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D. Independent living
D1. Choice of living arrangements
In Belgium forced admission into an institution is set by law and is only possible for mentally ill persons who are a danger to themselves or others and refuse treatment. There is no law that obligates persons with a disability to live in an institution, but neither is there a law about the legal right to live independently in the community. The decentralised governments are aware of the importance for persons with a disability to live independently and to participate at all facets of life on an equal basis with others. This aspect is still subject to improvement e.g. there are several measures being taken for the reduction of long waiting lists concerning access to services. The Communities have taken several measures on the subject of support schemes concerning independent living, next to a serious set of home care services. For example in Flanders the Flemish Agency for Persons with a Disability (VAPH) offers a Personal Assistance Budget (PAB). Thanks to assistance in daily activities, persons with a disability can live independently. On 1 January 2011 there were 1,808 persons with a PAB. The VAPH further foresees a contribution to persons with a disability who want to adapt their home. The level of this contribution depends on the type and level of the disability. Because the VAPH wants to broaden their supply of services to support independent living for persons with a disability, they approved of the plan 'Perspective 2020' in 2011. They want better rights for the persons with a disability and more power of decision wherein a fundamental option for personal budgets is proposed. In this context, the PAB is replaced (since 1 January 2017) by a Person Following Finance (PVF) divided into a basis support budget for every person with a disability and a person following budget for those for whom the basis support budget is not enough to cover the costs. The Walloon government has also recently started to provide personal assistance budgets (budget d’assistance personnelle or BAP) for persons with disability. The conditions of attribution are set in the Decision by the Walloon Government of 14 May 2009. It should give the persons with disability the chance to live in their personal environment, organise their daily life and improve their family, social or professional integration. In October 2011 there were 115 persons with a disability using the BAP.
The government in Belgium is aware of the fact that it is important for persons with disability , to live independently and to participate in all aspects of life on an equal basis with other citizens. Concerning the support scheme of independent living, the communities have taken some important measures. In Flanders, many ambulatory services provide support to persons with disabilities living at home, such as: psychosocial support, aid with daily living activities, financial management, etc. Apart from these care services, independent living of person with disabilities can also be supported by such aids as technological instruments and adjustments in the house. The Flemish Agency for Persons with Disabilities (VAPH) offered a Personal Assistance Budget (PAB). Since 1 January 2017, this is replaced by the Person Following Finance (PVF). This is a personal budget that can be used to ‘buy’ support within your own network, volunteers, professional care, institutions, etc. This support can be used for household, during daily activities or during the night. This is part of the 'Perspective Plan 2020' which stands for more 'person-centred care' and 'community care'. The Walloon Region authorises and subsidises assistance services provided by a team of professionals to persons with disabilities and also foresees a Personal Assistance Budget to help a person with disability to stay longer in his/her environment.
Throughout different Belgian regions we see that the motto “regular when possible, special when needed” is promoted as a support model for persons with disability. 'Regular' services such as home keeping services, home nursing, and informal help from within the informal network such as family, friends, neighbours are to be installed first, before persons with disabilities can apply for disability-specific care. In Flanders, a specific organisation, subsidised by VAPH, exists to map out together with persons with disabilities and their close network (free of charge), how different services can be activated to accomplish a personal support plan.
In respect to housing for persons with disability, we see social housing with the option being either small housing projects co-funded by groups of parents or housing projects set up by larger institutions.
D3. Quality of social services
There are a number of different initiatives of the decentralised governments on the level of independent institutions that establish the protection of the integrity of persons with disabilities. The Decision of the Flemish government as of 15 December 2000 concerning the quality of care in institutions for social inclusion of persons with disabilities gives a list of quality criteria that the institutions must respect.
The Decree of the Flemish Community as of 17 October 2003 concerning the quality of health and social care organisations states that every health and care institution has to deliver adequate care. This means that care delivery needs to be efficient, continuous, socially acceptable and user-friendly. Quality management needs to be part of the management of the care organisation. Every organisation needs to install a quality management system, carry out an annual self-evaluation and deliver the results to the Flemish authorities.
An intern agency was established in response to the Decision of the Flemish Government (as of 26 March 2004). The Agency is called ‘Care inspection’ and is responsible for checking the quality and support in care institutions. As of 1 January 2019, a ‘monitoring decree’ was put in place. This decree sets out clear rules for inspectors within the policy domains: welfare, public health and family, and outlines what has to be inspected in these domains.
The Walloon Agency for the Integration of Persons with Disability (AVIQ) can take measures in relation to authorised and subsidised agencies for persons with disabilities. Once a year, the Walloon Government does a 'Walloon Advisory of the social action and Health' concerning the complaints they receive.
In 2017, a new plan by the Minister of Welfare, Public Health and Family Jo Vandeurzen was put forward. The concept ‘An integrated care in primary health care’ proposed by the Minister Jo Vandeurzen was approved by the Flemish Government on 17 February 2017. This concept outlines the reformation of the primary health care in Flanders and aims to provide more accessible quality care.
D4. Provision of assistive devices at home
In Flanders, persons with disability can count on the care provision and finances of the Flemish Agency for Persons with Disability (VAPH) until the age of 65. In the Walloon region, these people can count on the care provision and financial support of the Walloon Agency AVIQ (Agency for the Quality Life; formerly known as AWIPH). They can appeal on several services that support them in their ADL and IADL activities of ambulatory basis in their own environment as mentioned above. Besides these services, technical devices and home adjustments can also be provided as additional supports to persons with disabilities. Among these can be, for example, a telecom emergency system, the installation of a stairway elevator, a wheelchair and so on.
In Flanders and the Brussels capital region, persons with disabilities can get a support plan with the help of the Department of Welfare, Public Health and Family. The ‘support plan service’ will provide help in search of assistance.
D5. Availability of personal assistance schemes
In Flanders and in the Walloon Region Persons with a Disability can take up a Personal Assistance Budget (PAB) to put together a care package to live as independently as possible with support in their ADL and IADL activities. Because the VAPH (Flanders) wants to broaden their services supply to support independent living for persons with disabilities, they approved of the plan 'Perspective 2020' in 2011. They want better rights for persons with disabilities and more decision power wherein a fundamental option for personal budgets is proposed. In this context, since 1 January 2017, the PAB is replaced by a Person Following Finance (PVF) divided into a 'basis support budget' for each person with a disability and a 'personal additional budget' for those for whom the basis support budget is not enough to cover the costs:
- Level 1: BOB = basic support budget: This is a budget of EUR 300 per month.
- Level 2: PVB = personal additional budget: This is an extra budget, depending on the person’s support needs, when the budget of EUR 300 is not sufficient to pay for the care needed. This budget is allocated to the person when the person makes use of the care provided by VAPH institutions.
This cash for care is an alternative form of in-kind care. This is a step to a more independent life and greater social integration. This cash for care provides care to persons with disabilities with needs such as: getting dressed, cooking, eating, cleaning up, doing groceries, transportation and remedial support.
D6. Income maintenance
The Income Replacement Allowance is intended for persons who are not able to participate in the regular labour market and therefore have a loss of at least one third of their earning capacity in comparison with a non-disabled person in the labour market. The calculation of this allowance is means-tested on a household level and the person needs to be at an active labour age (21-65 years old) and be a resident of Belgium.
D7. Additional costs
The federal government provides, as well as income allowance, an Integration Allowance that covers the additional costs of living independently. An Integration Allowance is meant for improving the daily life of persons with disabilities, because it often involves making costly arrangements: a motorised wheelchair, ergonomically design kitchen utensils, special bathroom equipment, etc. are just a few examples of this.
This allowance is means tested on a household level. The person with disability needs to be between 21 and 65 years of age and an actual resident of Belgium. This allowance can also be granted after 65 years of age, but only when the person with disability has already received this allowance before the age of 65. After 65 years of age, persons with disabilities may apply to the cash system of the Allowance for Care to Elderly Persons following a medical assessment that determines the severity of their care needs. Eligibility for the allowance is means-tested, and the amount of the benefit depends on the severity of the care needs and on the financial situation of the applicant, taking into account the current income, financial and non-financial assets. At the regional level, only Flanders, more specifically the Flemish care Insurance, provides an Additional Allowance. This is a separate long‐term care insurance scheme that pays a monthly allowance to persons who score at least 35 points on the BEL scale or who can prove their need for care by other means. The monthly allowance, which used to differ between home care and residential care recipients, is not means‐tested. There is no age limit, but eligibility is restricted to Flemish residents and the co-paying residents of the Brussels Capital Region.
D8. Retirement income
For people with disability in Belgium the ‘Income replacement allowance’ is the main income. This allowance is intended for persons who have never been able to participate in the mainstream labour market and who have a loss of at least one third of their earning capacity in comparison with a non-disabled person in the labour market. These persons receive an Income Replacement Allowance during their active age, until the age of 65.
After the age of 65, a general measure is set up by The Public Service for Retirement. This is an additional retirement income for the elderly, including the elderly with disabilities. This Guaranteed Income for the Elderly (IGO) is an extra financial help to elderly persons. The Public Service for Retirement automatically checks if an elderly person can appeal for such financial help, e.g. at the time of application for a retirement income.
Specifically for the elderly with a need of care, the Flemish social protection provides an additional ‘care budget’. There are five categories in which a person can be classified in order to decide on the budget. This classification depends on the self-management of the person.