18 december 2012

Meeting on improving the quality of life of the elderly

Transcript of the beginning of the meeting:

Dmitry Medvedev: Ladies and gentlemen, we have met in St. Petersburg but the subject of our meeting concerns the entire country. Today I’d like us to discuss problems facing elderly people.

Let me recall that practically every fifth person in this country is advanced in years. There are tens of millions of them and their life must be a normal and decent human life, if you will. Their life largely depends on us, the Government, but not only it.

In the last few years we have been trying to improve the quality of life of the elderly in this country. I’m referring to social services, medical assistance and provision with medications, including essential ones. Prices of these medications do not grow quickly – about 3.5% per year. They are different in different regions but this is the national average and it stands below the rate of inflation. This is still an important change.

In 2012, 200,000 people over the age of 56 received high-tech medical aid. The total number of complex operations, including joint replacements with endoprosthesis, has grown. This number has grown considerably: 12,000 such operations were carried out in 2009; 31,000 in 2012. These operations improve the mobility and, most importantly, the independence of elderly people. They are able to work, to help their relatives, children and grandchildren.

Relevant regional programmes are being carried out in Russian regions. They improve the quality of life of the elderly. Representatives of regions are present here. Let them brief us on the successes of these programmes, on what is interesting and new. I’ve just visited a nursing home. I know that such homes are not found everywhere, in all regions, but this is good experience. I’ve just spoken to Mr Poltavchenko, the St Petersburg Governor, and he says they are going to erect up to 50 such homes, is that right?  

Georgy Poltavchenko: Yes.

Dmitry Medvedev: Yes, this is a large construction project. Why do I mention this? Because this is also good experience. The people residing in such homes are primarily lonely people without relatives or with relatives who live far away. But these elderly people live in normal conditions with normal services. I say it because such situation is rather rare, and there are problems concerned with the transfer of property – the minister told me about it, there are problems with conducting all these operations. However, this experience is interesting.

There are a lot of sensitive problems: people write to the Government and to the United Russia bodies. The main problems include hospitalisation, healthcare and sanatorium and resort treatment, and jobs for those who are still capable of working.

It is obvious that we need a whole range of measures helping to create a modern and efficient system of social support, social services. These are the goals of the state programme Social Support, which was approved by the Russian Government on November 29.

What are the concrete tasks? I’ll name them. The first task, which is very important in this country – there is a considerable gap in access to healthcare among the various regions. St Petersburg has one level of access, Siberia has a different level, and the Far East has another level, but our people live everywhere, and these are middle-aged and old people. Therefore, we have to introduce various forms of healthcare that are most suitable for a specific area with respect to lonely and sick people. I mean homecare, sitter services and mobile medical complexes. I have seen many such complexes, they are especially needed in rural areas, in distant provinces where healthcare is more complicated for understandable reasons.    

Second – the development of new forms of social services. And I hope that this will finally make it possible to eliminate the waiting list for servicing elderly people. Since 2006, this waiting list has reduced by over 7 times; yet the waiting list is still considerable. According to my data, it includes more than 35,000 people waiting for hospital services and home care in roughly equal proportions.

Third, social services institutions include a proportion of just over 1% of non-state institutions. Of course, the state will have to continue to perform a considerable amount of this work; the state cannot entrust this work to anybody else for understandable reasons. On the other hand, public-private partnerships, including with youth volunteer groups, businesses, charitable organisations, is the proper way to do this work, and we should become more active in this area. In addition, we have special budget funds earmarked for this. There is a special programme entitled Making State Support for Socially-Oriented Non-Profit Organisations More Effective. It has received good funding – 1.5 billion roubles for 2013.

Fourth, currently in Russia there are 10 million employees who are above the working age and, in addition, more than 300,000 pensioners who wish to work. We often hear about the coming workforce shortage, but as a rule elderly people are skilled and can be useful to their country, to their town or village, to themselves, to their relatives, because when an individual works, he has an active life. This is a personal issue, everyone must decide for themselves, but on the whole this is the right solution; it is necessary to extend professional longevity, including in apprenticeship programmes, in the system of vocational education and at enterprises.   

Practically 15% of people of preretirement and retirement age want to acquire vocational education, or improve their skills, or acquire new skills. Once I visited the House of Veterans and saw some veterans learning how to use a computer, which is a good thing. Mr Poltavchenko, I see you are nodding, as you should be. It will be necessary to create computer classrooms in all 18 veteran councils in the city. The cost is not high – my colleagues say it will cost about 1 million roubles; but this will help our dear veterans and the older generation to learn the values of civilisation. Sometimes computers help; and they also help people speak with relatives or write a letter – which is also a good thing to do. 

Among the people wishing to improve their skills, 70% have secondary or higher education. They are well trained and definitely deserve better prospects than a job as a concierge or a security guard at a car park.

We have many examples of people living an active and productive life even at a very advanced age. Tourism (as far as it is possible) and cultural leisure should not only prolong lifespan but make these years meaningful. Such examples should become routine rather than a lucky exception. This is the task not only for the state but for all of society, because obviously the responsibility of every human being extends beyond his or her children but also to the older generation. This is how society is arranged and this is normal. I hope that the governors of the regions will be guided by these principles.

I have tentatively outlined a range of issues. I will be happy to hear other proposals on improving the quality of life of the elderly people. Let’s listen to some brief remarks by the Minister of Labour and the Minister of Healthcare. Mr Topilin, (Maxim Topilin, Minister of Labour and Social Security) let’s start with you.

Maxim Topilin: I will briefly discuss the problems that are being addressed by the Ministry of Labour along with relevant non-profit organisations. I would like to start by giving you a quick overview of the demographic situation in Russia. Today, we have 32 million people aged 60 and over in Russia, which is indicative of the importance of the problem and also of  the need to improve elder care in our country. However, we should be mindful that ten years from now this age group will grow by another 7-8 million people to a total of nearly 40 million. Thus, developing elder care infrastructure is important, all the more so since one of our goals in to increase life expectancy in Russia. Today, it stands at 70.3 years and is expected to reach 74 years by 2018. Compared to developed Western countries, life expectancy in Russia is not so high. In Switzerland, it’s 82 years; in Italy also 82; and in France and Sweden it’s 81 years. In other words, we have room for improvement.

I would like to say a few words about what we are doing in terms of financial support for older people. First, we are working to improve the pension legislation. We keep adjusting pensions in accordance with the documents issued by the Government. Today, the average pension to subsistence level ratio stands at about 180%, whereas by 2030 this ratio will stand at 2.5-3(times) as projected by the draft strategy of the pension reform. Annual adjustments of pensions are a real way to increase pensions, and we will continue this policy.

The Government has drafted and the President signed a new law on the consumer basket that revises approaches to consumer basket calculations. It is very important that we focus on pensioners in our calculations. The subsistence level for this category of citizens will increase by 8-9% through changes in the structure of the consumer basket alone. We will focus on the variety of foods included in the consumer basket (this list was significantly underrepresented previously), and this alone will increase retirement benefits by 15% in 2014. Through the structure alone it will increase by this figure, as well as by the consumer price index.

Mr Medvedev, you mentioned employment issues in your remarks. Pursuant to the decisions made by the State Council, afterthey considered and discussed this issue, we have put together special amendments to the Law on Employment and the Administrative Code. Yesterday, the ministry submitted these amendments approved by all ministries and departments to the Government. Here’s what these amendments are all about. Under the current legislation, a person can be considered unemployed only if he or she is under 60 or 55, respectively, meaning that people of retirement age cannot be officially considered as unemployed. Therefore, we have authorised regions and employment services to retrain employees over 60 years of age. As of now, this right is non-existent, and even if the regions are willing to do so, they have no funds available for such purposes. This law will entitle the regions to provide such support and organise training for people of retirement age.

We all know that our society and job seekers resent seeing age restrictions in jobs ads, so the bill bans such restrictions. We understand that this will not resolve the unemployment problem in its entirety, but such a ban would give a signal to prospective employers that people over 45 years of age are as employable as younger people.

Dmitry Medvedev: Yes, that’d be the right thing to do, because such restrictions look unseemly in moral terms. This does not mean that we’ll put a gun to an employer’s head and make him hire a person of retirement age even though he needs a young and healthy employee in his line of work. However, lifting this requirement will remove some pressure from the jobs market.

Maxim Topilin: Yes, we understand how things will play out in real life, but we still believe that this is the right thing to do. The Code of Administrative Offences will provide appropriate sanctions for placing ads with age restrictions.

We also continue to support regional mentoring programmes, related to a critical situation in labour market, I mean programmes that stipulates mentoring, tutelage which you also mentioned. I hope that this bill will be quickly considered and adopted by the State Duma. We will make sure it does.

With regard to strengthening the material and technical base, we continue to develop stationary services and provide regions and regional social services with social transport as part of regional programmes to support Russian regions (1 billion roubles go to these programmes each year). Over the past year, these services received 600 vehicles, and this programme will continue. It was decided to allocate 350 million roubles from the Presidential Reserve Fund. A corresponding directive was signed quite recently and 38 regions will receive an additional funding in the amount of 350 million roubles for the needs of 80 stationary social services institutions.

We continue to implement the Accessible Environment programme and we believe that it’s very important not only for people with disabilities but also for the elderly. It's all about convenience: special easy-to-use transport, handles and ramps.

I would like to focus briefly on two points. You spoke about involving public organisations in work with non-profit organisations during the service provision process. We are now working closely with the Ministry of Finance on transitioning to regulatory per capita funding. We are working on the assignments, and I think we soon be able to resolve this problem. We are almost ready to submit a draft law on basic social services to the Government. It was thoroughly discussed with non-profit organisations, and I believe that this bill will lay the foundation for the regions to be able to make such decisions legitimately. Regulatory per capita funding (we do have experience with this) is all about spending the money on specific purposes, which also includes private nursing homes, which should also receive a significant boost.

Here’s my final point, if I may. We have already begun preparations for the 70th anniversary of victory in the Great Patriotic War. I believe that we should already start thinking about social support measures to be provided to veterans in two years. I would like to have it included in the minutes that in conjunction with the Ministry of Finance we have already begun working on this issue. The previous amount of the allowance was just 5,000 roubles. I believe we can provide a more substantial financial allowance to veterans on the 70th anniversary of victory. Thank you.

Dmitry Medvedev: Thank you. Over to you, Ms Skvortsova (Veronika Skvortsova, Minister of Healthcare). Please update us on health care for the elderly.

Veronika Skvortsova:  Thank you. Mr Medvedev, colleagues, with increases in life expectancy across the world, including Russia, the trend of a growing number of elderly people is clearly underway. There is a parallel trend resulting in a greater numbers of active, experienced and skilled workers  among them who can become the main drivers of economic and social growth and development in our country. Hence, two main objectives of heath care: first, medical support of active longevity and, second, slowing down and overcoming certain age-related ailments, such cardiovascular diseases, musculoskeletal disorders,  senile diabetes and neurodegenerative diseases, to name a few.

We are focusing on early detection of diseases and their possible treatment. Please note that beginning in 2013 we are resuming medical exams for all adults from 21 years of age and up. The exams will be held once every three years and will include a visit to several specialists, including a neurologist, an ophthalmologist, a gynaecologist, an urologist, and other specialists, as well as a wide range of lab, instrumental and functional tests. In 2013, about 30 million adults will take their physical exams, including over 6 million people over the age of 60. Physicals help identify risk groups: 72% of people over 60 have some kind of a chronic disease and more than 17 million people see their doctor regularly for particular conditions.

The quality and availability of a primary health care facility within a walking distance is important for the elderly, so we focus on this particularly by expanding the network of outpatient care in urban areas and developing the network and non-cutting the number of its various health care institutions in rural areas.

Over the past two years, we have re-opened many rural health posts. Today, we have 39,810 of them and 3,741 general practice centres.

Dmitry Medvedev: How many rural health posts?

Veronika Skvortsova: 39,810.

Dmitry Medvedev: How many did we have before? Is their number growing or declining?

Veronika Skvortsova: Growing by over 200.

Dmitry Medvedev: Per year?

Veronika Skvortsova: That’s the increase over the past two years, in the process of modernisation. We have standard projects for new modular health posts in several regions that are comfortable and modern, so we will replicate them across all Russian regions. Wherever possible, we substitute general practice centres for rural health posts, of which we have 3,741 and 4,441 rural ambulatories.

Notably, we are also organising in-house hospitals. To date, we have organised 232,414 hospital beds and created 7,044 home-based first-aid facilities and trained their personnel accordingly.

We are also actively using field medical teams to provide medical care in remote areas.

In 2012 we formed 6,600 mobile medical teams and purchased more than 700 units of special mobile medical equipment, including mobile health centres, mobile outpatient clinics, medical and obstetric stations, fluorography and mammography machines, to name a few. In 2013 the regions will buy an additional 235 mobile medical centres to cover the majority of people with an annual physical exam. Some regions have a positive experience in transporting older people in rural areas to healthcare facilities and back on medical buses.

The general disease rate for people over 60 exceeds 66 million cases a year. There are 208,000 diseases for 100,000 people over 60. Correspondingly, 28.7% of all inpatients are older people. For the most part, medical assistance is rendered in general hospitals but we have added an additional 1,390 geriatric beds. The need for them is obvious because age-related, physiological and disease-related characteristics and the peculiarities of pharmacokinetics and pharmacodynamics are becoming increasingly known. It is necessary to adjust 

medical therapy to the needs of the ageing population. In effect, gerontology provides us with a methodological basis for considering the requirements of older patients in rendering different types of medical aid.

As Mr Medvedev said in his opening address, the percent of high-tech medical aid for the elderly has increased substantially – by 44.4% this year. This is linked with an increase in the quality of this aid and reduction in the risk of failure. It is also linked with an increase in the percent of high-tech medical aid rendered by the regions. In one year it went up 3.2 times. In 2012 alone, 62,100 patients over 60 received medical aid in regional rather than federal institutions.

I’d like to note that the percent of high-tech aid has increased considerably in the medical disciplines that are most in demand – twice in ophthalmology (mostly cataract and glaucoma) and 1.5 times in the treatment of various cardio-vascular diseases.  In addition, the percent of prosthetics for locomotor patients has increased by 34%. This applies to the surgery procedures mentioned by Mr Medvedev.

The number of operations for people over 81 years has doubled. This is a very good figure that points to two achievements. The first is the high level of professionalism among physicians, including anesthetists who provide such complicated procedures for those at advanced age. The second one shows that access to high-tech medical aid has become much easier.

We are paying special attention to the veterans of the Great Patriotic War. Today we have 63 hospitals with a total of 16,800 beds for them in 56 regions. In 2011 314.600 people underwent medical treatment there. I would like to emphasise that we are maintaining these hospitals for the veterans of the Great Patriotic War in good condition – by the 65th anniversary of the victory in the war they were thoroughly repaired and fitted with modern equipment. We are monitoring their supply with medicines.

Another important effort in our work is the rendering of palliative assistance to patients that cannot accept more radical treatment. For the first time we included the notion of palliative aid in the law on the foundations of healthcare at the end of 2011. We covered the assistance rendered in healthcare facilities with the programme of state guarantees for no-cost medical aid. At present we have about 2,000 palliative beds, or 1,952 to be exact. We are planning to increase that number almost 10 times in the next few years.

Concurrently, we are developing a network of beds for nursing care. Today we have more than 21,000 such beds.

To be able to provide assistance to the elderly, you definitely have to have a medical education that allows doctors who practice different specialities to take effective care of elderly people. We hope that the development of gerontology, which studies the diseases of the elderly, will be bolstered in the near future. There are three mechanisms for training geriatricians: two-year internships, four-month retraining courses and advanced training courses.

In 2012 alone, over 1,000 doctors from all of the country’s 83 regions completed advanced training in gerontology. At the same time, the focus is on training methodologists, gerontologists and geriatricians. Currently, there are only 147 such specialists in Russia. These professionals help different medical specialists to receive advanced training in gerontology, and hence the Ministry will focus on this project. We have upgraded the system of training specialists in gerontology, and I can tell you that a decision has been taken to introduce the post of chief nonorganic geriatrician, who will effectively head a group of experts coordinating this work in the country.

A few words on the provision of subsidised and free medicines. Mr Medvedev, I’d like to say that 55% of the federal recipients of free medications are over 60 years of age. In 2012, we allocated nearly 19 billion roubles to purchase medicines for these people. The average annual cost of prescriptions is about 600 roubles. There are also 15 million recipients of regional benefits, including 4.6 million people who are over 60. Regional budget allocations for free prescriptions reached 23.5 billion roubles; the average annual cost of prescriptions in the regions was 750 roubles. Moreover, the number of people over 60 with expensive to treat conditions who receive free prescriptions has increased to 27,000, 30% of the total; allocations for this group came to 7.3 billion roubles in 2012, and the average annual cost per person was 75,600 roubles. In short, the work is continuing and the plans for 2013 are expanding.

A package of special measures has been taken to increase the availability of medications. Towards this end, small pharmacies have been set up at 3,599 community health centres to issue medicines to local residents. We have also extended the period of prescriptions to three months, which cuts down the number of visits needed to the doctor in order to receive prescriptions. We have also introduced a service which allows people to order medicines by phone or email, established social dispensaries and are offering pharmaceutical discounts to elderly people. Working together with the social services, we have devised a system of delivering medicines to the homes of elderly people. We have created a system for compiling lists of people who need this service, which includes making rounds of residential blocks and asking the opinion of older people during the provision of in-home support services and visits by ambulance teams, as well as polling elderly people, including those who live in residential care homes.

Efforts are also being made to inform people about the possibilities of subsidised and free prescriptions.

Apart from our routine everyday work, a subprogramme of the Healthcare Development programme is focussing on the development of medical science, including gerontology. I’d like to say in conclusion that there are plans to implement big, comprehensive research programmes starting in 2013. They include the development of comprehensive programmes for an active old age, early genetic screening, a database of people who are likely to suffer from age-related diseases, and promoting regenerative medicine, cell and tissue therapy, for restoring functions affected by disease. We hope very much that this customised, predictive approach will enable us to make a research contribution to promoting a more active old age. Thank you.

Dmitry Medvedev: Thank you.


* * *

Dmitry Medvedev’s closing remarks:

Thank you very much. In my opening remarks, I spoke about the exceptional importance of creating public-private partnerships to address the problems of our middle-aged and elderly citizens. Both sound well, but I think we should try to avoid the game of hyper-political correctness, which some friendly states love to play. It does not matter much what we call these people.

Anyway, judging by the data at hand, private companies account for only 1% of the total number of social care establishments. But judging by our discussion today, these non-state companies, these volunteer and non-profit organisations are the most active in raising the issue. This is good, because it shows that the system is gradually changing and that it will never be as completely state-backed as it was during the Soviet era, for understandable reasons.

Frankly, the system was not very good even during the Soviet period. Older people – our middle-aged and elderly citizens – know how it was, and all of us have been to these establishments to visit our relatives or friends. So we must think about the future. I will certainly issue instructions – I have a list of proposals here. I believe that the idea which one of the speakers put forward here – to set up a group to assess the legislation in this field – is absolutely correct. We need to create this group, to update our legislation and to think about new support methods, new trends, as well as the state system as a whole, because the state system will shoulder the biggest burden for a long time to come, for a very long time.

And lastly, I’d like to thank all of you for attending this event and to express the hope that you will remain involved. I am grateful to our elderly citizens who welcomed us today in their residential care home, grateful for everything they do, for their work and their energy. When I look at you, I understand how one should live. Good-bye.

More Information