Care Homes for the Elderly Are Forgotten in Local Priorities

New streets, roads, kindergartens, parks… This is what mayors’ announcements usually look like, especially before elections. But in these announcements no one has ever promised care homes for the elderly. Data show that around 1,000 older people are cared for in public institutions in the country – 650 of them in care homes and the rest in pensioners’ homes. The Ministry of Social Policy, Demography and Youth admits that there are waiting lists in both public and private institutions, but not how many people are on them. If we go by the World Bank report, as a country we face the challenge of dealing with an ageing population. The question is: what are we doing about it?

Macedonia faces new local elections this year. The promises have already begun. The Government has invited municipalities to submit projects to be financed from the Hungarian loan. The projects received are currently being reviewed, after which it will be decided who will build what – and we will see whether any mayor has included a care home. In the past period, Kochani municipality applied to the Ministry of Social Policy to build a residential home for older people, while Kumanovo municipality applied to reconstruct its existing care home.

It looks like a real building ready to move into, but this is only a scale model and an unfulfilled wish of Kochani’s pensioners for almost a decade and a half, since they paid almost 30,000 euros for the design.

“The home is designed for 157 pensioners from the towns in our region: Kochani, Vinica, Berovo, Delchevo, Kamenica and Pehchevo. This is the site the pensioners’ association has, approved and given by the municipality… The home was supposed to be here, with a park for pensioners to rest and get fresh air, a car park and play areas intended exclusively for this group of citizens. Every year everyone makes promises – the pre-election marketing starts here. We as a pensioners’ association are not giving up; we have hope and we are going all the way,” explains Elica Zafirova, president of the Pensioners’ Association in Kochani.

Three years ago, the authorities asked the pensioners to cut the capacity by a third, to only 50 beds. No one is doing anything, and older citizens are living very hard lives, Elica says.

“In recent years young people have moved away from this area; only old people are left, and many are immobile, need care and need a home like this. They look for a place in other homes around the country, but it’s very hard there too,” she adds.

A hope ten years old

The story of Shtip’s pensioners is similar to that of their neighbours in Kochani. Last year, after 10 years of waiting, hope returned that Shtip would get a care home.

“I wouldn’t comment on the reasons why the building was improperly built about ten years ago, or why it did not have proper building approval. Our priority is to make it possible for the building to acquire use value and an occupancy permit in the future, and for what has practically been built to be put into use and into operation, because the pensioners’ money was spent and the building has been standing like this for more than 10 years. I believe a solution will be found; the project is in government procedure, at a Government session… Additional investment is also needed to fit out the interior and for technical acceptance so that the pensioners can use it,” says the Mayor of Shtip, Ivan Jordanov.

Until some hundred pensioners get the chance to be cared for in the Shtip home, the only real, habitable home in this region is the one in Berovo.

86-year-old Nada Dakikj has been in the home for four years. She has no one close to look after her.

“I’m completely alone. It’s very nice here. Sometimes we play cards, sometimes Ludo, board games; we go upstairs to exercise and draw,” says Nada Dakikj.

Besides Nada, many other pensioners have found their home here. In almost a decade, this home has increased its number of beds by 50.

“The municipal public institution for the care of older people ‘Dr Jovan Vlashki’ in Berovo was established by the Council of Berovo Municipality, which is its founder. At the moment 39 people are cared for, and with the new 28 the number is higher. The competence is municipal; part of the funding comes from Berovo municipality’s budget and part through transfers from higher levels of government as a block grant for social protection. In 2017 the home had only 15 beds, and 14 were in the first phase of construction. Today the home is an impressive institution, the only one at local level that justifies the funds invested,” the Mayor of Berovo, Zvonko Pekevski, told us.

Besides Berovo, there are public institutions for older people in 4 other cities across the country: Skopje, Kumanovo, Prilep and Bitola. They house 650 senior citizens.

Besides public institutions, accommodation for older people is also provided by 44 private homes. But their services cost 30,000 denars or more.

Not enough places in pensioners’ homes either

Besides public institutions for older people, Macedonia has 14 pensioners’ homes with 380 flats in 11 municipalities, housing more than 400 people.

Pensioners’ homes are residential units only for housing pensioners and fall under the Pension and Disability Insurance Fund of Macedonia and the pensioners’ associations. They house only pensioners who have housing problems, while they meet their other needs independently. There are about forty people on the waiting list for a place in these homes.

Stanka Trajkova says there is not enough accommodation capacity, and the services, assistance and home care on offer are inconsistent.

“We promote social services, but we don’t know who finances them, whether the person will contribute with their own money, whether there will be a difference between higher and lower pensions, whether the state will contribute, whether a pensioner will be able to choose only certain services that they need… there is a whole range of questions that need to be settled. Information is a very important factor,” says Stanka Trajkova, president of the Union of Pensioners’ Associations of Macedonia.

Tackling the challenges of an ageing society requires a service delivery model that improves the efficiency of public spending and expands access to high-quality health services, including long-term care, the World Bank report states. The Ministry of Social Policy, Demography and Youth replies that it continuously develops policies aimed at supporting older people where they live, to prevent their institutionalisation. Every year the number of licensed service providers grows, as does funding from the Ministry. Municipalities also had the opportunity to take part with projects implemented with World Bank support for home and community services for older people.

The Association of Units of Local Self-Government (ZELS) says municipalities are aware of the needs of senior citizens, but that huge funds are needed which they do not have, and that they are not responsible for such capital investments. Back in September 2023, at the Commission for Monitoring the Development of the Financing System of Local Self-Government Units, ZELS representatives launched an initiative for an urgent debate on the shortage of care homes for the elderly – pointing out that not a single municipality has built a new facility of this kind, that the old ones are in poor condition and that there is a shortage of staff.

This content was produced by the Institute of Communication Studies.

Journalist: Natasha Janchikj Menkovski

Camera: Sladjan Miloshevski

Editing: David Miloshevski

This article was translated from Macedonian using artificial intelligence (AI). The original Macedonian version is available here.