COVID-19 and the Long-Term Care system in Poland

By law and by tradition, families are primarily responsible for care provision, with social institutions’ intervening when families are incapable of undertaking adequate care measures and LTC is provided mostly by unpaid carers in Poland. Some home care as well as residential care services are however also available through health and social care sector and more recently day care centres have gained prominence in providing support for people with LTC needs (Golinowska et al. 2017). The rate of long-term care beds in Poland is  low, even though it has increased from 65 877 in 2011 to 76 090 in 2019 (source: Statista: Poland long-term care beds). There geographical distribution is uneven: in 2019, nearly one-fifth of counties had no access to long-term residential care. About 2.7 % of older people are in institutional care settings and 3.4 % use home care services. Some families draw on migrant carers, mostly from Ukraine, who tend to provide round-the-clock care (source: 2021: Ageing policies – access to services in different EU Member States).

References:

Golinowska, S., Sowa-Kofta, A. (2017) ‘The Polish policy landscape. Retrieved from CEQUA: Poland Country Report

Poland has one of the most rapidly ageing populations in the European Union (EU): by 2060, the proportion of the population aged 65–79 is expected to double and the proportion of the population aged 80+ is expected to triple (Golinowska et al. 2017).

References:

Golinowska, S., Sowa-Kofta, A. (2017) ‘The Polish policy landscape. Retrieved from CEQUA: Poland Country Report

Public LTC expenditure in Poland was estimated to represent 0.5% of Gross Domestic Product in 2016 (source: European Commission: The 2018 Ageing Report). Public care for dependent older people is provided through health care sector, which includes cases of dependency or palliative care requiring a range of medical and rehabilitation services, and the social care sector, which includes care for dependent older people who are in a socially difficult situation (i.e. those who live alone, come from dysfunctional families, or are poor). Care for older dependent people is predominantly a family domain in Poland. In most cases, caregivers are family members who – in case of care for older dependent people – receive little or no financial remuneration for the care provided. In wealthier households, family carers may be supported by immigrants employed informally (Golinowska et al. 2017).

References:

Golinowska, S., Sowa-Kofta, A. (2017) ‘The Polish policy landscape. Retrieved from CEQUA: Poland Country Report

LTC services in Poland are provided by both private and public providers. The former includes unpaid carers and a grey zone (including immigrant carers) as well as non-for profit and for-profit residential care providers. Non-governmental organizations are active in the provision of care for older people – in supporting hospitals, care, and nursing facilities (Golinowska et al. 2017).

References:

Golinowska, S., Sowa-Kofta, A. (2017) ‘The Polish policy landscape. Retrieved from CEQUA: Poland Country Report

There is no formal quality framework regarding LTC services in particular, though various regulations address the presence of goal and process-oriented measures with respect to quality assurance separately in the healthcare and social sector. In the social sector, standards are set particularly in respect to residential care, covering minimum standards of the room size, access to toilets and kitchen, sanitation requirements, rooms furnishings and equipment, food as well as minimal staff requirements. Community day care services are standardised within dedicated programmes, such as ‘Senior+’ where minimum requirements regarding facilities and staff are set. Standards in home care are set covering broadly the types of services available and staff qualifications (source: European Commission: 2021 Long-term care in the EU).

LTC in Poland is organised by national health care and local social services. The coordination of activities between sectors has been hampered by different governance priorities. The health sector concentrates on the long-term goals formulated in the National Health Programme. In the social services sector, ‘senior policy’ was formulated, aimed at the social activation (e.g. day care facilities) and social integration of older people (Golinowska et al. 2017).

References:

Golinowska, S., Sowa-Kofta, A. (2017) ‘The Polish policy landscape. Retrieved from CEQUA: Poland Country Report

The Law on Older Persons, introduced in 2015, requires that the Council of Ministers of the Republic of Poland must provide annual information on the situation of older people (60+) regarding, among other things,  their health status, access to healthcare and long-term care services. The report also contains information about the implementation of the tasks of local governments in providing support for older people. The information is publicly available on the website of the Ministry of Family and Social Policy and the Central Statistical Office (source: 2021: Ageing policies – access to services in different EU Member States).

Community services include home-based care comprised of nursing services provided through the health sector and services provided through the social sector. Home care services cover assistance with everyday activities, personal hygiene, tasks related to housework, nursing (if prescribed by a physician), and support in social networking. Specialist home care is adjusted to the specific medical and rehabilitation needs of the recipients, and services are provided by qualified personnel, such as physiotherapists. An important and recently developing type of care is day care centres offering leisure time activities for older people and people with disabilities. Activities ranging from education, culture, to excursions are provided for persons living at home, whose family members are not able to provide care because of work responsibilities, during working hours (Golinowska et al. 2017).

References:

Golinowska, S., Sowa-Kofta, A. (2017) ‘The Polish policy landscape. Retrieved from CEQUA: Poland Country Report

LTC employment is low compared to other EU countries, namely in 2016 there were 0.5 LTC workers per 100 older people (EU-27 average was 3.8). There are inequalities in working conditions and wages between the healthcare and the social sector. The number of carers is increasing, however the country is experiencing ageing of LTC staff will put additional pressure on ensuring adequate staffing levels (source: European Commission: 2021 Long-term care in the EU).

Prevalence and characteristics of unpaid carers

Families are primarily responsible for care provision in Poland, and it is estimated that between 80% to over 95% of LTC is provided by unpaid carers. Typically, carers are women, who tend to be older themselves, often resigning from work and taking early retirement to provide care.

Cash benefits

Informal carers are mostly supported through cash benefits provided either to the carer or to the person with care needs, and benefits tend to be low. Most cash benefits cannot be combined with care, and overall there is little support to allow carers combine paid work with caring (Golinowska et al. 2017).

In-kind services

Such services as respite care, trainings and psychological help as scarce, and if they exist they tend to be provided by charities. A programme to introduce and develop respite care was launched in Poland in 2019 (EC, 2021).

References: 

European Commission, EC (2021) 2021 Long-term care report. Trends, challenges and opportunities in an ageing society. Country profiles Vol. 2. Joint Report prepared by the Social Protection Committee (SPC) and the European Commission (DG EMPL)

Golinowska, S., Sowa-Kofta, A. (2017). The Polish policy landscape. CEQUA Report 

The country was poorly prepared to deal with the pandemic, moreover, the shortfalls of the LTC system became more visible during the pandemic (e.g. limited financial resources for LTC system, poor access to tests, PPI, problems with isolating infected individuals (sources: Alert Zdrowotny 2; Alert Zdrowotny 3).

Data illustrated that by 12 November 2021, there were overall 78 555 deaths attributed to Covid 19. People aged 65 years or more constituted about 80% of all Covid-19 deaths and people aged 80 years or more about 44%. Moreover, an early report showed that in June 2020 about 9% of COVID-19 cases were related to infections in long-term care facilitates in Poland: 3% in nursing and care homes and 6% in social welfare homes.

Expert highlighted that the situation in Poland in terms of absolute numbers of deaths among the elderly in LTC facilities is not as dramatic as in other countries because care is provided mainly in families rather than through formal services, e.g. less than two percent of the elderly reside in LTC facilities whilst provision of home care is also low (sources: Alert Zdrowotny 2; Ageing policies-access to services in different EU Member States).

Sources:

Raport zakazen koronawirusem (SARS-CoV-2) -Portal Gov.pl (www.gov.pl)

Sowa-Kofta, A. Responding to the Covid19 in residential long-term care in Poland

Alert Zdrowotny 2

Ageing policies – access to services in different EU Member States.

Community centres (centres for people with special needs (srodowiskowe domy samopomocy) and some day-care centres in social sector have been temporarily closed. Restrictions were imposed on admission to social assistance homes to safely admit new residents (source: EU: Long-term care report). Equally, some municipalities during the pandemic have issued recommendations that home-based care services should be provided only where it is most necessary, moreover,  eligibility assessments for home-based care were limited during pandemic for a number of reasons (E.g.  social workers carrying out eligibility assessments/ interviews preceding the granting of care services took place less frequently in order to minimise social contact, but also because of the numerous additional challenges that faced municipalities workers during the pandemic. Moreover, some service recipients were unwilling to receive home-based care due to fear of catching infections from care workers, especially that the latter often travel via public transport between different care recipients  (source: Opieka dlugoterminowa w Polsce raport). 

EU data from also suggest that about 28% of people over the age of 55 in Poland had the unmet needs for medical treatment during the pandemic, which was above the EU 27 average of 20% (sources: Ageing policies – access to services in different EU Member States; Jakosc zycia osób starszych w Polsce).

Overall, reports indicate lack of access to medical care among older people in Poland during the pandemic, as well as decreased physical activity among older persons (source:  Jakosc zycia osób starszych w Polsce).

Report indicated that long-term isolation of people in care homes (due to visiting bans) and limiting interpersonal contacts negatively affected well-being and residents’ health, e.g. increase in personal conflict between residents or apathy, the same report indicated that  residents in care facilities faced  problems with the access to medical care.

A qualitative study by Mackowiak et al., (2021), indicated that people with dementia living at home experienced a burden resulting from limited interactions with social contacts. Uncertainty around the pandemic, has increased their perception of loss of control and overall decreased well-being of people with dementia. Moreover, the lack of stimulation that resulted from restrictions accelerated emotional and cognitive decline.

References:

Mackowiak, M.; Senczyszyn, A.; Lion, K.; Trypka, E.; Malecka, M.; Ciulkowicz, M.; Mazurek, J.; Swiderska, R.; Giebel, C.; Gabbay, M.; et al. (2021). The Experiences of
People with Dementia and Informal Carers Related to the Closure of Social and Medical Services in Poland during the COVID-19 Pandemic – A Qualitative Study. Healthcare. https://doi.org/10.3390/ healthcare9121677

A qualitative study among informal carers of people with dementia, indicated that increased caring responsibilities during pandemic (e.g. due to closures of social and medical services) have led to lower mental and physical well-being for carers, leading to  causing sleep disturbances, depression or anxiety as well as increasing carer burnout (Mackowiak et al. 2021).

References:

Mackowiak, M.; Senczyszyn, A.; Lion, K.; Trypka, E.; Malecka, M.; Ciulkowicz, M.; Mazurek, J.; Swiderska, R.; Giebel, C.; Gabbay, M.; et al. The Experiences of
People with Dementia and Informal Carers Related to the Closure of Social and Medical Services in Poland during the COVID-19 Pandemic – A Qualitative Study. Healthcare. https://doi.org/10.3390/ healthcare9121677

During the pandemic, pre-existing workforce shortages were exacerbated (source Poland presentation; Long-term care in Poland Nov 2021). According to a recent report (February 2022) by The Federation of European Social Employers, Poland has experienced an increase of between 1 – 10% in staff shortages since 2021. The sub-sector most critically affected by staff shortages across the countries surveyed for this report were services for older persons. The job position most affected was nursing, but care assistants and homecare / social care workers also face real shortages. The most common reasons given for staff leaving the social care sector for another include low wages, and mental and physical exhaustion relating to the pandemic.

The decentralization of authority has had negative consequences for pandemic response (particularly during the first wave of the pandemic), with local authorities responsible for social welfare homes, and the split between healthcare and social sector had a negative impact on responding to the threat quickly and comprehensively. In case of social welfare homes, the management of the crisis depended on the ability of the local authorities and managers to mobilize the resources and led to geographical differences in pandemic response (sources:  Responding to the Covid19 in residential long-term care in Poland ; ESPN Flash Report 2020/43).

At the onset of the pandemic, significant issues were reported relating to lack of coordination between health and social care which impaired pandemic response.  Recommendations issued by experts to address shortages in LTC sector include improved coordination between health and social care and regulation (source: ESPN Flash Report 2020/43).

The government promoted volunteering services in the community and neighbourhood to support older people with care needs in household activities or with groceries, among others (source: Ageing policies – access to services in different EU Member States).

Providers of residential care faced financial shortages for a variety of reasons (e.g. additional costs of PPE, increasing prices of hygienic/cleaning products, food during pandemic, increasing costs of staff (both wages and food) who resided in the homes during quarantine). Additional money from the national and local governments partly addressed the financial challenges,  NGOs, firms’ as well as private donations were also invaluable in addressing financial gaps, however residential care providers were increasingly considering increasing costs for residents (source: Domy-pomocy-spolecznej-w-dobie-pandemii-19-11.pdf (hfhr.pl).

During the pandemic, the central government put additional financial resources for equipping LTC facilities. The Ministry of Family, Labour and Social Affairs decided to devote an additional 20 million z? (ca. €4.7 million) to addressing protection needs in social welfare homes. These resources have been distributed to social welfare homes by the regional authorities, and have been used to support investments in equipment, rearrange facilities according to the sanitary guidelines, and to improve access to protection and preventive measures (masks, gloves, etc.). In the healthcare sector, all financial needs related to COVID-19 are financed from the central budget. The pandemic highlighted the underfunded nature of the LTC system and experts highlight the need for increased payments for services (source: ESPN Flash Report 2020/43). 

During the pandemic, the central government increased the remuneration of medical and nursing staff in LTC sector, there was also an increase in sickness benefit of medical and care employees during quarantine and isolation in response to high infection risk they face in every-day work ( (source: Ageing policies – access to services in different EU Member States). To address workforce challenges which were brought to attention during the pandemic, experts recommended investment in the training and employment of nursing and care staff. For example, it was recommended that additional educational activities should be offered to trainees (e.g. trainee nurses in LTC), taking into account the apprenticeship of foreign workers. For current employees, it was recommended that training is provided regarding the application of new technologies in LTC sector, as well training to assure the necessary minimum knowledge in the field of psychology, public health (disease prevention), medicine and digitization. Recommendations were also issued to revise the standards, working conditions and increasing wages in LTC sector, to incentivise and address workforce shortages in LTC sector (source: Alert Zdrowotny 3).

In response to the pandemic, local authorities introduced regulations restricting employment of LTC staff to a single facility, and made efforts to enable isolation of staff and residents within the facility (source: ESPN Flash Report 2020/43).

In the spring of 2020, the recommendations of the Ministry of Family, Labor and Social Policy included recommendations concerning the limitation of visits to and admission to Nursing Homes by unauthorized persons, as well as leaving the facilities by residents. In most local municipalities visiting bans had been introduced, in some areas visitors had been subjected to rapid testing before meeting residents or meetings were held only outdoors, with sanitary regimes applied. Due to the limitation of real contacts, care homes have been obliged to ensure the possibility of maintaining relationships with relatives via telephone or the Internet. However, in the face of the limited staff there were problems in ensuring contact. Ban on leaving institutions posed additional problems, and some local policy makers noted that there was no clear legal basis for restricting the rights of home residents to leave the premises (source: Domy-pomocy-spolecznej-w-dobie-pandemii-19-11.pdf (hfhr.pl).

Lack of PPE in care homes has been a challenge, partly addressed by donations from private companies, NGOs and individuals donors. Lack of procedures for coordinated/joint purchases of PPE equipment for several care homes made it harder for individual care home facilities to get adequate PPE supplies (sources: Domy-pomocy-spolecznej-w-dobie-pandemii-19-11.pdf;  Long-term care report – Publications Office of the EU).

The government introduced online or telephone medical consultations when feasible to compensate for lack of face to face consultations as well as to contain spread of infections (source: Ageing policies – access to services in different EU Member States).

Vaccination priority was given to older people, residents of long-term care facilities, medical and care personnel, and groups facing the risk of severe development of the disease due to the existence of other health risks (e.g. cancer). By mid-June 2021, over 60% of the people age 60 + received at least one dose of the vaccine, a higher share of people aged 70-79 were vaccinated (about 78%) than those aged 80+ (just under 60%) (source: Ageing policies – access to services in different EU Member States; Szczepienie przeciwko COVID-19 Gov.pl).

In 2018, Poland implemented a programme that finances care services in rural areas and smaller towns, which are particularly prone to depopulation and ageing due to migration processes. Under the programme, local authorities may be granted a subsidy to enable homecare services.  In 2019 a cash benefit was introduced for adults who are unable to live independently. A definition of ‘inability to live independently’ was established, together with new assessment rules (source: Employment, Social Affairs & Inclusion – European Commission).

In 2019, a programme entitled ‘Respite care’ (Opieka wytchnieniowa) was started in Poland to provide help for informal carers (source: EU: Long-term care report).

Although in 2021 there are no major reforms planned to increase coherency of LTC sector, various efforts have been made over the past few years to strengthen LTC services in Poland. Since 2018, a programme ‘Care 75+’ (Opieka 75+) has been in place, supporting local authorities in rural areas and small towns financially to provide care services (rural areas and small towns are particularly prone to population ageing due to migration and have informal care deficits). In 2018, a complementary programme ‘Care services for people with  disabilities’ (Uslugi opiekuncze dla osób niepelnosprawnych), targeting people with disabilities under the age of 75 was introduced. Moreover, in 2019 a cash benefit was introduced for adults incapable of living independently. The benefit of PLN 500 (around EUR 119) is targeted at individuals with lower incomes, as a support measure in need for LTC. A definition of incapability to live independently with a new assessment for this purpose was implemented. Local governments have also also planning  to organise meals on wheels for older people or targeted social assistance benefits for acquiring meals (Posilek w domu i w szkole na lata 2019–2023) (source: Long-term care report – Publications Office of the EU (europa.eu).

Moreover, in the aftermath of pandemic, the promotion of digital technologies has become one of the priority areas of the Activity+ programme, which was established in 2021 and is aimed at stimulating the social participation of older people (source: Ageing policies – access to services in different Member States (europa.eu).