Welfare nursing care
The aim of the Health Insurance Fund is to improve the availability and quality of nursing care. Funding nursing services in general care homes also brings other health services closer to the person, as the nurse can monitor the health needs of the residents in a systematic way and address their health concerns in a more coordinated manner.
Residents of a general care home have the option of receiving nursing care on site. Nursing care in a care home is free of charge for the person, i.e. it will be paid for by the Health Insurance Fund.
The nurse assesses the health of the residents by monitoring vital signs such as body temperature, respiratory rate, blood pressure, and blood sugar. The nurse also performs urine and blood analyses and other necessary nursing procedures as needed. The nurse additionally helps to monitor and implement the treatment plan and the treatment procedures prescribed by the doctor. With the permission of the doctor, a nurse can independently treat a person with, for example, painkillers, administer medication, or remove sutures.
The nurse is also involved in counselling and disease prevention. For example, the nurse monitors for signs of mood disorders and dementia in care home residents.
The service is intended for people with mild or moderate health problems. This means that a nurse cannot solve serious
health problems or treat a seriously ill person.The costs of care services, medicinal products, and technical aids are borne by the person or their relative.
There are several ways in which care homes can provide this service. A care home with a home nursing activity licence can employ a nurse and provide the service, or it can work in partnership with a family physician or a health centre that provides nursing care in the home. The care home may also work with a home nursing service provider to provide nursing services in the care home.
In order for nursing services to be provided by care homes, the licensed health care provider (care home or nurse) must submit an application to the Health Insurance Fund and enter into a contract for the provision of health services.
The provision of nursing care is an option for care homes, not an obligation. We added all care homes providing nursing services to the Health Insurance Fund’s map application (in Estonian) in early 2020. Select the ‘Nursing care’ (Õendusabi) view and from there, in the ‘B services’ (B teenused) filter, select ‘Nursing care in a nursing home’ (Õendusteenus hooldekodus).
Care homes must ensure that their residents have access to health services. Pursuant to the Social Welfare Act, a care home must ensure that a care plan is drawn up, including an assessment of health service needs.
The nursing service provided in a care home is provided by the contractual partner of the Health Insurance Fund, i.e. the health care provider, who is responsible for the quality of the service and compliance with the conditions set out in the contract.
If a care home resident is unable to independently visit a health care provider, it is the responsibility of the owner of the care home to provide the necessary services, including transport to the doctor.
The care home must provide the care procedures and other support services specified in the care plan.
If the person is unable to buy personal aids, their family has to provide them. Technical aids are reimbursed by the Social Insurance Board (e.g. rollator, sheets to prevent bedsores) and medical devices by the Health Insurance Fund (e.g. bandages, urinary catheters, orthoses, glucometer test strips and lancets, etc.).
The discount of the Social Insurance Board is available for the purchase of aids if the person has been issued with a technical aid certificate and a personal technical aid card. You can find more information on this on the website of the Social Insurance Board.
The Health Insurance Fund reimburses medical devices that are included in the list of medical devices and for which a digital medical device card has been issued by the treating doctor for the purchase under preferential conditions. For more information on the reimbursement of medical devices by the Health Insurance Fund, see the website of the Health Insurance Fund.
The costs of care services, medicinal products, and technical aids are borne by the person or their relative performing the maintenance obligation. Close family members of the care home resident need to familiarise themselves with how services are organised in the care home (care services, health services, counselling, information, transport, etc.).
They must also monitor the health and well-being of the care home resident and inform the care worker, nurse, or doctor of any health problems.
The nurse will inform and advise them as necessary.
There are several similarities in the provision of different nursing services. Nurses working in care homes deal with persons who have a low or moderate need for health services compared to persons in independent in-person nursing care. In a care home, the nurse monitors the health of the residents on a regular basis. The home nursing service is visit-based, and a family nurse only makes a home visit on the order of the family physician (e.g. to take a blood sample).
Home nursing services cannot be provided at that time.
The Health Insurance Fund has set a minimum for the provision of the service, i.e. that the service is provided on working days and during the day. The provision of nursing care at other times is agreed between the care home and the nursing care provider.
There are a variety of software programmes, and each nursing service provider can choose the one that suits them best.
Not all nursing activities performed are recorded under the capitation fee codes. Under the capitation fee codes, the most important activities with indicative content are grouped together to provide the Health Insurance Fund with input for the further development of the service.
The provision of nursing care in general care homes funded by the Health Insurance Fund is an option. We recommend implementing nursing services in a general care home as soon as possible.
Yes – if the care home and the nursing care provider enter into a cooperation agreement and the family nurse does not provide nursing care in the care home during the time they should be working at the family physician’s practice. Therefore, a full-time family nurse working in a family physician’s practice cannot provide nursing services in a care home at the same time.
No. A home nursing service provider needs an activity licence, but it is not linked to the place of establishment.
The care home must provide the care procedures and other support services and procedures specified in the care plan.
If you become entitled to different dental care benefits during the calendar year, you will receive the benefit in the highest amount. For example, an insured adult who is also pregnant or the mother of a child under one year old is entitled to a benefit of 85 euros per calendar year.
All residents in the care home must be assessed using the assessment tool. A nursing plan must be drawn up for those residents for whom the assessment shows that health services are needed.
There is no fixed frequency: it is important to upload the final summary, but if it is a long case, intermediate summary should also be uploaded, in particular to keep the family physician informed about the health of their patient.
No. Only a doctor’s prescription/order/treatment regimen is required.
The nurse must be registered as a nurse/midwife with the National Register of Health Care Professionals of the Health Board.
The care home and the home nursing service provider agree on how the work is organised.
- The nurse in the care home registers the death and draws up a death notice in the IT program, which is then transmitted to the Health Information System. The nurse will then notify the family physician by telephone (within 24 hours).
- The family physician draws up a notice of cause of death and forwards it to the Health Information System.
After the cause of death has been established (by the family physician), a death certificate can be downloaded from the Health Information System and issued (by the care home) to the people close to the deceased so that they can take further action.
Please note! More information on this can be found on the website of the Health and Welfare Information Systems Centre.