The purpose of nursing care is to maintain and, where possible, improve patients’ state of health and ability to cope, to provide treatment and support to patients in a stable condition and, if necessary, to alleviate their ailments. Nursing care also helps people prepare for going to a care institution or home. Nursing care is provided both in inpatient (hospital or care institution) and outpatient (home nursing, home supportive care for cancer patients) environment, depending on the patient’s need.
Nursing care is not the same as nursing homes and care services, however, they do have overlapping areas, as people living in nursing homes often have health problems. More information on welfare services (nursing homes, etc.) is available at local governments.
A doctor decides whether a patient needs nursing care and provides a patient with a referral for the service.
A valid referral is required when referring a patient to an inpatient nursing care or home nursing care service. The information indicated in the referral must comply with the applicable conditions and procedure for documenting the provision of healthcare services and storage of these documents (read more here). Please note that nursing care can only be provided when the referring doctor has determined the treatment and necessary frequency for nursing care.
Nursing care in a hospital
Inpatient nursing care i.e. provision of nursing care in a hospital, is intended for a patient in a stable condition not needing continuous medical care, but who needs help and treatment procedures to the extent that exceeds the facilities of home nursing. A patient may need such assistance after a trauma or serious illness, or when a chronic condition worsens, but also to alleviate ailments caused by a serious illness. The family physician or medical specialist alone or together with a nurse decide whether a patient needs to be referred to a nursing hospital. The length of stay in a nursing hospital and the services provided depend on the patient's state of health and the need for nursing care.
Patient’s co-payment in inpatient nursing care
Inpatient nursing care patients covered by health insurance pay 15% and EHIF 85% of the per diem fees. In addition, the patient may be charged a bed-day fee of 25 euros for the first ten days of hospital stay.
In 2020, the patient's co-payment for one day of nursing care is 11.86 euros. In inpatient nursing care, similarly to specialized medical care, a bed-day fee for the first ten days of treatment applies. Thus, a bed-day fee of 25 euros (10 x 2.50 euros) is added to the amount for the first ten days.
Home nursing is intended for patients whose health condition does not require inpatient care, but who still need professional medical care. Home nursing may be necessary to a person with reduced mobility who is not able go to the doctor on their own. A home nurse is, therefore, also an important link between a family physician or attending physician and a person in need. A family physician or medical specialist decides whether a patient needs home nursing service. A referral is required, where the physician has to indicate the patient's health problems and treatment, and the nurse has to note any needs for nursing care. Home nursing, like all other outpatient nursing care services, is free of charge for insured persons. EHIF pays for these services.
Activities carried out during a home nurse visit include drawing up a nursing care plan, counseling and nursing the patient, performing treatment procedures and certain tests. All home nursing services are listed in Regulation No. 55 of the Minister of Social Affairs: List of independently provided nursing care services.
For example, during a home visit, a home nurse:
- gives advice - teaches how to use aids, instructs and teaches family members and offers diet advice;
- performs nursing procedures - prevents and treats bedsores and performs position treatment; measures blood pressure; installs a bladder catheter; maintains a permanent catheter; maintains and replaces a suprapubic catheter; maintains stomas; treats wounds and ulcers; maintains a tracheostomy tube; places and maintains a peripheral venous cannula; places a nasogastric tube; teaches tube feeding; performs inhalations and measures blood sugar with a glucometer;
- performs medical procedures based on a doctor's decision - removes wound sutures; performs oxygen therapy; administers medicines intramuscularly, intravenously, subcutaneously, orally or rectally; administers nutrient solutions; performs pain management; performs peritoneal dialysis and, if necessary, certain laboratory tests;
- provides symptomatic treatment and relieving treatment in cancer patients.
Nursing care in a nursing home
From 2020, EHIF finances nursing care services in general nursing homes. This provides nursing homes with an opportunity to provide free nursing care to their residents. Health care services provided in a general nursing home improve the availability of medical care and helps ensure that residents’ health is constantly monitored under the direction of a nurse and in case of health concerns the best solution is found in cooperation with a doctor.
What healthcare services does a nurse provide in a nursing home?
A nurse assesses residents’ health status, for example, measures body temperature, blood pressure, performs urine and blood tests, and other necessary nursing procedures. A nurse also helps to follow and implement the treatment plan prepared by the doctor for the patient. With a doctor's permission, a nurse may perform medical procedures on a patient, such as pain management, as well as prescribe medication or remove sutures. A nurse also provides counseling and takes care of disease prevention. For example, a nurse monitors for signs of mood disorders and dementia in nursing home residents.
A nurse co-operates with the resident’s relatives, informing and advising them, if necessary.
What is the responsibility of a resident’s family member?
Family members of a nursing home resident must be familiar with the organization of services in the nursing home (care services, healthcare services, counseling, information, transport, etc.).
The costs of care services, medicines and aids continue to be borne by the person or his/her relatives.
Resident’s family members also have to monitor his/her health status and well-being and inform a caregiver, nurse or attending physician of his/her health concerns.
Which nursing homes offer nursing care?
Provision of nursing care service is an option, not an obligation, for a general nursing home. We will add all general nursing homes offering nursing care services to the EHIF's map application at the beginning of 2020. From the map view, under services, select "Nursing care service in a nursing home".
Care service and nursing homes
You can get updated information about nursing homes near your place of residence from your local authority. You can always turn to the Social Insurance Board for advice.
A person is placed in a nursing home when he/she needs 24h care, i.e. he/she needs external help, guidance and supervision 24 hours a day. Usually there are waiting lists to nursing homes managed by local governments, and therefore, people who need exactly this service are given priority. The local government should assess a person's situation and find a suitable solution. In addition to nursing homes, the use of a personal assistant, for example, can also be considered. There are also several private nursing homes in Estonia where a person in need of care or their relatives can turn for inquiry. A home nurse or family physician can also help a person in a nursing home.
Nursing homes prepare an individual care plan for each person needing care, which identifies the type of need. Both the person’s relatives and local government must be involved in the preparation of the plan. The nursing plan is reviewed at least once a year.
If a person or their relatives are not able to pay for the place in the nursing home, local government will provide financial support to pay for the place. On average, a person pays 480 euros for a place in nursing home per month, and local government pays 150 euros. Each local government, in cooperation with the family, must find a reasonable and affordable solution so that the availability of assistance does not depend on the family's income.