costurile aferente pregătirii și prezentării ofertei sale, iar AO Homecare nu va fi responsabil pentru aceste costuri, indiferent de comportamentul sau rezultatul procesului de selectare.
  7.  AO Homecare își rezervă dreptul de a accepta sau de a respinge orice oferă, de a anula procesul de selectare și de a respinge toate ofertele în orice moment înainte de atribuirea contractului, fără a-și asuma responsabilitatea față de ofertanți.
  1. Ofertele se primesc pînă la 31 mai  2018,  ora 16.00, la adresa Chișinău, str.Ștefan cel Mare nr.119, ap.26, Biroul central al Asociației Obștești HOMECARE.

Informații suplimentare pot fi obținute de la: Daria Suhareva +373 23 55 21,  ao.homecare@gmail.com

Director AO HOMECARE

Tamara Adașan  ___________________________ L.Ș

A recepționat cererea de ofertă

_________________________________________L.Ș.             Data __________

______________________________________________________________________________________________________________________________________________

10 mai 2018

INVITAȚIE

 

Asociația Obștească Homecare vă invită respectuos să ne prezentați oferta de preț pentru multiplicarea materialelor informaționale în cadrul   proiectului ”Suport și asistență pentru sectorul social în Republica Moldova 2017-2019” finanțat de Agenția Cehă pentru Dezvoltare:

 

 

Bunul solicitat

Unitatea de masura /bucați

1

Buclete ( privind îmbătrînirea activă)

Marimea A4, culori  4+4, Hirtie 135 gr m/p, gloss, pleat in 2 părți

800

2

Buclete ( privind dezvoltarea voluntariatului)

Marimea A4, culori  4+4, Hirtie 135 gr m/p, gloss, pleat in 2 părți

800

3

Leaflete ( privind activitatea AO Homecare)

Marimea A5, culori  4+4, Hirtie 135 gr m/p, gloss.

500

 

  1. OFERTANȚII pot depune o singură ofertă care să includă toate elementele din cadrul prezentei cereri. Ofertele de preț vor fi evaluate pentru toate elementele împreună și contractul va fi acordat companiei care oferă cel mai mic preț total evaluat.
  1. OFERTA dumneavoastră, în formatul atașat, va fi transmisă prin E-mail  sau   în cutia poștală la adresa:

Asociația Obștească Homecare

Adresa: Republica Moldova, Chişinău, str. Ștefan cel Mare 119 ap. 26

Fax: /+373/ 22 23 55 21

E-mail: ao.homecare@gmail.com

4.DATA LIMITĂ pentru primirea ofertelor de către AO Homecare  la adresa menționată la alineatul 3 este:  31  mai  2018 ora 18 00. Ofertantul trebuie să ia toate măsurile astfel încât oferta să fie primită de către AO Homecare  până la data limită menționată pentru depunere.

5. OFERTA dumneavoastră în limba română va fi depusă în conformitate cu termenii și condițiile de livrare și trebuie să fie însoțită de:

- copie a Certificatului de Înregistrare sau a Deciziei legale care să ateste că societatea este înregistrată ca persoană juridică;

- copie licenței emise de Camera de licențiere dacă activitatea este supusă licențierii.

6.  EVALUAREA ofertelor de preț vor fi efectuate prin intermediul procedurii de procurare stabilite manualul de procurari elaborate de partenerul de implementare Caritas Cehia.

7. OFERTA trebui să fie prezentate în conformitate cu următoarele instrucțiuni.

PREŢUL:  Prețul calculat la cota 0 TVA  în Lei Moldovenești (MDL)

  OFERTA TREBUIE  PREZENTATĂ în corespundere cu cererea de ofertă prezentată pe foaie cu antetul organizației, cu suma totală care nu depășește 19 320 MDL.

EVALUAREA ŞI ACORDAREA CONTRACTULUI: Ofertele vor fi evaluate prin compararea prețurilor.

La evaluarea ofertelor, AO Homecare   va stabili pentru fiecare propunere prețul evaluat prin  ajustarea ofertei de preț, cu efectuarea corecțiilor pentru orice erori aritmetice, după cum urmează:

(a) în cazul în care există o diferență între sumele în cifre și litere, suma în litere va predomina;
(b) în cazul în care ofertantul refuză să accepte corectarea, oferta sa va fi respinsă.

ACORDAREA CONTRACTULUI Contractul va fi  acordat companiei care oferă cel mai mic preț total evaluat

VALABILITATEA OFERTEI: Oferta dumneavoastră trebuie să fie valabilă timp de 45 zile din momentul prezentarii acestea.

8. INFORMAȚII SUPLIMENTARE pot fi obținute de la:

Tamara Adașan – Director Tel. /+373/ 60204442,tel:  /+373/ 22 920 320

Daria Suhareva  –Manager de finance

Tel: /+373/ 22 23 55 21

E-mail: ao.homecare@gmail.com

9. OFERTANTUL trebuie să examineze bine cererea de ofertă. Necomunicarea tuturor informațiilor sau documentelor solicitate prin cererea de ofertă poate duce la respingerea ofertei.

Un ofertant potențial care necesită clarificări privind cererea de ofertă va contacta în scris AO Homecare la adresa specificată în paragraful 8. AO Homecare  va răspunde în scris oricărei solicitări de clarificare, cu condiția primirii unei astfel de cereri Nu mai târziu de cinci (3) zile calendaristice înainte de data limită de primire a ofertelor.

În orice moment înainte de termenul limită pentru depunerea ofertelor, AO Homecare poate modifica cererea de oferte prin emiterea unui amendament. Orice act adițional emis va face parte din cererea de ofertă și va fi comunicat în scris tuturor celor care au obținut invitația de cotare direct de la AO Homecare.

10. OFERTANTUL va suporta toate costurile aferente pregătirii și prezentării ofertei sale, iar AO Homecare nu va fi responsabil pentru aceste costuri, indiferent de rezultatul procesului de selectare a ofertei.

11. AO HOMECARE își rezervă dreptul de a accepta sau de a respinge orice oferă, de a anula procesul de selectare a ofertei  și de a respinge toate ofertele în orice moment înainte de atribuirea contractului, fără a-și asuma responsabilitatea față de ofertanți.

12. PLATA: Plata  va fi efectuată în termen de 3 zile lucrătoare după livrarea mărfii.

13. FACTURARE: Furnizorul va emite factura în baza legislației în vigoare.

 

Director AO „Homecare”                                       Tamara Adaşan __________

A recepționat  invitația __________________________________ L.S.

_____________________________________________________________________________________________________________________________________________

 

3 May 2018

MĂSURAREA CALITĂȚII SERVICIILOR SOCIALE DE ÎNGRIJIRI LA DOMICILIU

In sfera serviciilor sociale poate fi aplicat un anumit tip de instrument al calitatii si anume modelul celor sapte etape, folosit pentru oferirea de servicii de calitate beneficiarilor. Etapele acestui model sunt:

  • crearea unui climat prietenos: prezentarea proprie, folosirea numelui beneficiarului, acordare unui timp suficient pentru a explica cum se va derula procesul de acordare de servicii, evitarea semnelor de nervozitate, de iritare sau nerabdare;
  • obtinerea informatiei necesare prin ascultarea ctiva si intrebari : trebuie sa ne asiguram ca am obtinut toate informatiile necesare si sa evitam situatiile ambigue;
  • verificarea pentru intelegerea completa: trebuie verificate datele cu beneficiarul, pentru asigurarea ca fiecare parte a inteles ceea ce trebuie sa se inteleaga;
  • propunerea unui plan de actiune;
  • obtinerea unui acord a ceea ce urmeaza sa se faca, de catre cine, unde cand si cum- trebuie sa verificam daca asistatul a inteles planul de ingrijire intocmit, realizat de comun acord, evitand astfel situatiile negative;
  • asigurarea asistentei asupra careia s-a convenit: trebuie implinite promisiunile, respectiv contractele si planurile stabilite.
  • monitorizarea in vederea asigurarii rezulatelor: trebuie sa ne asiguram pe perioada interventiei ca beneficiarii vor obtine ceea ce si-au dorit.