The Quality of Public Elderly Care

Comparative Analysis in the Municipality of Varena

Nord+ Geonordbalt Lithuania 3rd of May 2018

Anni Kaup Emilija Rimaitė Karol Piotr Matusiewicz Matthildur Ármannsdóttir

Abstract

In this paper, we will undertake the difficult task of researching how the public institutions in the Lithuanian municipality of Varena correspond with the expectations and the needs of the elderly. We will attempt to analyze the situation in different institutions and compare the attitude of different actors towards the complex and relatively new issue of the ageing society. In this paper we will use qualitative methods in the form of semi-structured interviews which we have conducted both in the elderly homes and with the representatives of local authorities.

We hope, that our work will provide deeper insight into the issue of the ageing population, how to address it, and what can be done, in order to provide necessary care for the elderly. In our paper, we want to analyze the so-called “silver economy” phenomena considering various factors it consists of. We will try to compare both public care homes, and find similarities and differences. We will attempt to find out what the issues are and how are they being dealt with. We will also look closely on how the social relations look like both inside the care homes, and also how it is connected to the outside world. We will try to draw conclusions based on our observations, and shortly discuss them. Next, we will try to answer how the future of these public institutions might look like.

Next, we will focus on the perspective of the authority, how is it managing to reach people’s expectations in regard to the care homes, what is the policy towards elderly people, and how can the authority improve it. Then, based on our own observations, we will try to analyze the perspective of the authority.

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Table of Contents – Images and Tables

Figure 1. Varena district ...... 7 Figure 2. The population of Varena district 2013-2017 ...... 8 Figure 3. Population by age group in Varena municipality ...... 8

Table 1. Varena’s care home budget ...... 14 Table 2. Merkine’s care home budget ...... 15

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Table of Contents

1 Introduction ...... 5 2 Theory ...... 6 2.1 Varena ...... 6 2.2 Silver Economy ...... 8 2.3 Social services ...... 8 2.4 Elderly care ...... 9 3 Methodology and Data Analysis ...... 11 3.1 Comparison Between Two Public Care Homes ...... 11 3.1.1 Problems ...... 12 3.1.2 Workers ...... 12 3.1.3 Costs ...... 13 3.1.4 Contact with community ...... 15 3.1.5 Future ...... 15 3.1.6 Discussion and observation ...... 15 3.2 Perspective of the authority ...... 17 3.2.1 Strategy and future ...... 17 3.2.2 Problems and solutions in Varena ...... 18 3.2.3 Contact with the community ...... 18 3.3 The Social Services Center ...... 19 3.3.1 Social workers ...... 19 3.3.2 Demand for care ...... 19 3.3.3 Financial help from municipality ...... 20 3.3.4 Care home funds ...... 20 3.3.5 Future ...... 20 3.3.6 Enjoyment of the work ...... 21 3.3.7 Problems ...... 21 3.3.8 Government Action ...... 21 3.3.9 Discussion and observation ...... 22 4 Conclusion ...... 23 5 Resources ...... 24

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1 Introduction

Lithuania is a Baltic state, located in Northeastern Europe. The country borders with Russia (Kaliningrad oblast) to the west, Poland to the Southwest, Belarus to the East, and Latvia to the North. According to the World Bank, Lithuania’s population was estimated to be 2.868.231 people (The World Bank, 2016). The majority of the population is Lithuanian, however it is inhabited by many minorities that have immigrated to the country. By the estimate of the world bank, the country’s total GDP was 42,733 billion US dollars (The World Bank, 2016), making it the 24th economy in the European Union (Eurostat, 2017).

“According to the latest 2011 Population and Housing Census of the Republic of Lithuania, the country was inhabited by people of 154 ethnicities. Lithuanians made up 84,2%, Poles – 6,6%, Russians – 5,8%, Belorussians – 1,2%, Ukrainians – 0,5% of the resident population; residents of other ethnicities accounted for 0,6%” (Jolanta Pivoriene, 2016).

In Lithuania, the unemployment rate measures the number of people actively looking for a job as a percentage of the labour force. The average unemployment rate in Lithuania is 8.1%. Since 2018 January an unemployment rate started to increasing to 9.1%. As compared to Varena’s municipality where the unemployment rate is about 10%. Another problem that Lithuania faces is that one third of Lithuania’s population are retired people. It is alarming because the economy, and the social system are getting to a stagnation point where supply doesn’t meet demand. So, for the purpose of this research the question is:

• What is the best model of elderly care considering both the perspective of the people and the government?

In the eyes of outsiders Varena looked depopulated at first glance. That turned out to be the situation almost throughout our 4 days of field work. The city had a very calm atmosphere, even in times where the most people were out in the streets. There were barely any encounters with locals but those we noticed were either young males, gathered in rather large groups, doing nothing but listening to music or old people wandering alone in the city. The young guys seemed

5 rather annoyed with outsiders in their city but the elderly were observing us and were rather curious about our reason for visiting. 2 Theory Varena is a peripheral municipality, located in the Southeastern part of Lithuania (figure 1). The capital of Varena’s municipality was established in 1862, during the construction of the Warsaw-St. Petersburg railroad (Visit Lithuania, n.d.). It has borders with Belarus to the South, Alytus municipality to the North, Lazdijai municipality to the West, and Vilnius municipality to the Northeast. In the Varena municipality, there are around 160 lakes, and the great part of the municipality is covered by forests which consists of around ⅔ of the whole municipal area.

Figure 1. Varena district

2.1 Varena With the forest covering such a great part of Varena, the municipality has a great variety of mushroom species and is widely known as the mushroom capital of Lithuania. The main source of income for elderly people is for example picking mushrooms and berries. They put up tables and sell it near the main roads, standing on the roadsides. Since 1996 there has been a mushroom celebration every year in the last weekend of September.

The population is rapidly decreasing in the municipality of Varena. In 2015 there were 1129 more people living there than in 2016. In 2017 there were 22 399 inhabitants in the municipality, which is around 600 less inhabitants than in 2016 (figure 2). The population decline trend can be observed in all age groups. The information is from a report by the Government of the Republic of Lithuania (Statistics Lithuania, 2016).

In terms of demography, as presented in the graph above, the population is rapidly decreasing and the majority of the inhabitants live in rural areas, not in the city of Varena. However, we found out that data provided by the Statistics Department of Lithuania doesn’t correspond with the description of the graph given by the government of the Republic of Lithuania. For instance,

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the report states that in 2015 there were 1129 more people living in the municipality, while the graph depicts a change by 519 people in the year 2016.

Figure 2. The population of Varena district 2013-2017. Source: The Statistics Department of Lithuania

As can be observed from the graph below, Varena’s municipality population is growing old. Due to the ageing process taking place in the municipality, the need for elderly homes, and nursing centers is also growing.

In Varena’s municipality the mortality rate is one of the highest in comparison with other municipalities of the country. In the year 2015 the municipality was in 5. place in terms of male mortality with 2095.29/100 000 men in Lithuania and in 17. place in terms of female mortality with 1773.51/100 000 women in the country (Statistics Department of Lithuania, 2017).

Figure 3. Population by age group in Varena municipality

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2.2 Silver Economy Silver economy is a relatively new concept which refers to the greying hair of the elderly. The concept has not been yet adopted all around the world. The main idea is how countries around the world plan to involve their elderly people more in their community and their culture. The silver economy concept is trying to change people’s thinking about the elderly as a market. The combination of words “silver” and “economy” suggests that the elderly are more than just a market. They are to be considered important with reference to silver being a precious metal. The economy stands for itself, meaning that the elderly contribute to society in a way like others in the community. Ageing is very rapid in today’s society and becoming a problem in many countries. Therefore it is very important to identify the concept of the silver economy and adopt it’s notions into the economy (The International Silver Economy Portal, n.d.).

The silver economy’s impact can be seen in every market and industry according to the International Silver Economy Portal. For example, home accommodation, insurance, health and sports and leisure. To adopt the concept into the economy in different countries and culture there are a few concepts can be used instead of silver economy. Other terms could for example be greying economy or ageing economy (The International Silver Economy Portal, n.d.). The name of the concept might not make much of a difference but the concept itself is very important in the times of fast ageing countries.

The European Union has been aware of the ageing in Europe for quite some time. They have analyzed and assessed the main opportunities and problems of the elderly in Europe and what needs to be done for that society group. Along with opportunities and problems they have assessed what service the elderly need (European Union, n.d.).

2.3 Social services Various project teams engaged in the restoration of municipal buildings should be merged into one group. The governance in Lithuania is de-concentrated, therefore, stricter control and optimization of the number of local government bodies “from the centre” is not so easy. It must be held that greater centralization of control would contradict to the European Charter of Local Self-Government. The main lever for the Lithuanian Government to restrict expansion of institutions and their staff in municipalities is the reduction of funding. However, to achieve this would be a difficult task, given the high politicization of municipalities.

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Municipal bureaucracy in Lithuania is still dependent on the dominant political parties in a specific municipality (Smalskys et al, 2017).

In the year 2016 in the Varena municipality there were 17 social service institutions which provided both general and special services to the residents of the municipality. All of the following are municipal institutions: - Varena Social Services Center - Merkine Care House - Varena Care House - Valkininkai Children's Care House "Spengla".

Although the majority of these institutions are located in Varena city, the municipality also provides social services to rural residents taking into account the needs of the population. Most of the various social related services are provided by the Varena Social Services Center to both the urban, and the rural population. It provides general, social, and daily care services. The institution has been assessing the growing need for home assistance and day care at home. Starting in 2017 the Varenos Social Services Center, which is the social care center in Varena, provides integrated care services both to the disabled, and elderly residents of the municipality.

2.4 Elderly care In modern times many families are too busy, or unwilling to take care of the needs of their parents, and grandparents. In some cases there is a need for the daily care of elders because of their serious illness. In those cases the family members have to quit their jobs and take care of the elderly. Lots of people do not want to leave their jobs because of finance problems. That is the reason, why there is a care for elderly house in the first place.

The demand of elderly care is rapidly rising where the highest number of ageing in Europe is in Lithuania. Varena’s municipality is no exception (Bertelsmann Stiftung, 2018). This problem that the country faces is though in all respects not only a problem but also an opportunity for the municipality to expand and improve their economy. The silver economy has expanded hugely in the last years and is on a fast way upwards. They are becoming the greatest part of the economy and there is a huge business potential for business entrepreneurs to work for and with that society group.

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In Lithuania, residential care services account for a high proportion of services in the elderly care sector. According to Statistics Lithuania the number of recipients of residential care services grew by 31% in 2005 to 2015 (Blažienė, Žalimienė 2017). Considering that 68% of elderly people prefer living in private nursing homes and only 22% in public ones proves that there’s an increasing demand for informal help in the future in Lithuania (Blažienė, Žalimienė 2017). Elderly care is not a popular profession and one solution would be to hire people who are retired. A great percentage of retired pensioners are ready to take care of other elderly people, either for free or for money (Blažienė, Žalimienė 2017).

3 models are likely to be under the greatest demand in Lithuania in the near future. Taking into account users expectations regarding home care services, in particular:

1. Formal trilateral – service contract based – home care services provision model. In this model, there are three main participants involved: organisation providing services (employer), service provider (employee) and service user (client).

2. Bilateral – employment contract based – home care services provision model. This model involves two main participants in service delivery: service provider (employee) and service user (employer).

3. Informal – non-contract based – model of providing elderly care services at home. This model also has to two participants in service delivery: service provider (family member,) and service user (family member) (Blažienė, Žalimienė, 2017).

The Lithuania’s dominant model of elderly care at home is informal care provided by working or non-working family members. The main problem thereof is related to the fact that in the majority of cases informal caregivers receive little support from the state/community.

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3 Methodology and Data Analysis This research used the methods of qualitative research with semi-structured interviews. Qualitative research often uses interviews to get a wider and deeper view of the subject. Semi- structured interviews are where the researchers go into the interview with a pre made frame of a certain theme. The frame often contains bullet points connected to this theme or even some pre-made open ended questions to help with the flow of the interview. This way the interviewee has the option of expressing his opinion instead of having only a few options available as answers that might not match their opinions. This gives the depth and wideness often needed for research. During a qualitative research it is important for the researchers to listen with an understanding to the interviewee and put aside their own opinions on the matter. Otherwise there could be an experimenters bias (Bryman, 2016).

Interviews were taken with four people; a vice chairman of Varena’s district local action group, a director of the elderly home in Varena, the mayor of the eldership in Merkine, the director of the social care center and the mayor of the eldership in Merkine. The interviewees were all chosen with a purposive sample. The interviewees were chosen from their job titles relevant to this research (Bryman, 2016) The questions for the interviews were all open ended and the interviewees were therefore all more able to express their opinions and feelings on the matter.

3.1 Comparison Between Two Public Care Homes The elderly home Varėnos Globos Namai owned by the municipality was established in 1993. There are 25 places in the home but at the moment 26 people live there due to the shortage of room. Only 5 people are in good health while 21 of the elderly people require additional attention and special care. For now, Varena’s care home is only capable of taking in sick people due to high demand and lack of free spaces. The home is located in Varena’s eldership in the Varena district. Merkine’s care home that is owned by the municipality was established in 1994 and they moved to current location in 2014. For building this new house they got around 70% of the cost paid from EU and the rest was paid by the municipality of Varena. Now there are around 44 – 46 residents living in the home, which makes it twice as big as Varena’s care home. In Merkine’s

11 care home there are more people that require special care due to their conditions. Merkine’s care home is located in Merkine’s eldership in the Varena district.

Varena’s municipality has set rules about the amount of workers correlated with how many people live in the elderly homes. When the number of elderly people increases, more workers will be needed. Despite that there are few guidelines from the Social Care Center in Varena where care homes are mostly independent. Both care homes are operating themselves.

3.1.1 Problems There is a demand of places for elderly people in general. In Merkine’s care home problems are about country people, who think that Merkine’s care house is the place to die and there is bad health care. In the society the institution is called a hospital. The director knows that the elderly don’t feel like they are in a home. Family members also don’t visit their relatives very often. In Varena’s care home alcohol is a problem. Some elderly people get alcohol from their friends and unfortunately care house workers can’t handle this.

3.1.2 Workers

In Varena’s care home they have daily nursing with 16 workers in total, including one doctor, two nurses and one assistant nurse. However there are no nurses at night. During changes in directors the whole retirement aged collective was replaced with younger ones (not over 40 years) by the current director. The old workers weren’t really managing this really hard work. In Merkine’s care home there are 33 workers, including one doctor and two nurses with two assistants staying for the night.

A shortage of specialized workers is a problem almost everywhere in rural areas and this case is no different. As shown, in both care homes there is one doctor and two nurses. In Merkine’s home there is exactly half of more elderly people than in Varena’s home. In Varena’s care home every worker needs a qualification opposite to Merkine, where there is no need for qualification. It is enough, when someone applies for a position there that they want to work there. This is due to the fact that there is just no replacement for current employers. In addition, workers in Varena have to seek training for 16 hours per year to improve their knowledge. Both care homes ask people around the community to come and work seasonally during the holidays or in winter. Those people come from the labour program and it adds to their monthly income.

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3.1.3 Costs

In Varena’s home there are two different costs and there’s no difference between months. The first one is the cost for elderly that can take care of themselves. That cost is 570€/month. The second one is 716€/month. That is for the elderly who need people to care for them. The people need to try to cover the cost themselves. The annual budget of Varena’s care home in 2017 was 177.000€ per year (table 1) for medication, infrastructure, qualification and salary. 68,9% of the money is for salaries. The average pension is 200 – 300€. The municipality of Varena covers what is missing for those who can’t cover the whole cost of living in an elderly home. This money comes from taxpayers. For Varena’s care home there is the possibility to ask the municipality for additional money. At the moment the home is asking for money for functioning beds.

Table 1. Varena’s care home budget

Costs (in thousands of euros) 2016 2017

Wages and social insurance contributions 115,5 122,3

Nourishment 26,0 25,5

Other goods 16,8 10,2

Pharmaceuticals (and Health and Safety at Work) 3,9 4,2

Utilities 9,3 9,2

Qualification lift 0,3 0,7

Other services 2,7 1,9

Clothing and bedding 4,6 2,3

Transportation maintenance 4,6 0,5

Connections 0,4 0,5

Total 180,7 177,3

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In Merkine’s home there are also two different costs, similar to Varena’s. Firstly the cost is, 589€/month for those who are minimally sick and secondly the cost is 701€/month for elderly who need more care. 80% of the elderly’s pension covers the cost of the place in the care home and the municipality of Varena covers the rest 20%. The cost is higher in winter, when there are extra workers, for example working on heating and dealing with snow. The annual budget for Merkine’s home was 361 000€ per year in 2017 (table 2), detailed costs is bellow.

Table 2. Merkine’s care home budget

Costs (in thousands of euros) 2016 2017

Wages 188,5 202,2

Social insurance contributions 58,1 62,0

Nourishment 46,2 45,7

Pharmaceuticals 4,8 5,3

Connection services 1,0 1,0

Transportation maintenance 3,5 3,0

Clothing and bedding 6,4 4,3

Prints 0,1 0,1

Other goods related to nursing 15,9 10,5

Current repair of fixed assets 0,5 0,3

Qualification lift 1,1 1,0

Utilities 21,9 20,4

Other services 5,1 3,9

Purchase of fixed assets 9,9 1,5

Total 363,2 361,2

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Salaries are too low in both care homes and are not equal to amount of work or their education. Care taking is hard both physically and emotionally. In Merkine workers are sharing emotions with each other for around 5-30 minutes each day, during that time they try to lift some weight off their shoulders with emotional support towards each others. In Varena, the elderly care workers get around 600€ and around 500€ in Merkine per month. In Merkine, this year they had the opportunity to raise the salary by 5%. In Merkine’s elderly home there are also pensioners who get both salaries and pensions. The director of Merkine’s home feels that she has no right to say: „You are a pensioner and have to leave your work“.

3.1.4 Contact with community

There are lot of volunteering in both care home, but more in Merkine. Many volunteers come from the school in the town. In Merkine there are girls, who want to work with elders and the volunteering is a great way to get to know the job. Small community deepens communication between the elderly and the rest of the community, but at the same time elderly feel left behind.

3.1.5 Future

Varena’s care house director is running an expanding development project funded by Europe Union. Varena’s care house is going to expand from 25 to 40 and buy new computers, washing machines, etc. Also they have plan to built another care house in Valkininkai with 40 places. In Merkine they are focusing on the communication with the neighbors in the area. The workers are inviting people to participate in activities at the elderly home.

3.1.6 Discussion and observation

After comparing the situation in both care homes we came up with interesting results. Even though both homes like to present themselves as equal and serving the same purpose there is a lot of discrepancies between them. Obviously the work that they are doing is necessary, valuable and most admirable. However, the means used in order to achieve their goals vary differently. In the case of Varena’s care home, we all had an impression that it is not an institution; that it is a home which provides a friendly, safe and caring environment. People in general were happy, smiling and seemed to be like a close community, despite the fact that they all seemed to be older by average than the people in the Merkine care home.

Varena’s care home, to outsiders, looks like a close community which was not the case in Merkine. When walking into both homes it seemed that the workers did everything for the

15 people with a motto along the lines of: “people first”. Everyone we met and talked to in Varena’s care home felt wonderful about being there and would not want to move back to their homes even when having that option. The residents would never change the place. In Merkine we found that people were not as happy and did not feel like they were in a home but in an institution.

The first impression of the director of Varena’s home was that she a is a very friendly, kind and an open lady. All the old people seemed to love her and treat her as their own family. Even though that was the experience of the residents it was a bit of a “too perfect to be true” situation. The director was showing us around but it felt more like she was following us and watching our actions. In the interview it felt like she wasn’t telling the whole truth about certain topics.

When meeting with the director of Merkine’s care home she was very welcoming and a very nice lady. She told us that she found that people didn’t feel at home but they were taken care of. That was an honest answer and we really felt she was not hiding anything. The interview felt much more honest than that with the director of the first care home.

The worker in Varena’s nursing house seemed more like a tough lady. She seemed a bit numb, after all these years of working in this nursing facility. When asked about her personal feelings regarding “how tough is it when someone passes away” she told us, that in the case of some people its really a pity, and she feels sad about it, but in the case of many others – not really. She said that some of them have been drinking their whole lives, and even their children don’t want to see them.

The cost of living for the elderly seems to be at a very similar level in both nursing homes, however the salaries for the workers are not. The workers in Varena earn by average around 100 euros more than their counterparts in Merkine. Another interesting thing we came by while comparing both institutions was that in Varena, there are 16/26=0,62 workers per one elderly and in Merkine there are 33/47= 0,7 workers per one elderly. Even though there is no need for qualification in Merkine’s home the quality of care could be poorer, compared to the qualified staff in Varena.

However, not everything in Varena is perfect. We found out that the elderly are given sleeping pills for the night, which in our opinion is ethically wrong. In Merkine there are two nurse

16 assistants for the night, but we do not have any insight if the elderly are given any medication to calm them down during the night.

The biggest issue however, in the case of both elderly homes is that the elderly feel left behind, and lonely. Their families do not visit them, and despite all the activities they are provided with, they lack contacts with other human beings.

3.2 Perspective of the authority

The silver economy is really new and a growing theme in Lithuania. Silver economy is based on the municipality level where the local municipality is dealing with elderly people. There is not a policy on the central government level, they don’t quite acknowledge the silver economy as an issue so there are some issues on how it can be on a local level. Each local municipality decides their own structure on how they will manage with elderly people’s problems.

3.2.1 Strategy and future The municipality of Varena has a strategy for rural development (2014-2020). Local action groups are trying to build a new way of life where the aim is to build social business. There’s a problem with elders from bottom to up where the society sees the problem but government doesn’t. Fortunately Varena’s local strategy is a bottom up approach. The municipality tries to find entrepreneurs to go to the rural areas to build houses for the elderly people. Potential entrepreneurs can apply for projects and get money for the project.

In Varena there are two empty houses that the municipality wants to renovate for elderly people. The council has given the permission to businessmen to renovate buildings. The municipality has lots of buildings that they can sell or rent and there is unused infrastructure but it’s always based on money. The municipality can create more jobs for people that are taking care of older people and make the municipality more attractive for those who want to create a company in this business.

Varena is not a industrial town and locals don’t want to change that. There are iron mines in the area, so it would be possible to build a factory, but people don’t want to due to beautiful nature. People are afraid of changes. Also there is a national park, which means that it is impossible to create some kind of a industry there.

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3.2.2 Problems and solutions in Varena

There are 3 main issues with the silver economy in Varena:

- Money - The municipality council decided to close medical centres a little time ago in rural areas, because they spent a lot of money. In Lithuania money is a power; politicians try to hold all the money for themselves, even in Varena. - People don’t care – Social issues are not the theme, it is about what people are interested in talking about. - Political affiliation – The municipality members from the opposite side can’t make decisions because no one listens to them. There is also a problem with changes in politics since municipality members are changing all the time. There is no time to reach any goals set in the beginning.

In the municipality there should be people who know about the problems. There is also a need to change the “post-communist” mindset. Politicians are mostly 60+ and they care only about their own opinions. It is on the other hand very important that locals are included in the decision- making process.

3.2.3 Contact with the community

In Varena city there is very little contact with the community. The stronger communities are mostly in the rural areas. In Varena the thinking is mostly everyone for themselves. Therefore it is easier to deal with rural people. The municipality knows what their problems are and they communicate more. The people from the municipality travel around the region, speak with the community as well as trying to understand what the people need. Active members are older people from 50-70 years old. There is little to no cooperation with other municipalities on the silver economy case (on municipality level), but cooperation with other Non-Governmental Organization (NGO) exists. NGO’s get money from the Europe Union where they make a strategy, give it to the government in Vilnius and decide if it will applied or not.

The next financed period is between 2020-2028. In that time there will be more attention on local community business. Today, NGO’s get 85% of funds from the EU and 15% from the Lithuanian government. For the next period (2020-2028) it will be around 50-60% from the EU. For businesses they can fund 70% for innovation in rural areas.

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3.3 The Social Services Center

Every municipality has this kind of an institution. It was established in 2009 and those services of the care center are for the elderly. The center helps with transportation to hospitals, rehabilitation, take care of their needs in terms of hygienic needs, offer social culture, and sport services. In addition to taking care of their basic needs they offer the service to those that can’t take care of themselves that they can for example take a shower and wash their clothes in that center. Those individuals who are unable to move from their homes are visited by social workers.

3.3.1 Social workers

There is a big demand for social workers. There are 110 people who need that care and there are 30 social workers. They visit the elderly based on their needs; once or twice a week or 5 days a week. The social workers are required to be at the elderly’s homes for at least 2 hours. Those two hours are only for necessary work. There are 8 elderships and in each eldership there are 1-2 social workers who collect information on those that need the services. They have to visit the elderly people, count them, and let the municipality know about their problems. They will also know when the elderly need more care than the workers can offer and they are cooperating with the care homes. For every social worker there are 4 elderly. There is a shortage of educated social workers but a lot of assistants are working with the elderly. One of the problems is that there are not so many educated social workers in this municipality.

3.3.2 Demand for care

When the social services center was established there were 40 people requiring these home services. Today the number has gone up to 110. For now they don‘t have waiting lists, there are 100% of the people that get the service. The service work is advanced work for the workers where they have to estimate every single client. There are healthier people and then those that require lots of needs. Those people who want to live in their homes are 30, they are very sick and need extra special care. The social workers are trying to keep the people in their home where they take care of those weaker as well; the harder cases. If the elderly want to go to an elderly home they can but it is good if they want to live at home.

3.3.3 Financial help from municipality

The Social Services Center is a budget institution where the money comes from the municipality. The larger amount of money that the municipality can’t cover comes from the EU

19 funds. There is a problem with the salaries of the workers since this is really hard work. The low salary is not equal with the hard work or the education of the workers. It was mentioned that the center is offering money for the elderly to buy medicine. That is their immediate financial help. The financial help is also for those elderly who live in villages that can‘t manage with heating and other expenses. That what they can‘t manage; the center offers contributions. About 600 people are getting that financial aid from the municipality because they can‘t manage from their pensions. For those that are facing the financial problems they can even be dismissed from taxes completely and that is also covered by the municipality.

3.3.4 Care home funds

The care homes have projects to get money. They do lots of work by themselves and get funds and financial help from the government. The care home gets 4% of the budget from the municipality but they don’t get as much as for example education. The education is first and social work is second. The Social Services Center are changing their work all the time with for example constant evaluation. An example would be the expansion process of Varena’s care home.

3.3.5 Future The services and activities are expanding; for example with the adding of 25 places to 40. The care home is actually planning to finish the expansion in December this year. With that the silver economy is also expanding. The salary of the workers is slowly rising in small steps but the low salary is compensated by social benefits. The motivation for the workers are mostly social benefits, education and health insurance.

3.3.6 Enjoyment of the work

The workers actually believe in what they do, they like it and with their home visits they are the reason the elderly can stay for a much longer time in their home. They are happy that the family members of the elderly don‘t have to leave their work to take care of the elderly. As well as being happy with Merkine’s care home. That home is reflecting the EU standards since it is brand new and it can offer much more service than in Varena.

3.3.7 Problems There is a shortage of places and the workers face conflicts of situation about overview. There is especially a different perception with the people and the government. The workers are not

20 really listened to and since they work in the field it would be good for the government to hear the workers out and get ideas to better their work.

The conflicts between the elderly and the workers is for example where the elderly don’t want the workers to be touching their belongings and it is difficult for the workers to do their jobs to the fullest. The workers need to work with each and every elderly since after a long time of solitude the elderly have to restore their ability to make contact. The workers need to establish some sort of a contact with the elderly and that is often an issue due to a long time in solitude.

There are some problems in care homes where for example in Merkine there are waiting lists. The home is full because the demand is higher than the supply. There are not a lot of ungoverned places where the people are taking care of themselves but the community is taking care of its people. The disadvantages of the work is that they face conflicts between the perspective of the people and the perspective of the government.

3.3.8 Government Action

The Social Services Center doesn‘t really feel the hand of the government but they notice the government is establishing a new policy for workers where there is integral help policy directed to the elderly. Integral help means nursing for the elderly. There is a problem in Merkine with a full waiting list. The demand for the services is higher than the supply. There are also plenty of places where the authority can’t reach so people need to take care of their own needs.

3.3.9 Discussion and observation

From the interview with Varena’s municipality council member came very interesting and important background information about the silver economy in Lithuania. The chairman of the Varena district local action group is the youngest person (34 years) in the municipality’s council. He is from younger generation and sees problems differently than the older ones, who are still stuck in the time of communism. Due to being opposite side in municipality, his ideas aren’t very often accepted. We feel the chairman is a right person in the right spot, who really wants to change the attitude in the community and make life better in Varena. But being quite alone with his opinions in the old and uninnovative environment his potential isn’t used to the fullest.

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4 Conclusion Due to radical changes in the age structure of the population, authorities need to take care of the ageing population. Considering the limited resources and rapid depopulation the municipalities face a rather difficult task. The silver economy and the care homes are becoming more and more important in European countries, including in Lithuania.

As highlighted by the member of the city council of Varena - it is not just because of the fact that many people do not acknowledge the ageing population as an issue, but also they just simply do not know how to solve the problem. There are two elderly care homes in Varena’s district; in Varena, and in Merkine. Together they have around 72 places for elderly people, but there are still people on the waiting list. Fortunately the municipality council understands the increasing problem, and they are planning to increase the number of care homes in Varena’s district. Elderly people require particular treatment, due to their special needs. It is not surprising that they miss their family members and understandably the care homes can’t replace them. However, as interviews in both care homes have shown, the situation of elderly care in the municipality of Varena is improving. The municipality is allocating more funds for elderly care than in the previous years. Care homes are managing well, and if necessary they can even ask for extra money if there is a need. The municipality council of Varena, Social Services Centre and care homes are cooperating. The biggest problem in care homes is to find qualified workers, especially in rural areas. Due to difficulties in finding qualified staff, Merkine’s care home does not require special education.

The main issues holding the municipality back from addressing the needs of the elderly properly, however, are money issues, authorities indifference in acknowledging the issue and political affiliation often affecting the judgement. Younger generation in the municipality could bring some fresh ideas and help to shape the future of both the municipality and the country as it is not affected by the “post-communist” mindset.

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5 Resources

Bertelsmann Stiftung. (2018). BTI 2018 Country Report — Lithuania. From http://www.bti- project.org/fileadmin/files/BTI/Downloads/Reports/2018/pdf/BTI_2018_Lithuania.pdf

Bryman, A. (2016). Social Research Methods (5th issue.). Oxford: Oxford University Press.

European Union. (N.d.). From http://www.smartsilvereconomy.eu/silver-economy

Eurostat. (2017). Share of Member States in EU GDP. From http://ec.europa.eu/eurostat/web/products-eurostat-news/-/DDN-20170410-1

Jolanta Pivoriene. (2016). Ethnic minorities in Lithuania. From http://www.sociology- society.ff.ukf.sk/archiv-cisel/c1/c1-jolanta-pivoriene.pdf

Merkine’s nursing home financial report. From: http://www.merkinesglobosnamai.lt/ckfinder/userfiles/files/2017%20finansines%20ataskaitos /metu/2_4_FB_at.pdf

Statistics department of Lithuania. (2017). Gyventojai. From https://osp.stat.gov.lt/documents/10180/3329771/Gyventojai.pdf

Statistics Lithuania. (2016). Demographic Yearbook. Vilnius: Lietuvos statistikos departamentas

Visit Lithuania. (N.d.). Varena (Varėna). From http://www.visitlithuania.net/lithuania/cities/229-varena-varna

The International Silver Economy Portal. (N.d.). What is the Silver Economy. From http://www.silvereco.org/en/what-is-silver-economy/

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The World Bank. (N.d.). Lithuania. From https://data.worldbank.org/country/Lithuania

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