Legal Framework for Social Services Delivery in the United Kingdom Germany France and Belgium

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Germany, France, and Belgium European Standards Comparative Analysis


Bulgarian Center for Not-for-Profit Law Sofia, Dobrudja Str. 6 March 2002
The purpose of the present study is to describe the European Standards for the efficiency of and
mechanisms for the delivery of social services.
The analysis covers the legislation and best practices in the area of social services in the United
Kingdom, France, Germany, and Belgium as well as the relevant documents of the Council of
The study of separate national legislation involv es the applicable legal framework, the existence
of legal definitions, the process of financing of the social services delivery, the contracts for the
delivery of social services, the established sy stems for the delivery of social services, the
subjects performing social services, the types of social security, the principles of social activity,
the competent authorities in the provision of social services, and the role of non-governmental
organizations in the process of social services delivery.
Through the presentation of the positive practice of the most advanced countries in the
European Union, the authors of this study purport to initiate a debate on the issues related to
the improvement of the legal framework for the delivery of social services in Bulgaria. The
authors also believe that the established european practices will be used as a basis for future
legislative changes and reforms in the social sphere in the Republic of Bulgaria.
Documents of the Council of Europe
There are no universally accepted international and European principles governing the delivery
of social services. The Universal Declaration for Human Ri ghts (1948) does not contain
provisions to that effect. The Convention for the Protection of Human Rights and Freedoms of
1950 does not govern the public relations in connec tion to social services either. The European
Social Charter of 1961 (last amendment 1996) ex pressly proclaims the right of employees to
participate in the process of determination and im provement of working conditions and to social
security by the employer (art.22). Such a provisio n does not exist in relation to social services.
The provision of article 14 establishes the duty of the states to encourage and promote the
participation of natural persons and voluntary or ganisations in the delivery and maintenance of
the package of social services. The text is generally formulated with regards to the persons and
organisations authorised to deliver social se rvices. The provision of art.15 of the Charter
acknowledges and guarantees the right of pe rsons suffering from physical and mental
deficiencies to social integration and participatio n in public life. However, this text does not
specify the role of the beneficiaries of social services in the process of their delivery.
The provision of art.30 of the Charter establishes the right to social protection of natural
persons. It obliges the states to implement measures that would guarantee the access of
persons threatened by poverty and social exclusion, to education, social and medical help,
active cultural and public life. When such measur es have been provided for by legislation, the
state must ensure their effective implementation to socially weak persons.
Treaty for the establishment of the European Communities
The new provision of art.137, chapter 11 of the Treaty establishing the European Communities
authorises the Council of Ministers to adopt a new strategy and new approaches aiming at the

combating of social exclusion. The active participation of users in the mechanism of social
services delivery is an intrinsic part of this new approach.
Evaluation of the practice of the EU Member States
According to the European Commission the French law is a successful legislative model for
combating of social exclusion. Under the provision of art.5 of the law the state is obliged to
evaluate annually the effectiveness of the mechanism for the delivery of social services and to
take the opinion of the persons and organisations engaged in this sector. The text of art.31
expressly mentions the participation of voluntary or ganisations in the delivery of social services
particularly in providing shelter for the homeless.
The Dutch Social Assistance Law of 1988 is al so a good model of a working mechanism as
acknowledged in the report of the European Co mmission. According to this model, the local
authorities must implement in the local legislation such provisions as to ensure the various
forms of active participation of users in the delivery of social services.
United Kingdom
General characteristic of the social sphere
Social services involve the provision of care and support to a considerable number of people so
as to help them live a better and more complete life. Thousands of people in England rely on
social services in cases of family or personal crisis, mental illness, bringing-up children – born
invalids, divorce, death, or other events as a result of which a person is left without the
necessary means for living and support.
Since 1948 the provision of social services has been assigned to the Mi nistry of Health (on
questions of public health and other aspects of social assistance), the Ministry of Social Affairs
(assistance to persons of age and to the invalids), and the Ministry of Child (childcare). In 1960
these institutions merged to form the Ministry of Social Affairs in Scotland and the Ministry of
Social Services in England an d Wales. This merge accelera ted all social activities.
Nowadays the system for the delivery of social se rvices in the United Kingdom is established as
one complete system administrated by the state and including three types of benefits:
1/ income-related benefits (income support, un employment benefit) and financed through the
national tax system; this type of benefits function as a network for security;
2/ contributory benefits. This type of benefits ar e financed by the National Security Fund formed
from the mandatory contributions made by empl oyers and employees. The assistance covers
sickness, maternity, unemployment, retirement benefits, widowhood benefits, and are normally
of equal amount;
3/ non-contributory benefits. These benefits ar e financed through the national tax system and
are determined on the basis of the individual characteristics of the given person (child,
disability). Thus, for example, the National Health Office provides universal healthcare which
does not depend on the making of contributions.
The Ministry of Social Security is responsible for the development and realisation of the social
security programs. The policy decisions in the soci al sphere and on objectives and priorities are
taken by the Secretary of State and the rest of the ministers in the government. The Inland
Revenue is in charge of collecting contributions and registering all contributors, and of the
assessment and payment of the tax credits for the working families and working persons
suffering from disability or illness. The employment office at the Ministry of Labour and the
Assistance Agency hold a joint responsibility for the administration of the benefits to the
unemployed while the local authorities manage the assistance provided to households.
Employers are obliged to pay sickness leave and maternity leave as determined by the law. The

National Health Service, through its organs, receives funding for the delivery of healthcare
services to the local community on the basis of contracts with the health trusts and other
persons/organisations delivering su ch services. The social services are delivered by the local
councils on the basis of the legal framework and f unding provided by the Ministry of Health. The
employees, on their behalf, must make national security contributions to support those who are
unable to meet their needs independently. Thos e who can afford it may make supplementary
voluntary contributions, for instance, for pension.
Legal Framework
General legal framework: Nation al Health Service and Community Care Act of 1990, Community
Care (Residential Accommodation) Act of 1992, Carers (Recognition and Services) Act of 1995,
Community Care (Direct Payments) Act of 1996, National Health Service (Primary Care) Act of
1997, Community Care (Residential Accommodation) Act of 1998, Care Standards Act of 2000;
Healthcare: National Heal th Service Act of 1977, Health and So cial Care Act of 2001, Health Act
of 1999;
Sickness: Social Security Contri butions and Benefits Act of 1992, Social Security (Incapacity for
Work) Act of 1994;
Invalidity: Social Security Contributions and Bene fits Act of 1992, Social Security (Incapacity for
Work) Act of 1994;
Maternity: Social Security Contri butions and Benefits Act of 1992;
Aged persons: Social Security Contributions an d Benefits Act of 1992 and the Regulation on its
implementation, Pensions Act;
Unemployment: Social Security Contributions an d Benefits Act of 1992, Jobseekers Act of 1995
Family benefits: Social Security Contributions and Benefits Act of 1992;
Statutory sick pay and industrial injuries: Social Security Contributions and Benefits Act of 1992,
Social Security Administration Act of 1992;
Childcare: Children Act of 1989.
Legal definitions
The National Health Service and Community Care Act of 1990 contains a definition (art.46(3))
for “local authority” for the purposes of providin g social services as “the council of a county, a
metropolitan district or a London borough or th e Common Council of the City of London”. The
“community care services” are defined as “services which a local authority may provide or
arrange to be provided under any of the following provisions:
(a) Part III of the [1948 c. 29.] National Assistance Act 1948;
(b) section 45 of the [1968 c. 46.] Health Services and Public Health Act 1968;
(c) section 21 of and Schedule 8 to the [1977 c. 49.] National Health Service Act 1977; and
(d) section 117 of the [1983 c. 20.] Mental Health Act 1983; and
“private carer” means a person who is not employed to provide the care in question by any body

in the exercise of its functions under any enactment.”
The Standards Act of 2000 defines in its art. 2(7) in chapter 14 the health services listed in the
act as including:
• medical treatment under anaesthesia or sedation;
• dental treatment under general anaesthesia;
• obstetric services and, in connection with childbirth, medical services;
• termination of pregnancies;
• cosmetic surgery;
• treatment using prescribed techniques or prescribed technology.
The Carers (Recognition and Services) Act of 1995 provides in art.1.2(b) that where such an
individual (carer) “provides or in tends to provide a substantial amount of care on a regular basis
for the disabled child, the carer may request the lo cal authority, before they make their decision
as to whether the needs of the disabled child call for the provision of any services, to carry out
an assessment of his ability to provide and to co ntinue to provide care for the disabled child;
and if he makes such a request, the local author ity shall carry out such an assessment and shall
take into account the results of that assessment in making that decision.”
The Social Security Contribution s and Benefits Act of 1992 defines which persons are obliged to
make social security contributions. The contributor is a person (“employed earner”) who is
“gainfully employed in the United Kingdom either under a contract of service, or in an office
(including elective office) with emoluments chargeable to income tax under Schedule E…” or is
self-employed (art.2(1)).
Participation of non-governmental organisations in the delivery of social services
The Community Care (Residential Accommodation) Act of 1992 governs in a special section the
conclusion of arrangements for provision of accommodation in premises maintained by
voluntary organisations. The provision of art.(1A) governs these arrangements when they are
made with any voluntary organisation or other pers on if they are for the provision of residential
accommodation with both board and personal care for such persons as are mentioned in section
1(1) of the Register ed Homes Act 1984.
The enactment of the National Health Service and Community Care Act in 1990
brought about the establishment of a new model for the provision of social services. Before,
these services were mainly provided by the local authorities (local social councils); now these
authorities delegate their provision to volunt ary and private organisations representing the
independent sector.
Under the system of social care in the UK the beneficiaries of social services who pay directly for
them do not rely only on assistance provided by the local councils. They can benefit from a
package of social services including also services from independent providers.
Financing of social services
Type of social services -Financing

Sickness and maternity healthcare – Services provided by the National Health;
Services are funded by the government and to a small degree by contributions
-cash allowances: Paid by contributions and taxes:
a/ statutory maternity pay; b/employers require 92% of these expenses from government,
small employers
may ask for the whole amount plus 5% compensation.
a/statutory sick pay; b/paid by employers with he lp from government in cases of long periods of
incapacity for work.
Long-term attendance – There is no single sch eme for providing long-term attendance. Such
allowances are financed by the government from taxes;
homes for the elderly and for invalids are financed by local authorities
Invalidity – Long-term invalidity is financed by the National Insurance Fund on the basis of
Benefits for the aged. The pensions on a no n – contributory basis are financed by the
government. The remaining part is paid out by contributions.
Industrial injuries – The full amount of benefi ts is paid by government out of taxes.
Unemployment – The contributory benefits are pa id on the basis of contributions, the income-
related benefits – from taxes
Child’s allowances – Paid by the government out of taxes.
The contributions due are determined on the basis of the weekly income:
1/ for the employee – for income under 106 EUR no contribution is due; above this amount the
contribution is 10% of the income; for income between 106 and 801 EUR the contribution is
8.4%; 2/ for employers – for income under 133 EUR no contributions are due; above this
amount the contribution is 12.2% of the income.
Contract for providing social services
The National Health Service Act provides for the conclusion of contracts for the provision of
social services: this is an agreement according to which one health service body assigns to
another such body the provision of goods and services, where the delivery of these goods and
services falls within its competence and func tions. A healthcare body means (a) Health
Authority, (b) Health Board, (c) Common Services Agency for the Scottish Health Service, (d)
Family Health Services Authority, (e) National Health Service Trust, (f) recognised practice –
funds-owner, (g) Dental Practice Boards, (h) Pu blic Health Laboratory Service Board, and the
Secretary of State.
At the end of last year, a Compact on Relati ons between Government and the Voluntary and
Community Sector in England was signed. The compact is a framework document promoting a
new approach towards partnership between the state and the independent sector. Under the
Employment Project – Millennium the Greenwich Council has entered into partnership
relationship with the local colleges and with a certain number of small enterprises. The subject
of the partnership is providing support to elderly people with difficulties in education often

accompanied by mental or physical problems. The project is jointly funded by the participating
organisations and by the European Social Fund.
Legal Framework of the basic types of social services
a/ family allowances: these are provided on a monthly basis and amount to 100 EUR for the first
born child and 67 EUR each for the next born children until they reach the age of 16 (or until the
age of 19 if they continue their high-school education). These benefits are not taxed.
b/ maternity pay: 160 EUR for expected child, born or adopted, paid out of the Social Fund and
not taxed.
c/ unemployment benefits: there exist two schemes for unemployment benefits: 1/ contributory
benefits determined on the basis of the paid co ntributions for a period of at least two years
back, and 2/ income-related benefits. The benefits are paid on the condition that the person is
non-voluntarily unemployed, has a capacity to work, is in active search of employment, is not
engaged in work for more than 16 hours per week, is not a regular student, resides in the
United Kingdom, does not possess savings over 12, 808 EUR, and is not older than 65 years
(men) and 60 years (women).
Compensations paid by third persons to adults as a social service
The French Law of 30/6/1975 officially recognises the right to third persons to support adults
with disabilities preventing them from perfor ming everyday life activities. The so-called
compensatory payment aims to assist the disabl ed persons in performing such activities. The
beneficiaries have the freedom to decide on the use of the monthly amounts they receive. They
have to declare only the expenses over 80% of the compensation used and therefore the
allocation of expenses is unlimited. The compensa tion may be used by the disabled persons or
by their families, may be invested, or may be us ed to pay other persons without having to be
declared before the tax authorities. Generally, there is no guarantee that the compensation will
be used for the particular purpose for which it has been provided.
Services to dependants – another type of social service
The legislative imperfection described above lead to the introduction of the so-called service to
dependants (PSD). Before, the situation of the ag ed persons in need was similar to that of the
disabled. They were supported through the fina ncial help provided by third persons. Socio-
demographic studies indicate that 60-80% of the financial help provided to persons by
departments was allocated to retired persons. There is no guarantee that the aged persons
could be assisted by their spouses or by their children who may not live close enough as to
provide everyday assistance to their parents.
The service to dependants wa s introduced by Law No. 9760 of 24/1/1997. The primary purpose
of the service is to provide support to the elderl y. The law establishes cumulative conditions for
eligibility for such a service related to the age of the applicant (at or above 60 years) and to the
availability of means for living under a certain threshold.
Persons providing the service
The service is provided by one or more persons hired as personal assistants through an agency
specialised in the delivery of such services or through an organisation with such activity. A
member of the family (except the spouse) may also be hired as a personal assistant and receive
a compensation.
To summarise, the most widespread mechanisms for providing social services in France are two:

mechanisms for compensatory payment by third persons and mechanism for providing services
to dependants.
Setting up the criteria for dependency and ev aluation of needs. Application procedure and
Similarly to the compensatory payment by third persons, the service to dependants is provided
in response to an application for assistance submitted by the dependant. The assistance is
provided by a third person and intends to meet the basic living needs of the dependant. The
application is submitted to a medico-social te am at least one member of which must have
visited the applicant. The evaluation is made by experts applying a national program known as
AGGIR schedule. The program covers the following categories of persons:
ISO Group-Resources (GIR I) – aged persons with limited ability to move, unable to leave the
bed or wheel-chair, with serious mental distur bances who are in need of permanent care;
GIR II – covers two categories of persons. One includes people whose mental ability is not
completely disturbed and who need attendance in performing basic everyday living activities.
The other includes people with mental dist urbances but with preserved ability to move
GIR III – covers aged persons with preserved me ntal ability and certain ability to move but who
are in need of assistance several times per day in order to maintain their physical
GIR IV – covers people who are attended to at their home and the service is financed from their
pension fund or from social benefits to the retire d. This type of financing is subject to criticism
but its positive feature is the well organised assistance.
The medico-social team develops a plan for assistance within 40 days after the day of
submission of the application for help. The applic ant must either approve the plan within 8 days
or demand the development of another plan. The payment commences no later than 2 months
after the application has been submitted.
Evaluation of resources and calculation of payments
The service to dependants as a source of financing is combined with the personal resources of
the person in need and where necessary, with the resources of the spouse. The upper limit for
the financing is fixed at FRF 72,000 per pers on per annum and FRF 120,000 for a married
couple. In other words, the amount of the benefit is FR F 6,000 per person and FRF 10,000 per
couple per month.
The service to dependants is a form of payment for a social service, it is due to be given back by
the inheritants of the person who has received such service but only if the payment has
exceeded the sum of FRF 300,000.
Form of payment
The service to dependants may be provided in-kin d or in cash (for example, a cheque in the
name of the applicant). It may only be used to cover the expenses originally indicated in the
plan. This is the principal difference between th is type of service and the compensatory payment
where there is a freedom of disposal with the paid compensation.
Mechanism of allocation of means an d providing personal assistance
The person using a service to dependants may hire one or more persons working for the local
authorities or for a non-governmental or commercial organisation or even neutral persons, for

example, neighbours. He/she may hire members of the family except the spouse or partner.
The funding for this type of social service may be used to cover normally the expenses for food
and activities like alarm system, temporary residence, change of shifts, etc. These activities are
funded according to the original plan.
At least one member of the medico-social team must monitor the home of the person who has
received the service. This would mean to make at least one annual assessment of the efficiency
and quality of the provided service.
If the assistance endangers the health, security and the moral or physical well- being of the
service recipient, the recipient may demand th e appointment of another assistant. In cases
where this proves impossible, the recipient may demand a termination of the service.
Positive aspects of the service
• It is a co-ordinated and personalised care plan implemented jointly with the local authorities;
• The period for evaluation of the application is short – 2 months;
• The dependants have the right to choose their personal assistant;
• The monthly payment per person (about FRF 3,200) is a considerable sum;
• The assistance may be provided at the homes of the assisted persons.
Potential of the system
For the year 1999, the areas of priority for development of social services include:
• qualification of the persons providing assistance
• paid assistants
• family assistants
The law establishes rules for the training of assistance personnel but as for the moment there is
no funding planned, the rules have not been implemented.
The co-ordination among the person s providing this type of services is done by evaluating the
needs of the individual persons. On the other hand , it is also necessary to co-ordinate the policy
of the various institutions, departments, centers for social services, associations, and funds.
Categories of assistants
The hourly rate for the service provided to dependants varies according to the provider:
• a hired paid assistant receives FRF 50 per hour);
• home personal agency working with the local authority, or
• voluntary organisation (its staff works for FRF 80 per hour).
In summary, the service provided to dependants combined with the plan for personalised care

has proved to be an effective method for ensuring home personal assistance to individual
persons and their families.
Subjects of the right to assistance under the Code of Social Activity and Families
Persons aged 60 and over
Under the provision of art.113 pa r. 1-3, each person aged 60 and over may be the subject of
the right to social assistance which, for this category of persons, may take two forms:
à/ lodgement in a social institution;
á/ lodgement with private persons.
The lack of capacity to work of these persons is evaluated by a special committee. In addition,
at the state level there exists a Committee on Gerontological Development whose task is to
evaluate the quantity and qualit y of the periodically granted benefits and their importance for
the recipients.
Persons with difficulties, invalids, and persons wi th physical, mental and sensory disturbances
The provisions of art.114 et seq. of the Code of Social Activity and Families govern the equal
status of persons with physical, mental, and sensitive disturbanc es as compared with that of
other natural persons. As a result of their co ndition, they are entitled to compensatory
payments irrespective of the origin and the nature of these disturbances, their age and way of
life. The funding aims to ensure a minimum of means for covering their living activities.
Competent authorities in the provision of social services
The Code of Social Activity and Families contains provisions on the authorised social services
providers. These include:
² . Public and State authorities:
• the state;
• the departments;
• the municipalities;
• social security organisations.
II. Community and inter-community social activity centers
Municipal social activity centers – legal framework under the Code of Social Activity and Families
(art. L 123)

The municipal social activity center has as its main purpose the protection and social
development in the municipality. This activity is performed in close cooperation with the existing
public and private institutions. One of the center’s functions is to promote the process of
financing under the form of retrievable or irretrievable sums. This is one of the forms of social
assistance as defined by the law.
Certain municipalities have established communal and inter-communal centers for social activity
which exercise control on the municipalities involved in the area of social activity. These centers

act as administrative formations – municipal property. They can be managed by a Managing
Board, by the mayor of the municipality, or by th e president of an institution for inter-municipal
Associations – legal framework under the Law on Services to the Handicapped of 1975 (Loi n°
75-534 du 30 juin 1975 d’orientation en faveur des personnes handicapees – Journal Officiel du
1er juillet 1975)
The provision of art.1 of the law defines the persons and institusions that can deliver services to
the handicapped persons and to persons lacking good conditions of life. These include:
• the state;
• the local public authorities;
• the public institutions;
• the social security institutions; and
• the associations.
These legal subjects are engaged in activity towards ensuring a complete autonomy of the
dependent persons in performing their everyday activities.
The state exercises an overal co-ordination of the activities related to the national policy in
consulting handicapped persons. The state serves as a mediator between the various interested
parties through the Inter-institutional Committee for coordinating the adaptation of invalids. It is
also engaged in active cooperation with the associ ations performing activity in the social sphere.

The mechanism for cooperation between the state and the non-governmental organisations in
the area of education is as follows: in each department a commission consisting of highly
qualified members has been established by force of the law. The members of the commission
are elected upon the suggestion of: associations of parents, associations of children, or
associations of families of handicapped children.
The provision of art.56 of the law specifically refers to the participation of non-governmental
organisations in the delivery of social services. In order to facilitate the socio-professional
integration of handicapped persons the state, in cooperation with organisations and associations
active in this area, drafts and implements a program for the constant information of the public
about the various categories of hand icapped persons and their problems.
Legal framework
Care Insurance law (01.01.1995 ã.)
General provisions
Care providers. Sources.
The social care institutions are private, public , and state. They are sponsored from three main
• clients of the care-providing institutions (fro m their personal resources or from the financial

help they receive from the social insurance);
• contributions paid by the social insurance on the basis of assessment of needs;
• contributions paid by the social insurance in cases where the client is not eligible for social
The social care providers pay for expenses covering:
• personal care/personal hygiene of the client;
• nutrition;
• mobility;
• household.
The hourly rate for social care delivered at home depends on the region as determined in the
contract between the social security institutions and the social care institutions.
Note: Social care/services means all kinds of services needed by the client, including medical
New program for social insurance
Permanent/long-term care)
The persons in need of permanent social care are those who, as a result of disease or incapacity
to work are helpless to a degree which requires permanent assistance for the performance and
satisfaction of their everyday activities and needs.
The new program for permanent social care insurance to the needy involves all persons hired to
work in Germany irrespective of their nationality.
The program introduces a mandatory system based on the principle that the long-term care
insurance follows health insurance; i.e., as the health insurance may be mandatory (social) or
private (voluntary), the permanent care insurance follows the same model.
In this respect the new legal framework for the insurance unites two schemes – the program for
social (mandatory) care insurance, and the pl an for private (voluntary) care insurance.
• Long-term social care insurance
Each person who is mandatorily or “socially” insured is also oblidatorily
included in the program for long-term mandatory “s ocial” insurance for social care. In practice,
this system applies to all public servants and the members of their families (about 92% of the

• Long-term private insurance
The individuals included in the system for private health insurance are also
insured privately for long-term care – they represent about 7% of population.
Long-term “social” insurance – mandatory insurance for care
Note: In this paragraph, “social” insuranc e is used to mean mandatory insurance.
The new scheme for long-term insurance is based on several principles:
• relief of persons in respect of expenses related to social care and assistance;
• avoidance or decrease of the need for so cial care through medical prophylactics and
• advising and consulting and providing the persons with lists of insurance funds so that the
client may have a choice of an insurance fund
The long-term “social insurance” is financed fr om the equal contributions made by employers
and employees. The payment of contributions is not required for the insurance of unemployed
spouses and children.
The contributions from employees are deducted in advance from their salaries by the employer
who forwards them to the health-insurance fu nds. From these funds, the contributions are
forwarded to the respective social care fund.
The new system of insurance is implemented by the health-insurance funds through their offices
throughout the country.
The long-term social care insurance funds are autonomous legal persons with a non-profit
purpose holding a status of public corp orations independent from the state.
The private clinics and agencies for home social care delivery are not a property of and are not
managed by the social care insurance funds. Th ese belong to public, beneficial, or private
About 10% of the private clinics are a property of the local authorities, 54% belong to churches
or other beneficial or ganisations, and 36% are a private property.
43% of the agencies for home care are a private property, 51% belong to beneficial
organisations, and 4% – to local authorities.
Contract for care delivery
Under the law, the private clinics and the agencies for home care may provide care to the
persons in need at the expense of the insurance funds only on the basis of the so-called contract

for care delivery (Versorgungsvertrag).
The parties to the contract are:
• the respective private clinic or the agency for home care;
• a joint group of regional associations of the long-term insurance funds.
The regional association of long-term insurance funds may refuse to sign the contract or may
terminate it only where the private clinic / agency for home care does not meet the standards of
care or if it fails to perform economically.
The contract for care delivery has three main functions:
• determines the type, the nature and the scope of the help and care that will be delivered by
the private clinic or by the agency for home care for the term of the contract;
• obliges the private clinic/agency for home care to deliver quality care to the persons in need
and insured by the funds;
• obliges the long-term care insurance funds to pay the care providers (private clinics, agencies
for home care) as agreed in the contract.
The private long-term care insurance is organi sed by private health-insurance companies.
The benefits available under a private care insurance plan are equal to those available under the
social long-term insurance scheme.
The private insurance companies are obliged to offe r acceptable terms and prices to families and
to elderly members.
In order to be insured for social care, a person must meet the following conditions as set up by
the law:
• a necessity for permanent, multiple, and substantive assistance in the performance
(satisfaction) of ordinary everyday human activities/needs for a long period of time;
• the need for care must have existed for a period of at least six months – this is the legal
meaning of “long-term”.
Where a given person meets the legal require ments for care insurance, he/she is
entitled to receive all types of care included in the insurance system. The financial condition of
the person in need as well as that of his/her family is irrelevant.
In the assessment of whether a person meets the legal requirements for care delivery, the
following four elements are taken into consideration:
• personal hygiene – washing, bathing, combing, etc.
• nutrition – including the preparation of food so as the person can accept it;

• mobility – getting out of bed, going to bed, dressing, undressing, walking, standing, climbing
of stairs, etc.;
• housework – cooking, shopping, cleaning, washing, etc.
There are eight basic types of long-term care that can be delivered.
Home care
The home care is provided in cash or in kind but only when the person in need has ensured the
receiving of the care from family members, relatives, or neighbours.
Where the person in need prefers to receive professional care at home, the scheme offers home
visits by professional nurses; In these cases, the social assistance benefit is paid directly to the
respective agency for nurses.
Assistance for support
Relatives, friends, neighbours or other persons providing non-profe ssional care to the person in
need, are entitled to four-weeks holiday per year, during which the insurance social care fund
pays for the delivery of professional home care up to 1,400 EUR. This is also valid where the
care provider is sick or otherwise prevented from delivering the care.
However, the care provider must have taken care of the person in need for a period
of at least twelve months before the moment when he/she is temporarily unable to provide the
Part-time assistance/care
Part-time care is provided to persons wh o need long-term care and cannot receive
the necessary assistance from members of their family or relatives.
Short-term assistance
Where the part-time and/or home care are not sufficient for the person in need,
he/she can receive the necessary assistance and care in an institution for short-term care.
Technical assistance
The persons in need are entitled to receive also technical assistance / facilities,
including special beds, adaptation of the home conditions to their requirements, etc.
Training of caretakers
The long-term social care insurance funds are obliged to offer to the relatives of the
persons in need or to other non-professionals free training for care-taking.
Insurance of non-professional caretakers

The relatives, friends, neighbours, or other persons providing non-professional
care to the persons in need, are covered by the retirement insurance schemes if they meet the
following requirements:
• they are unemployed or employed permanently for less than 30 hours per week;
• they provide free home care to the person in need for at least 14 hours per week.
Permanent/long-term professional care (assistance)
About 550,000 persons in need receive specialised professional care in homes for the elderly or
in private clinics.
Relevant legal framework
The legal framework of this issue is set up by the Law on the mandatory health and sickness
insurance of 14/07/1994 ã. (Loi re lative à l’assurance obligatoire soins de sante et indemnites).

Basic principles
The financial help for invalidity as a type of social service involves current income-
based financing on the basis of preliminary contributions.
Scope of application
The eligible applicants for this type of financ ing include persons who have been employed and
are able to continue their employment and possess the status of “employee”.
Risks covered by this type of financing. Defini tion of “invalid”. Conditions for financing.
An employee who, as a result of sickness or handicap cannot produce more than
one-third of the average production by an empl oyee of the same category and with the same
qualification is considered as an invalid.
The Belgian social system sets up a minimal degr ee of incapacity to work equal to 66,66%. The
period of financing starts after the first day of the period of incapacity to work and continues
until the persons reach the retirement age. The shortest period of financing is six months. The
specific amounts to which a given person is entitled is determined on the basis of the previous
income of the person and his/her family status. The specific amounts are determined as follows:

• 65% of the lost income where the person incapable to work has dependants;
• 45% of the lost income where the person does not provide for other persons;
• 40% of the lost income where the person has an extra-marital co-habitant but does not
provide for him.
In certain particular cases the recipient of the fi nancial help who lives alone or in co-habitancy
but does not have to provide for the co-habitant may be entitled to 65% of his/her former

income if it is proved that he/she needs assistance from third persons in performing his/her
everyday life activities. The periodically provided amounts of social financial help for invalidity
(indemnite d’invalidite) reach BEF 3,772.05 (EUR 94). Where the users’ price index rises these
amounts are increased accordingly.
To summarise, the amount of the financial help is adapted to the standard of life by using a
fixed annual quotient or an annual fee on the sums provided.
Accumulation of the financial benefits for invalidity and other social benefits
The social benefits for invalidity may be increased by adding:
• a social pension for accident at work;
• a pension for professional disease.
In cases such as these the increase may go up to a certain limit as set up by the law. The
invalids are entitled to engage in paid professional activity during their temporary incapacity to
work. The assessment of the capacity to engage in such activity is done by a medical expert
from an insurance company. With this type of in crease the financial benefit must not exceed the
daily amount which would have been provided without the increase.
Taxes and social insurance contributions
The financial benefits provided to invalids are subject to taxation with a possibility
to reduce the tax burden. There is a correspondence between the reduction of the tax, on the
one hand, and on the other – the tax due by a beneficiary without taxable income and without
dependants. The family status is also considered. The taxable base is determined on the basis of
the net income and the family status. If the net income is not exceeded, the reduction of the tax
for social insurance contributions is unlimited and therefore these contributions are not taxed.
Social insurance contributions from pensions
It is possible that a law or other legislative ac t provide for contributions deducted from pensions
for invalids, to be used for various social activities (for example, the so-called “solidarity
contributions” (cotisation de solidarite). They can vary from 0 to 2 % on the pension.
Legal subjects active in the delivery of social and healthcare services:
• the state;
• the local authorities;
• charity organisations;
• commercial companies;
• religious societies.
The new generation of social services is de veloped on the basis of the principle of de-
institutionalisation, of collective and community work, as well as through involving the users of
the particular services in the activity of the organisations-providers.
The state plays a vital role in the regulation and control of social services. Such authority is

vested in general on the local authorities which remain the primary providers of social services.
They perform their activity locally and through Community welfare centers.
The legal framework is provided for by the Law on Public centers for social help of July 8, 1976
(Loi organique des centres publi cs d’aide sociale – 8 juillet 1976) . Under the provision of art.118
et seq., the centers for social help may form their associations.

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