partners

European Observatory on Health Systems and Policies

Belgium


Health Systems in Transition (HiT) profile of Belgium

5.9 Services for informal carers

There is no national strategy for the protection of informal caregivers in Belgium. However, an increasing number of services, including respite care, are available at a local level. More recently, planning of new alternatives for home care at a national level aim to take into account caregivers’ needs in terms of respite care, psychological support and training (BS–MB 2009b).

According to Belgium’s Civil Code, individuals are legally obliged to guarantee minimum living standards to close family members. Parents and their children are obliged to mutually support one another and this obligation extends down to grandchildren. This legal obligation also extends to the family-in-law (parents-in-law and sons and daughters-in-law), except in the case of a divorce or after the death of the partner when there are no children (Code civil du 21 mars 1804). However, there is no exact definition of the extent of these obligations. For instance, children are legally obliged to cover part of the cost for stays in a nursing home when their elderly parents do not have enough financial resources.

In order to appraise individuals’ involvement in the provision of informal care, specific questions on care activities were included in the 2001 Socioeconomic Survey of Belgium. The survey covered all residents living in the country for that year. Questions were focused on the caregiver. Information on the person receiving care is limited to whether the person is a family member (sharing or not sharing the same household), friend or neighbour (FPS Economy 2003).

In 2001, 9.3% of residents in Belgium aged 15 years or older provided informal care. Among the 719 686 individuals looking after an ill person, almost 60% were women. Among caregivers, 51% did not provide care on a daily basis and 49% looked after a sick family member or friend every day (30% spent less than 2 hours and 19% spent more than 2 hours per day) (Farfan-Portet et al. 2007).

Training and information for caregivers is mostly provided by non-profit-making organizations (addressed to specific populations) and no specific policies are coordinated at a central level. In the same way, there is no centralized policy to provide respite services for caregivers. Nevertheless, several short-term respite care services are available. Due to the Belgian federalized structure, services are available at different levels in each of the country’s regions. Moreover, services at a local level (communes) are also provided. Most services tackle specific groups, such as caregivers of dementia patients or parents of disabled children. Short-term respite care includes care at home, day-care centres and short-term residential care facilities. Financial participation of families varies from one institution to another, and in some cases, sickness funds reimburse a part of the total expenses. Information on services is increasingly available through the Internet.33

Income replacement directly related to the provision of informal care is not currently available in Belgium. However, individuals participating in the labour market are entitled to two types of paid leave to care for an ill person. Leave to care for a person in end of life is available to all individuals working full-time or part-time. Labour force participants are entitled to a full month of leave, renewable once (BS–MB 1995).

The second type of leave can be used to care for a household or family member with a serious illness (Congé pour maladie grave d’un membre du ménage ou de la famille). The leave can be taken for up to 12 months. However, it is restricted to a minimum of one month and a maximum of three consecutive months at any one time. For both types of leave, the worker can choose a part-time leave (for instance, one day per week for five months) and could receive up to €726.85 in 2009 (for a month of full-time leave) (BS–MB 1998).

Two more allowances can be used indirectly to pay for the services of informal caregivers. The Flemish community introduced the dependence allowance (Vlaamse Zorgverzekering) in 2001. A monthly sum (€130 per month in 2009) is granted to dependent individuals living in the community who receive informal or formal care. This sum can be used to cover the caregivers’ expenses such as travel costs (BS–MB 2001b).

People with disability, living in the community, can also receive the “Personal Assistance Budget (PAB)” (Persoonlijke-assistentiebudget, budget d’assistance personnel). The PAB was introduced first in Flanders and more recently in Wallonia; it consists of a fixed amount that is granted to a disabled person to employ a “home-helper”. The PAB cannot be used to pay for services from an informal caregiver except if a legal work contract is established between the disabled person and the carer. The annual amount of the PAB depends on the person’s disabilities and the help used. For 2009, the PAB in Wallonia varied from €5000 to €35 000 and in Flanders from €8845.4 and €41 278.30 (BS–MB 2001a; BS–MB 2009a).

Other allowances relating to disability are also available, but they are set up as payments for the disability. The income replacement allocation is attributed to a person aged 21–65 who is not able to fully participate in the labour market. In 2009, this allocation varied between €5809.20 to €11 618.40 per year. In addition to this, individuals who incur additional costs relating to their disability can receive the integration allocation. This allocation varies from €1061.30 to €9550.30 per year according to the level of disability and income. For individuals aged 65 years or more, the allocation for the elderly is attributed to individuals who suffer from disability or age-related illness leading to loss of autonomy. The amount of the allocation varies from €907 to €6087 per year (FPS Social Security 2009g).

Since 1 October 2015, self-employed people can benefit from an amount of €1092.36 per month for a maximal period of 6 months (renewable only one time) to take care of a family member. The term “family member” is also extended to the second degree, i.e. for a brother, sister, grandchildren, grandparents, etc. During this period, the payment of social contribution is suspended while the pension entitlement is still maintained.
For details, see: http://www.inasti.be/fr/news/une-allocation-pour-les-aidants-proches-ind%C3%A9pendants (French) / http://www.rsvz.be/nl/news/een-uitkering-bij-mantelzorg-door-zelfstandigen?_ga=1.108297856.387769648.1444982782 (Dutch)

The law of 12 May 2014 recognizes the status of informal caregivers and sets the conditions related to this status. This is a first step in the process of supporting informal caregivers. Measures to support them are now under discussions.
For details see: Law of 12 May 2014 see “Loi relative à la reconnaissance de l’aidant proche aidant une personne en situation de grande dépendance”/ “Wet betreffende de erkenning van de mantelzorger”