Republic of Latvia Cabinet Regulation No. 138 Adopted 2 April 2019

Regulations Regarding the Receipt of Social Services and Social Assistance

Issued pursuant to
Section 3, Paragraph two, Section 9.¹,
Paragraph two, and Section 20, Paragraph four of
the Law on Social Services and Social Assistance

I. General Provision

1. This Regulation prescribes:

1.1. the procedures by which a family (person) receives social assistance;

1.2. the procedures by which a person receives social services;

1.3. the conditions for the receipt of social care services at the place of residence and in a long-term social care and social rehabilitation institution;

1.4. the criteria for determining the level of care and assessing clients;

1.5. the procedures for financing a long-term social care and social rehabilitation service financed by the State and appropriate to the level of care of a client;

1.6. the number and qualification of the personnel involved in the provision of the service of a long-term social care and social rehabilitation institution which is financed by the State.

II. Procedures by Which a Family (Person) Receives Social Assistance

2. In order to receive social assistance, a person living separately or a person authorised by a family shall address a social service office of a local government (hereinafter - the social service office), present a personal identification document and submit the following:

2.1. an application;

2.2. a statement of the employer regarding work remuneration for the last three full calendar months with regard to each employee in the family;

2.3. a statement regarding income from economic activity for the last three full calendar months with regard to each performer of economic activity in the family;

2.4. statements of accounts of all persons living together opened with credit institutions or postal settlement system for the last three full calendar months;

2.5. any other documents (for example, payment receipts, invoices) if it is necessary for taking of the decision to grant social assistance.

3. The social service office shall, in cooperation with a person in accordance with a law or regulation regarding recognition of a family or a person living separately as needy, prepare the declaration of subsistence means (hereinafter - the declaration) electronically in the information system of the local government.

4. In order to receive a benefit in a crisis situation, a person shall submit an application and documents justifying the crisis situation (for example, a statement, a report or a protocol) within three months from the month when the crisis situation has occurred. If a family (person) has not been able to seek assistance within three months due to objective reasons, the person shall submit to the social service office a document which confirms this.

5. Upon receipt of the necessary documents the social service office shall:

5.1. assess social situation of the person or family;

5.2. visit the person or family at its place of residence and draw up a home visit report if it is necessary for taking of a decision to provide support;

5.3. assess material resources of the person or family (income and property) and determine eligibility for the status of a needy or low-income family (person) (this does not refer to the crisis situation);

5.4. assess participation possibilities of the person or family and the need to conclude a corresponding agreement;

5.5. take a decision in accordance with the procedures referred to in Paragraph 7 of this Regulation.

6. Unless the material or social situation of the family (person) has changed, the social service office shall not re-assess material resources of the person or family in the period for which the status of a needy or low-income family (person) has been granted if the person or family requests social assistance benefits for ensuring the basic needs in this period.

7. The social service office shall, within one month upon receipt of the documents referred to in Paragraph 2 of this Regulation but, in the case referred to in Paragraph 4 of this Regulation, within 10 working days, take the decision to grant social assistance or to refuse to grant social assistance if requirements of this Regulation or the relevant binding regulations of the local government regarding the receipt of social assistance in the local government have not been complied with, and inform the person of the taken decision but if a decision has been taken to refuse to grant social assistance, justification for the refusal and procedures for contesting a decision shall be indicated additionally.

III. Procedures by Which a Person Receives Social Services

8. The local government shall ensure provision of social services which are fully or partially financed by local government, while the Social Integration State Agency (hereinafter - the Agency) shall ensure provision of social services which are fully or partially financed by the State, unless other laws and regulations prescribe otherwise.

9. A person shall request social services from the social service office of the local government in the territory of which the person has declared his or her place of residence or address a service provider directly in the cases specified in laws and regulations.

10. In order to receive social services a person shall present his or her personal identification document and submit to the social service office the following:

10.1. an application;

10.2. a statement issued by a family doctor on the state of health of a person indicating type(s) of functional disorders and signs of acute infection (for example, active pulmonary tuberculosis, acute infectious diseases) (if any) which may affect the procedures for providing social services. The statement shall additionally indicate recommendations for care and prevention if the person wishes to receive home care (including a safety button service), a service in a group house (apartment), halfway house, day care centre, a service of a specialised workshop, a short-term social care service or respite service, or a long-term social care and social rehabilitation service at an institution;

10.3. an opinion of a psychiatrist on the mental health of the person and special (psychiatric) contraindications for the receipt of social services (Annex 1) (only applicable to the persons with mental impairments if they wish to receive home care (including a safety button service), a service in a group house (apartment), half-way house, day care centre, a service of a specialised workshop, a short-term social care service or respite service, or a service in a long-term social care and social rehabilitation institution);

10.4. documents regarding income if the person has to make a payment for the social service and such information is not available to the local government;

10.5. any other documents if they are necessary for taking of the decision to grant an appropriate social service.

11. The social service office shall, within one month upon receipt of the documents referred to in Paragraph 10 of this Regulation, perform the following appropriate activities:

11.1. assess the social situation of a person, if necessary, visit the person at his or her place of residence or location and agree on a social problem for the solving of which support is required;

11.2. in accordance with the laws and regulations regarding requirements for social service providers, initiate risk assessment in a family with children with circumstances unfavourable to the development of a child;

11.3. carry out assessment of physical and mental abilities of a person and determine the level of care for persons with limited self-care capacity in accordance with the criteria or methodology of support intensity scale specified in Annexes 2 and 3 to this Regulation;

11.4. assess the need to develop an individual plan for social care or social rehabilitation;

11.5. assess the solvency of a person and his or her family members, as well as his or her provider (if the provider also has a duty to pay for the service) by completing the part of the declaration referred to in Paragraph 3 of this Regulation regarding income. If the person wishes to receive the home care service, a possibility of the person to pay for the service from the benefit for a disabled person requiring special care shall be assessed;

11.6. take the decision to grant the social service, to put a person on the waiting list for the receipt of the social service or to refuse to grant the social service or put on the waiting list, and inform the person in writing of the taken decision, as well as also inform the head of a long-term social care and social rehabilitation institution of the taken decision in the case referred to in Paragraph 34 of this Regulation;

11.7. send the documents necessary for the receipt of social service to the social service provider or the Agency if the social service is fully or partially financed from the State budget resources.

12. In order to receive social services in a night shelter, shelter, day centre, crisis centre, and community of social work services, a person shall address the service provider directly. The service provider shall take the decision to provide the service in accordance with the procedures laid down by the founder of the relevant institution.

13. An orphan and a child who is left without parental care shall be provided with the social service in a long-term social care and social rehabilitation institution on the basis of a decision of an Orphan's and Custody Court but a child with severe and very severe functional disorders - in accordance with the procedures referred to in Paragraphs 10 and 11 of this Regulation.

14. A child shall be provided with the service in a long-term social care and social rehabilitation institution upon request of the parents on the basis of the documents referred to in Paragraph 10 of this Regulation and taking into account the procedures referred to in Paragraph 11 of this Regulation.

15. If it is impossible in emergency cases to ensure care of an orphan or a child who is left without parental care with a guardian or a foster family, the child may be immediately placed in a long-term social care and social rehabilitation institution on the basis of one of the following documents:

15.1. a unilateral decision of a Chairperson of the Orphan's and Custody Court, a Vice-chairperson of the Orphan's and Custody Court or a Member of the Orphan's and Custody Court;

15.2. a police report regarding the fact that a child lives in conditions which endanger or may further endanger his or her health or life.

16. If in the case referred to in Paragraph 15 of this Regulation it is impossible to identify the place of residence of a child placed in a long-term social care and social rehabilitation institution, the head of the institution shall, within one working day, inform the local government in the territory of which the child has been placed in the long-term social care and social rehabilitation institution.

17. If in the case referred to in Paragraph 15 of this Regulation the provision of the social service in a long-term social care and social rehabilitation institution is the duty of the State, a local government shall submit to the Agency the documents referred to in Paragraph 10 of this Regulation, and the Agency shall take the decision to grant the social service for up to three months from the day when the child has, in fact, started to receive the service in the long-term social care and social rehabilitation institution.

18. The social rehabilitation services provided for from the State budget resources shall be provided to the following:

18.1. the victims of human trafficking in accordance with the laws and regulations regarding the procedures by which victims of human trafficking receive social rehabilitation services, and the criteria for the recognition of a person as a victim of human trafficking;

18.2. the victims of violence and adults who have committed violence in accordance with the laws and regulations regarding the procedures for providing the necessary assistance to a child who has suffered from illegal activities, and the laws and regulations regarding the procedures for providing social rehabilitation services to the victims of violence and adults who have committed violence;

18.3. the persons addicted to psychoactive substances in accordance with the laws and regulations regarding the procedures by which persons addicted to psychoactive substances receive social rehabilitation services;

18.4. the persons with functional disorders in accordance with the laws and regulations regarding the procedures by which persons receive social rehabilitation services in social rehabilitation institutions, and the requirements for social rehabilitation service providers;

18.5. the persons with functional disorders who require technical aids in accordance with the laws and regulations regarding technical aids, but the persons with visual and hearing impairment - in accordance with the laws and regulations regarding the conditions and procedures by which the Latvian Society of the Blind and the Latvian Association of the Deaf provide social rehabilitation services and ensure technical aids - assistive technologies for the people with blindness and deafness;

18.6. the persons with disabilities and the persons with predictable disabilities who require vocational rehabilitation in accordance with the laws and regulations regarding the procedures by which persons receive vocational rehabilitation services;

18.7. the children in palliative care and family members thereof who require psychosocial rehabilitation services in accordance with the regulations regarding the psychosocial rehabilitation service for children in palliative care and family members thereof;

18.8. the persons with oncological diseases and relatives thereof in accordance with the regulations regarding psychosocial rehabilitation service for persons with oncological diseases and family members thereof.

IV. Assessment of Clients and Determination of the Level of Care

19. If a person requires social care service, the social service office or the social service provider shall assess the needs of the person and determine the level of care.

20. The level of care of the client shall be determined in the following cases:

20.1. if the client requires the social care service at the place of residence or in a long-term social care and social rehabilitation institution and the level of care has not been determined previously;

20.2. in developing and updating an individual plan for social rehabilitation or social care of the client or upon initiative of the specialists referred to in Paragraph 22 of this Regulation if the client receives social care service at the place of residence or in a long-term social care and social rehabilitation institution and changes in functional abilities of the client have been established, except for the case when the plan for social rehabilitation is updated prior to the period of time specified in the requirements for social service providers for reasons not related to the changes in functional abilities;

20.3. if the client requests a social service corresponding to another level of care.

21. The fourth level of care shall be applicable to the children and blind adults without carrying out assessment, except for the case referred to in Sub-paragraph 23.3 of this Regulation.

22. Social workers or social carers (hereinafter - the specialists) of the following institutions may assess the needs of a client and determine the level of care:

22.1. the specialists of a social service office of a local government or of a service provider with which the social service office has concluded a contract for the assessment of the needs of clients and the determination of the level of care;

22.2. the specialists of a long-term social care and social rehabilitation institution, including the specialists of the institutions referred to in Annex 4 to this Regulation;

22.3. the social workers who have been trained to use the support intensity scale if the support intensity scale is used for the assessment.

23. The specialist shall assess a client as follows:

23.1. in accordance with the criteria specified in Annex 2 or 3 to this Regulation for the assessment of physical and mental abilities and the determination of the level of care if it is assessed whether a person with functional disorders is eligible for the receipt of the social care service financed by a local government;

23.2. in accordance with the criteria specified in Annex 3 to this Regulation for the assessment of physical and mental abilities and the determination of the level of care if it is assessed whether a person with mental impairments is eligible for the receipt of the long-term social care and social rehabilitation service financed by the State;

23.3. in accordance with the methodology of suppor intensity scale if the type and scope of the suppor is assessed which is necessary for a person with mental impairments from 16 years of age who wishes to receive social services at the place of residence, unless the relevant client is assessed in accordance with the procedures referred to in Sub-paragraph 23.1 or 23.2 of this Regulation.

24. Upon receipt of an application from a client or information regarding changes in functional abilities of a client, the specialist shall:

24.1. agree with the client on the time and place for carrying out the assessment;

24.2. identify the possible means of communication with the client and consequently interview and observe the client by determining his or her skills and abilities, if necessary, involving in the assessment process his or her legal representative or another family member or care person who is present on a daily basis and able to characterise the skills and abilities of the client in different areas;

24.3. assess the need and type of involvement of medical practitioners or other specialists (including by analysing information contained in statements, opinions, and descriptions in the client's file).

25. In assessing a client the specialist shall complete the relevant assessment forms and send the form referred to in Annex 2 or 3 to this Regulation but, in the case of application of the support intensity scale, a form of profile of the assessment results and a support plan to the following:

25.1. the social service office if the assessment is required to organise social care for the client or if it is necessary to provide the client with another social service which is more appropriate to his or her needs;

25.2. the social service provider if the client no longer requires long-term social care and social rehabilitation services in an institution and the client commences receiving social care services at the place of residence;

25.3. the Agency if the assessment is required to take the decision to grant the long-term social care and social rehabilitation service financed by the State or to change the service provider - the long-term social care and social rehabilitation institution.

26. The assessment referred to in Paragraph 23 of this Regulation shall be issued to a client or his or her legal representative if the client or his or her legal representative requests it.

27. The information contained in the assessments referred to in Paragraph 23 of this Regulation shall be used to organise social care and social rehabilitation service for a client and to evaluate changes in functional abilities.

28. As a result of the assessment:

28.1. the number of points in relation to the maximum possible number of points specified in Annexes 2 and 3 to this Regulation shall be converted into percentage in order to determine the scope of functional abilities of a client in percentage and correspondence thereof to the relevant level of care:

28.1.1. the first level of care - 99 %-75 %;

28.1.2. the second level of care - 74 %-50 %;

28.1.3. the third level of care - 49 %-25 %;

28.1.4. the fourth level of care - 24 %-0 %;

28.2. the standard number of points according to the support intensity scale shall correspond to the following level of care:

28.2.1. the first level of care - 8-22 points and not more than 6 points in the evaluation of the need for special medical support or special behavioural response;

28.2.2. the second level of care - 23-30 points and not more than 6 points in the evaluation of the need for special medical support or special behavioural response;

28.2.3. the third level of care - 8-30 points and not more than 6 points in the evaluation of the need for special medical support or 7-10 points in the evaluation of the need for special behavioural response;

28.2.4. the fourth level of care:

28.2.4.1. 31-52 points and not more than 6 points in the evaluation of the need for special medical support or more than 10 points in the evaluation of the need for special behavioural response;

28.2.4.2. any total of points if the evaluation of the need for special medical support indicates 7-32 points or special medical risk has been identified, or the evaluation of the need for special behavioural response indicates 11-26 points, or if especially high risk to the safety of other persons and the client himself or herself has been identified.

29. If it is established, within a month upon commencement of the provision of the social care service to a client, that functional abilities of the client do not correspond to the level of care indicated in the documents, the provider of the long-term social care and social rehabilitation service financed by the State shall re-assess the client.

30. If a specialist of a long-term social care and social rehabilitation institution concludes in the assessment, including the re-assessment referred to in Paragraph 29 of this Regulation, that the functional condition of a client corresponds to the first or second level of care and a social service at the place of residence might be required for the client with regard to which the client has expressed the relevant opinion:

30.1. the provider of the long-term social care and social rehabilitation service shall inform a social service office, which has taken the decision regarding the need for the long-term social care and social rehabilitation service financed by the State, of the assessment results in writing and send to the social service office the assessment referred to in Annex 2 or 3 to this Regulation and an application of the client by indicating that a decision may be taken to terminate provision of the long-term social care and social rehabilitation service, as well as specifying the services which are necessary for the client in order to preserve the determined level of care;

30.2. the social service office shall, upon receipt of the assessment from the provider of the long-term social care and social rehabilitation service, organise the social care service at the place of residence which is necessary for the client.

31. If the social service office does not agree with the results of the assessment referred to in Sub-paragraph 30.1 of this Regulation, the social service office shall, in cooperation with the Agency, organise assessment of the client carried out by independent specialists by also taking into account the opinion of the client, circumstances at the place of residence of the client and available services.

V. Receipt of Social Care Services at the Place of Residence and in a Long-term Social Care and Social Rehabilitation Institution

32. A client shall be granted the following social care services in accordance with the procedures laid down in this Regulation and established by a local government according to the assessment results and the determined level of care:

32.1. an assisted-living service, a service in a day care centre, home care service, including safety button service, a service in a group house (apartment) or another social care service at the place of residence which corresponds to the special needs of the person with functional disorders, provided that any level of care is determined with regard to the person;

32.2. services in a long-term social care and social rehabilitation institution if it is impossible to ensure the required scope of social care by providing services at the place of residence and the third or fourth level of care has been determined with regard to the person;

32.3. if the social care service is necessary for a child - social services according to the needs of the child in accordance with the assessment of individual needs and resources of the child carried out by a social worker and other involved specialists without assessing the level of care.

33. If a person has the right to the social care service financed by the State which may also be provided by the institutions referred to in Annex 4 to this Regulation, and the person has expressed a wish to receive this service, the social service office shall, within a month, submit the decision to the Agency regarding the need for the long-term social care and social rehabilitation service financed by the State, the relevant application of the client, the documents referred to in Sub-paragraphs 10.2 and 10.3 of this Regulation and the relevant assessments.

34. If a person with severe mental impairments living in a long-term social care and social rehabilitation institution wishes to change the social care service in the long-term social care and social rehabilitation institution for the social care service at the place of residence, the person shall address the head of the long-term social care and social rehabilitation institution by submitting an application for the provision of support to change the type of the social services. The head of the long-term social care and social rehabilitation institution shall, in cooperation with the local government which has decided to grant the long-term social care and social rehabilitation service, or the local government in the administrative territory of which the client wishes to live in the future, identify the possibilities of the local government to provide the client with appropriate social services at the place of residence.

35. If it is possible to change the services for the client in the long-term social care and social rehabilitation institution for social services at the place of residence which are more appropriate to the needs of the client, the head of the long-term social care and social rehabilitation institution shall send the following documents to the social service office of the local government in the administrative territory of which the client was living prior to admission to the institution or to the local government in the administrative territory of which the client wishes to live in the future:

35.1. the application of the client for the change of the service in the long-term social care and social rehabilitation institution for social services at the place of residence and the document referred to in Sub-paragraph 10.3 of this Regulation;

35.2. the assessment referred to in Annex 2 or 3 to this Regulation;

35.3. the assessment (in dynamics) of skills and abilities of the person carried out during the social rehabilitation course for life outside the long-term social care and social rehabilitation institution;

35.4. any other information relevant to taking of the decision to grant social services at the place of residence.

36. If the person referred to in Paragraph 35 of this Regulation is granted a service in a group house (apartment), the social service office shall, in cooperation with the provider of the service in the group house (apartment), submit to the Ministry of Welfare an application for granting the State co-financing in accordance with the laws and regulations regarding the co-financing of the establishment and maintenance of day centres, group houses (apartments), and half-way houses, unless the local government receives the State support to the local government with regard to this person. The application shall be accompanied by the documents referred to in Sub-paragraphs 10.2 and 10.3 and Paragraph 35 of this Regulation, the decision to grant the service in a group house (apartment) (copy) and any other documents which are at the disposal of the social service office and are relevant to the taking of the decision regarding State co-financing.

37. If a person receives the long-term social care and social rehabilitation service financed by the State and wishes to receive the social care service in another long-term social care and social rehabilitation institution which has the right to provide social care service from the State budget resources, including the institution referred to in Annex 4 to this Regulation, the person may, not more than once every 18 months, submit an application to the head of the long-term social care and social rehabilitation institution in which the person receives the social care service.

38. The head of the long-term social care and social rehabilitation institution shall send to the Agency the application of the person for the change of service provider and copies of the documents referred to in Sub-paragraphs 10.2 and 10.3 of this Regulation, the assessment referred to in Annex 3 to this Regulation, as well as the psychiatrist's recommendation for the change of service provider if the person wishes to receive the service in the institution referred to in Annex 4 to this Regulation (except for the case referred to in Sub-paragraph 39.1 of this Regulation).

39. If the person who receives the social care service in the State social care centre wishes to change the service provider, the following persons shall take the decision to change the service provider:

39.1. the head of the State social care centre in which the person receives the service if the person wishes to receive the social care service in another branch of this centre;

39.2. the head of the State social care centre in which the person wishes to receive the service upon an agreement with the head of the State social care centre in which the person receives the social care service, after receipt of the application of the person and the documents referred to in Sub-paragraphs 10.2 and 10.3 of this Regulation, as well as the assessment referred to in Annex 3 to this Regulation;

39.3. the head of the State social care centre in which the person receives the service if the person wishes to receive the service in the institution referred to in Annex 4 to this Regulation upon an agreement with the head of the institution in which the person wishes to receive the social care service, after sending to the relevant institution the application of the person, the documents referred to in Sub-paragraphs 10.2 and 10.3 of this Regulation, and the assessment referred to in Annex 3 to this Regulation.

40. In the cases referred to in Sub-paragraphs 39.2 and 39.3 of this Regulation the head of the State social care centre shall, prior to taking the decision to change the service provider, ascertain with the Agency electronically whether the conditions referred to in Paragraph 41 of this Regulation are present and send the relevant information to the Agency within five working days from the taking of the decision.

41. If in the cases referred to in Sub-paragraphs 39.2 and 39.3 of this Regulation it is impossible to ensure the change of the service provider due to the lack of places of for other objective reasons, the head of the State social care centre shall send the application of the person for the change of the service provider and the documents referred to in Sub-paragraphs 10.2 and 10.3 of this Regulation, as well as the assessment referred to in Annex 3 to this Regulation to the Agency which in this case takes one of the decisions referred to in Sub-paragraph 42.2, 42.4 or 42.5.

42. The Agency shall, within 10 working days upon receipt of the documents submitted by the social service office of the local government or the State social care centre, take one of the following decisions:

42.1. to grant the long-term social care and social rehabilitation service;

42.2. to put the person on the waiting list for the receipt of the long-term social care and social rehabilitation service;

42.3. to refuse to grant the long-term social care and social rehabilitation service if the requirements laid down in this Regulation or the relevant laws and regulations governing the area of social services are not complied with;

42.4. to change the provider of the long-term social care and social rehabilitation service;

42.5. to refuse to change the provider of the long-term social care and social rehabilitation service if the admission of the clients to the institution specified in the application of the person has been suspended or terminated or the relevant institution has terminated its operation;

42.6. to perform the task specified in Paragraph 31 of this Regulation.

43. The Agency shall, if necessary, within five working days upon receipt of the documents submitted by the local government, request the social service office to submit additional information necessary for the taking of the decision and inform the submitter thereof.

44. In the case referred to in Sub-paragraph 42.2 of this Regulation the Agency shall, if it is the turn of the receipt of the service, verify whether the person needs the social service, including by re-requesting the documents referred to in Sub-paragraphs 10.2 and 10.3 of this Regulation, as well as the assessment referred to in Annex 3 to this Regulation if they are older than 12 months, and take the decision to grant the social service or to refuse to grant the social service if the requirements laid down in this Regulation have not been complied with.

45. If the person is a recipient of the long-term social care and social rehabilitation service within the framework of the social care service financed by the State, the Agency shall take one of the following decisions:

45.1. on the basis of the application for granting the half-way house service submitted by the head of the long-term social care and social rehabilitation institution and the person, within 10 working days upon receipt of the submitted documents, take the decision to grant the half-way house service for 12 months or to refuse to grant it if the requirements laid down in this Regulation have not been complied with or if the person has been recognised as not eligible for the receipt of the half-way house service. The period of time for the half-way house service may be extended until the time when the person is able to commence an independent life in the administrative territory of the relevant local government or the person refuses to commence an independent life if the person wishes but it is impossible for him or her to commence an independent life in the administrative territory of the relevant local government due to objective reasons after the period of 12 months. If the person refuses to commence an independent life in the administrative territory of the relevant local government after receipt of the half-way house service, the long-term social care and social rehabilitation service in the institution shall be restored for this person;

45.2. within 10 working days upon receipt of the decision of the social service office to admit the person to the group house (apartment), take the decision to terminate the provision of the long-term social care and social rehabilitation service and draw up a confirmation that the person, within 12 months from the day of commencement of the group house (apartment) service, may re-commence receipt of the long-term social care and social rehabilitation service financed by the State if he or she will not be able to adjust to the life in the group house (apartment).

46. If a child with severe mental impairments living in a long-term social care and social rehabilitation institution reaches the legal age and it is impossible to provide the social service to the required extent at his or her place of residence, the Agency shall take the decision to grant the long-term social care and social rehabilitation service on the basis of the following:

46.1. an application of the head of the long-term social care and social rehabilitation institution accompanied by an application of the person, the documents referred to in Sub-paragraphs 10.2 and 10.3 of this Regulation, as well as the assessment referred to in Annex 3 to this Regulation;

46.2. a written confirmation of the social service office that it is impossible to provide the person with care to the required extent at the place of residence.

47. If in the case referred to in Paragraph 46 of this Regulation a disability group I or II has not yet been determined for the person who has reached the legal age as at the day of reaching the legal age, the person has the right to continue receiving long-term social care and social rehabilitation service until the day the disability is determined for the person but not longer than six months after reaching the legal age.

48. The Agency shall take the decision to:

48.1. terminate the provision of the long-term social care and social rehabilitation service if the long-term social care and social rehabilitation institution has taken the decision to terminate the long-term social care and social rehabilitation service;

48.2. suspend the provision of the long-term social care and social rehabilitation service if a person is absent without information as to his or her whereabouts for longer than two months from the day when the fact of the absence is notified to the police;

48.3. restore the provision of the long-term social care and social rehabilitation service from the day when the person has returned to the service provider if the provision of service was suspended for the person in the case referred to in Sub-paragraph 48.2 of this Regulation.

49. The Agency shall, within five working days upon taking of the relevant decision:

49.1. inform the person of the taken decision;

49.2. inform the service provider and the relevant social service office of the local government;

49.3. send to the service provider the assessment referred to in Annex 3 to this Regulation, except for the cases referred to in Sub-paragraphs 39.2 and 39.3 of this Regulation.

VI. The Number and Qualification of the Personnel Involved in the Provision of the Service of Care Institution Financed by the State and Financing of the Social Care Services Corresponding to the Level of Care of the Client

50. Social work specialists, medical practitioners, and other specialists who are necessary to ensure safety and life quality of the clients and who are specified in Annex 5 to this Regulation shall be involved in the provision of the services of a long-term social care and social rehabilitation institution that are financed by the State.

51. State budget financing for the long-term social care and social rehabilitation institutions referred to in Paragraph 50 of this Regulation shall be calculated by taking into account the number of the clients placed in an institution in the relevant level of care.

52. Costs of the long-term social care and social rehabilitation services financed by the State in an institution per one client shall be calculated by using the following formula:

	Expenditure on average	=	FxALG	+	Fatl.Aa + Ff.izd + Fuzt.kl	where:
	per one clientpan		Qx		Q

x - level of care of the client;

F_xALG - the planned financing for the expenditure for the remuneration of personnel working with clients of the x level of care in an institution;

Q_x - the number of clients in a long-term social care and social rehabilitation institution with a specific x level of care;

F_atl.Aa - the planned financing for the expenditure for the remuneration of support personnel (administration, household divisions and management personnel) in an institution;

F_f.izd - the planned fixed maintenance expenses of a long-term social care and social rehabilitation institution the amount of which is not affected by the number of clients in the long-term social care and social rehabilitation institution;

F_uzt.kl - the planned subsistence expenses of clients and other expenditure (not including F_f.izd) in an institution (including the planned amount of payments for clients of a long-term social care and social rehabilitation institution for personal expenditure, capital expenses);

Q - the number of clients in a long-term social care and social rehabilitation institution.

VII. Closing Provision

53. Cabinet Regulation No. 288 of 21 April 2008, Procedure for Receiving Social Services and Social Assistance (Latvijas Vēstnesis, 2008, Nos 63, 183; 2009, Nos. 69, 166; 2010, No. 101; 2011, No. 205; 2017, No. 237), is repealed.

Prime Minister A. K. Kariņš

Minister for Welfare R. Petraviča

 

Annex 1
Cabinet Regulation No. 138
2 April 2019

Opinion of a Psychiatrist on the Mental Health of a Person and Special (Psychiatric) Contraindications for the Receipt of Social Services

1. Opinion provided by	Medical treatment institution, specialist providing an opinion
	(name, registration number, given name and surname, qualification)
	Address of the provision of an opinion and contact information
	(street, house, block, city, municipality)
	(telephone number, e-mail)
2. Opinion received by	Person
	(given name, surname)
	.  .    . (date of birth: day, month, year)
	Address of the place of residence
	(street, house, apartment, city, municipality)
	(contact information - telephone number, e-mail)
3. Medical history of mental health and behavioural disorders of the person	Medical history (mark as appropriate with an x) Person: has severe or very severe mental and behavioural disorders has mild or moderate mental and behavioural disorders so far has not received treatment from the psychiatrist has received outpatient treatment from the psychiatrist has sought a specialist for the first time _______________________ has not received treatment in a psychiatric hospital has received treatment in a psychiatric hospital _______ time(s) over the last year has received treatment from the person providing an opinion (for how long), for the first time or on a regular basis
4. Assessment of mental health and behavioural disorders of the person	Orientation abilities (mark as appropriate with an x) not able to orient himself or herself in time not able to orient himself or herself in a room disorders in the awareness of himself or herself Abilities to function independently not able to organise his or her daily routine independently able to orient himself or herself in his or her usual environment (apartment or house) with little support not able to go outside house alone able to stay outside house alone in a known environment or route independent Communication skills does not recognise people around recognises known people but does not establish contact with people around does not have verbal communication skills communicates by using language, responds adequately Emotional field frequent mood swings inadequate emotions in a depressed mood frequently in an elevated mood frequently emotionally balanced v Perceptual disorders observed before present none Attention and concentration skills labile attention difficulties to switch attention not disturbed Thinking disturbances no disturbances formal thinking disturbances , what kind of ____________________ present re-assessment or psychotic delusion Memory short-term memory disorders, fixation amnesia long-term memory disorders dementia not disturbed Behaviour aggressivity self-destructive and auto-aggressive behaviour adequate to situation Attitude towards his or her mental health and behavioural disorders critical non-critical Addictions, previously/recently alcohol / smoking / medicinal products / non-substance addictions / drugs / no signs of addiction Use of medicinal products no understanding of the need to use medicinal products behaviour depends on regular use of medicinal products assistance required for the use of medicinal products supervision required for the use of medicinal products able to use medicinal products independently and has understanding of the use of medicinal products regular use of medicinal products not required
5. Information regarding existence of special (psychiatric) contraindications for the receipt of social services	Contraindications (mark as appropriate with an x) treatment-resistant psychotic disorders due to which the person is dangerous to both people around and himself or herself (a high risk of aggression or auto-aggression) asocial, emotionally labile, paranoid personality, organic personality with behavioural disorders, person with a high risk of aggressive (violent, destructive) behaviour, release of pathological traits high suicide risk (observed over the last year) compulsory measures of a medical nature have been applied to the person under a court decision psychoactive substance addiction with active use I hereby certify that the person does not have the indicated contraindications I hereby certify that the person has the indicated contraindications
6. Need for supervision	Supervision (mark as appropriate with an x) supervision not required supervision required for the use of medicinal products periodic supervision required (1-2 hours a week) periodic supervision required (during day) permanent supervision (24 h a day) required
7. Other information (also the recommended therapy if the person with mental impairments wishes to receive social service in a long-term social care and social rehabilitation institution)
8. Date of the provision of an opinion	.  .    .
9. Opinion prepared by	Psychiatrist     (signature*)

Note. * The detail of the document "signature" shall not be completed if the document has been prepared in conformity with the laws and regulations regarding the drawing up of electronic documents.

Minister for Welfare R. Petraviča

 

Annex 2
Cabinet Regulation No. 138
2 April 2019

Evaluation Card (Protocol) and Criteria for the Assessment of Physical and Mental Abilities and the Determination of the Level of Care for a Client with Functional Disorders

Given name, surname of the client
Date of birth		.  .    . (day, month, year)
Sex	F/M
Place/time of evaluation
Given name, surname, position of a specialist
Name and address of an institution

General criteria for the assessment of self-care, independence, and independent living abilities of a person	Maximum point value	Maximum percentage of self-care capacities	Results of previous assessment, if any (dd.mm.yy)	Recommended activities (if information is required for drawing up a care or rehabilitation plan)
1. Independent - 4 points - completely able to carry it out independently, ability/functionality is not disturbed 2. Almost independent - 3 points - tries and is mostly able to carry it out independently, ability/functionality is disturbed for carrying out individual activities. Services are required to support activities associated with the ensuring of function. 3. Partially dependent - 2 points - not able to carry it out independently, ability/functionality is disturbed, not able to carry out related activities without assistance. Services are required to maintain and support activities associated with the ensuring of function. 4. Significantly dependent - 1 point - not able to carry it out independently, ability/functionality is disturbed, services are required to compensate for the function/replace or maintain the related activities 5. Dependent - 0 points - not able to carry it out independently, no ability/functionality, services are required to compensate for the abilities/completely replace the related activities
1. Basic needs	16	20 %
1.1. eating, drinking (including ability to chew and swallow food)
1.2. food preparation and serving
1.3. establishment of provisions (buying) of foodstuff and industrial goods
1.4. physiological functioning (for example, ability to breath independently or compensate for dyspnea with medicinal products and devices, control blood pressure)
2. Mobility	16	20 %
2.1. movement (for example, from bed to chair and back)
2.2. mobility (for example, ability to move around house and outside it)
2.3. stairs (for example, ability to move up and down the stairs)
2.4. getting dressed (for example, ability to maintain mobility)
3. Self-awareness, cognitive abilities, and safety	20	15 %
3.1. awareness of himself or herself and his or her needs
3.2. cognitive abilities - to feel, perceive, remember, think, analyse, and imagine
3.3. orientation in time and space
3.4. communication skills
3.5. feeling safe
4. Behaviour and social contacts	12	9 %
4.1. self-control skills
4.2. ability to establish and maintain social contacts
4.3. ability to conduct transactions (for example, pay invoices), participate and organise meaningful leisure and working time
5. Personal hygiene	24	30 %
5.1. care for physical appearance
5.2. bathing
5.3. passing stool
5.4. urination
5.5. visiting the lavatory
5.6. use of medicinal products
6. Assistance in household	12	6 %
6.1. housework
6.2. laundry
6.3. household support, intermediary services
Total	100	100 %

The determined level of care*
Signature of the specialist**

Notes.

1. *Breakdown of points by levels of care:

Level of care	%	In order to convert the obtained number of points into percentage, the following point value coefficients of sections are used: section 1 - 1.25 section 2 - 1.25 section 3 - 0.75 section 4 - 0.75 section 5 - 1.25 section 6 - 0.5
Level 1	99 %-75 %
Level 2	74 %-50 %
Level 3	49 %-25 %
Level 4	24 %-0 %

2. Self-care, independence, and independent living abilities and skills of an adult shall be assessed by specialists of an interprofessional team according to their professional competence. A specialist may include control questions in the table indicated in this Annex which are formulated, supplemented, and clarified according to the abilities of a client to perceive and understand questions without changing the criteria and their maximum percentage value in the relevant sections.

3. If necessary, the criteria may be supplemented with sub-criteria which are appropriate by content and nature for the assessment of a criterion. If this changes the maximum possible amount of points to be obtained in a criterion, the point value coefficient shall be calculated for points of the relevant section in order for the percentage value of points to correspond to the percentage value of section indicated in the table.

4. ** The detail of the document "Signature of the specialist" shall not be completed if the document has been prepared in conformity with the laws and regulations regarding the drawing up of electronic documents.

Minister for Welfare R. Petraviča

 

Annex 3
Cabinet Regulation No. 138
2 April 2019

Evaluation Card (Protocol) and Criteria for the Assessment of Physical and Mental Abilities and the Determination of the Level of Care for a Client with Mental Impairments

Given name, surname of the client
Date of birth		.  .    . (day, month, year)
Sex	F/M
Place/time of evaluation
Given name, surname, position of a specialist
Name and address of an institution

 

Criteria for the assessment of self-care, independence, and independent living skills of a client 1. Carries it out independently/functionality is not disturbed - 3 points. 2. Tries and is able to carry it out independently with assistance, functionality is not disturbed in most cases - 2 points. 3. Tries and is able to carry it out independently with assistance, functionality is disturbed in most cases - 1 point. 4. Not able to carry it out independently/functionality is disturbed - 0 points.	1st assessment		2nd assessment
	(date of completion)		(date of completion)
	points		points
	able to	knows	able to	knows
Notes. 1. "Able to" - assessing mental or physical characteristics of a person which make it possible to successfully carry out a specific activity, task, perceive and react according to the situation and social environment. 2. "Knows" - assessing knowledge, skills, and competences of a person to carry out a specific activity, task. (In sections where abilities and skills are assessed (can and knows) the evaluation is doubled where the maximum number of points in each column is 6 = 3 + 3)
1. Self-awareness
1.1. Able to say and knows his or her given name and surname. Control question: What is your given name, surname?
1.2. Knows his or her year and date of birth, age, gender, and place of residence. Control question: How old are you? When is your birthday? What is your address?	-		-
1.3. Aware of his or her strengths and weaknesses. Control question: What do you do the best? What do you like to do the best? What do you not like to do?		-		-
1.4. Aware of why the assistance (support) is required. Control question if the person lives in a social care institution: Do you know why you have to live in the institution?		-		-
1.5. Able to understand and be aware of the consequences of his or her action. Control question: Please explain (the client is able to inform) what will happen if you annoy a dog of another person?		-		-
1.6. Able to and knows how to tell (knows how to inform) about his or her family, relatives. Control question depending on whether the client has a family, relatives: What is your relationship with your family?
1.7. Knows his or her rights, duties, and responsibility. Control question: What are your duties at home? What are you responsible for? What are your rights?	-		-
The number of points 15/12
The maximum number of points 27
Notes
2. Eating, food preparation, fluid intake
2.1. Able to eat independently. Control question: Where do you eat breakfast, lunch, supper?		-		-
2.2. Able to chew and swallow food. Control question: Which food do you like the most? Which food is the most difficult to eat/swallow?		-		-
2.3. Able to and knows how to use tableware appropriately. Control question: What kind of tableware do you usually use to eat?
2.4. Able to and knows how to serve himself or herself at the table, put food on a plate, pour tea, cut bread. Control question: How do you put food on a plate? Which sandwiches do you like the most?
2.5. Able to and knows how to prepare snacks. Control question: How to prepare, for example, sandwiches?
2.6. Able to and knows how to prepare food from fresh products. Control question: What is used to prepare food and how is it done?
2.7. Able to and knows how to stay hydrated. Control question: What do you drink the best - drinking water, juice, tea, coffee or some other drink? What is your daily fluid intake?
2.8. Able to and knows how to boil the water and prepare a warm drink, food, determine its temperature and amount in a container. Control question: How to boil the water and prepare hot tea or coffee?
2.9. Able to and knows how to use kitchen appliances: a cooker, a microwave oven etc. Control question: What is used to prepare food? What is used to boil the water?
2.10. Able to and knows how to lay and clear a table. Control question: What plates are required to eat, for example, soup? Tell me (the client knows) how do you lay and clear a table?
2.11. Able to and knows how to wash, dry, and put back dishes. Control question: What do you do with the dirty dishes after eating? Where do you put the clean dishes?
2.12. Able to and knows how to assess what may and what may not be eaten according to the determined diet. Control question: Which products are healthy and which are not recommended to be eaten frequently and much? Tell me (the client knows or is able to inform) are there any products which you may not use? Why?
The number of points 36/30
The maximum number of points 66
Notes
3. Getting dressed
3.1. Able to and knows how to get dressed and undress himself or herself. Control question (the client knows or is able to inform): How many times a day do you change your clothes?
3.2. Able to and knows how to button and unbutton clothes. Control question (the client knows or is able to inform): Which buttons of shirt/blouse do you like the best - large or small ones? How long does it take for you to button or unbutton your shirt/blouse?
3.3. Able to and knows how to deal with a zip in clothes. Control question (the client knows or is able to inform): Which clothes have a zip? How often do you wear them?
3.4. Able to and knows how to tie and untie laces in clothes and footwear. Control question (the client knows or is able to inform): Which clothes have laces? Do you wear them often? Which shoes or boots have laces? How do you deal with laces?
3.5. Able to and knows how to choose clothes and footwear according to weather conditions. Control question (the client knows or is able to inform): Which are your favourite clothes? What do you usually wear in summer and what in winter? When is it time to wear a warmer jacket?
3.6. Knows his or her clothing and footwear sizes. Control question: What is your usual trouser/shirt/skirt/dress size? What is your shoe size?	-		-
3.7. Able to and knows how to keep his or her clothes and footwear clean and tidy (wash, iron, make small repairs). Control question (the client knows or is able to inform): Which clothes do you wash yourself? Where do you usually iron your clothes? Where do you keep your footwear? How can you clean dirty shoes or boots? If a shirt is missing a button, what do you do?
The number of points 18/21
The maximum number of points 39
Notes
4. Cleaning and maintenance of rooms
4.1. Able to and knows how to keep his or her room and other rooms clean and tidy. Control question: Who cleans your room?
4.2. Able to and knows how to make his or her bed and change bed linen. Control question: Who makes your bed in the morning? Who changes a sheet, a pillowcase, and a blanket cover for your bed?
4.3. Aware (the client knows or is able to inform) of the need for upkeep of rooms. Control question: Tell me why it is necessary to wash floor and wipe dust from shelves in the room?	-		-
4.4. Able to and knows how to use products and tools for cleaning rooms. Control question: What do you use for brushing the floor in the room? What do you use for washing the floor?
4.5. Able to and knows how to wipe the dust, wash the floor. Control question: How often do you wipe the dust and wash the floor in your room? Which rooms do you clean as well?
4.6. Able to and knows how to take care of his or her things, arrange his or her things with understanding. Control question: Where do you keep your things, belongings? Where do you keep your comb, socks?
The number of points 15/18
The maximum number of points 33
Notes
5. Maintenance of personal hygiene
5.1. Understands the need for personal hygiene (the client knows or is able to inform). Control question: Tell me why do people wash themselves?		-		-
5.2. Able to and knows how to take a shower, a bath. Control question: Where do you usually wash yourself? Where can you wash yourself as well?
5.3. Able to and knows how to take care of his or her hair (wash, brush, dry, shave). Control question: Who washes your hair? When do you brush your hair? When do you usually shave - in the morning or in the evening?
5.4. Able to and knows how to take care of his or her nails (cut). Control question: Who usually cuts your nails?
5.5. Able to and knows how to brush his or her teeth/take care of his or her oral cavity and artificial teeth. Control question: When do you usually brush your teeth? If the client has artificial teeth - how do you clean your artificial teeth?
5.6. Able to and knows how to use products necessary for hygiene procedures (soap, sponge, shampoos, creams, tissue, deodorant etc.). Control question: What is the colour of your sponge? Which soap or shampoo do you like the best? What hygiene products do you know, which products do you usually use? Where do you keep them?
5.7. Able to and knows how to go to lavatory independently both during day and night. Control question: Where are toilet facilities? Who helps you to get to the toilet facilities? How can you go to the toilet at night when it is dark?
5.8. Able to and knows how to use diapers, liners, sanitary pads. Control question: When is it necessary to use diapers? If the customer needs diapers - who helps you to put on diapers? If the client is a woman - when it is necessary to use sanitary pads?
The number of points 24/21
The maximum number of points 45
Notes
6. Maintenance of health
6.1. Has basic knowledge of human anatomy (the client knows or is able to inform). Control question: Tell me where the heart, stomach, brain, and other organs are located in the human body?		-		-
6.2. Has understanding of the health and its importance (the client knows or is able to inform). Control question: What does it mean to be healthy? When do you feel healthy?	-		-
6.3. Has understanding of the use of medicinal products, if necessary (the client knows or is able to inform). Control question: In which cases it is necessary to use medicinal products? What medicinal products do you have to use?	-		-
6.4. Able to understand behavioural disorders related to the regular use of medicinal products, if the client has or may have behavioural disorders (the client knows or is able to inform). Control question: How does the use of medicinal products affect your health condition/behaviour?		-		-
6.5. Able to and knows how to observe the time of use of medicinal products (the client knows or is able to inform). Control question: How do you usually use medicinal products?
6.6. Has understanding of the use of contraceptives. Control question: What are contraceptives? How are they used?	-		-
6.7. Able to and knows how to tell (the client knows or is able to inform) if he or she feels unwell or about pain (toothache, stomach ache, headache, back pain, pain in legs or arms) and able to describe his or her well-being. Control question: How do you usually tell someone if something hurts?
6.8. Able to and knows how to seek medical help (the client knows or is able to inform), if necessary (injuries, illnesses etc.). Control question: Who do you usually turn to when something hurts or you feel unwell?
6.9. Has knowledge and understanding of the harmful effect of addictive substances and technologies on health (alcohol, smoking, medicinal products, drugs, gambling) (the client knows). Control question: Tell me what do you know about the impact of alcohol, smoking, and drug use on human health? How do you think whether playing cards/games on a computer a person may become so overwhelmed that he or she forgets everything in the world?		-		-
6.10. Able to recognise and describe his or her senses (the client is able to inform). Control question: Tell me how do you see and hear? The client may be given pre-prepared bags with peas, beans, groats, flour to touch - what differences can you feel?		-		-
The number of points 21/18
The maximum number of points 39
Notes
7. Mobility
7.1. Able to and knows how to change a pose and sit. The client is observed during the evaluation interview and asked the following: How do you feel sitting for a longer time?
7.2. Able to and knows how to sit on a chair, stand up from it. The client is observed during the evaluation interview and asked the following (the client is able to inform): What difficulties are caused by standing up from the chair or sitting on the chair?
7.3. Able to and knows how to get into and out of the bed. Control question: Tell me (the client knows) how do you usually get into bed? How do you get out of the bed?
7.4. Able to an knows how to get up after a fall. Control question (the client knows): What do you do if you accidentally trip and fall?
7.5. Able to and knows how to move around a room, use technical aids, if necessary. Control question (the client knows or is able to inform): Tell me how big is your room approximately? What shoes do you usually wear when moving around a room? Where do you go to watch TV? If a person uses technical aids - who helps you to use, for example, a wheelchair, walking stick etc.?
7.6. Able to and knows how to move up and down the stairs. Control question (the client knows or is able to inform): Who helps you to move up or down the stairs?
7.7. Able to stay and move in fresh air. Control question (the client knows or is able to inform): Where do you usually take a walk? How long do you walk outside?		-		-
The number of points 21/18
The maximum number of points 39
Notes
8. Orientation abilities in a room and environment
8.1. Able to and knows how to orient himself or herself in a room. Control question (the client knows or is able to inform): Tell me which rooms are close to your room?
8.2. Able to and knows how to orient himself or herself in the vicinity/territory. Control question (the client knows or is able to inform): In which direction you can find the park, pond etc.? Which place do you like the best when you have gone outside?
8.3. Has understanding of the safety on the street and behaviour according to the situation (the client knows or is able to inform). Control question: Tell me what you know about proper behaviour on the street? Where is it allowed to cross the street? Where is it not allowed to cross the street? If you stand on one side of the street and need to get to the other side, what do you do first?	-		-
8.4. Able to and knows how to use public transport, buy a ticket. Control question (the client knows or is able to inform): Tell me when was the last time you took a bus, train or urban public transport? Where do you usually get on a bus or another vehicle (depending on what type of transport the client uses or has used)? How do you know when to get off? Where do you buy a ticket?
8.5. Able to and knows how to recognise the necessary route, get off the transport at the necessary stop. Control question (the client knows or is able to inform): Which bus do you take to get (according to the route of the client)? At which stop do you have to get off?
The number of points 12/15
The maximum number of points 27
Notes
9. Safety
9.1. Understands the meaning of designations, such as "pedestrian crossing", "traffic light", "bus stop", "toilet" etc. Control question (the client knows or is able to inform): pictures with these designations are shown to the client, and the client is asked to explain what do they mean.	-		-
9.2. Knows what an emergency situation is, knows how and where to look for help. Control question (the client knows or is able to inform): Tell me what an emergency situation is. Where will you look for help and how?		-		-
9.3. Has knowledge of fire safety rules, knows how to act accordingly. Control question (the client knows or is able to inform): What do you know about fire safety? How would you act if you smelled smoke in the rooms? How would you act if you saw a wastepaper basket burning?		-		-
9.4. Able to and knows how to find the necessary specialist independently. Control question (the client knows or is able to inform): Where is a doctor? Where is the social service office?
The number of points 9/6
The maximum number of points 15
Notes
10. Basic education
10.1. Able to and knows how to recognise numbers, knows how to add, subtract or perform basic mathematical operations up to 10 (the client knows or is able to inform). The client is shown pre-prepared images with numbers and mathematical operations and asked questions, for example, what is 5 + 4; 6 - 4; 3 × 3 or 10 : 5.
10.2. Able to and knows how to perform mathematical operations up to 100 (the client knows or is able to inform). The client is shown pre-prepared images with numbers and mathematical operations and asked questions, for example, what is 50 - 20; 40 + 30.
10.3. Has understanding of weight, quantity, size, volume, distance (the client knows or is able to inform). The client is given two pre-prepared objects and asked which one of them is heavier? Which is larger? Which is further away - the table or the closet (for example)?	-		-
10.4. Able to and knows how to read. Recognises letters (the client knows or is able to inform). The client is given a pre-prepared text and asked to read it.
10.5. Able to and knows how to write. The client is dictated some pre-prepared sentences.
10.6. Able to and knows how to sign. The client is asked to sign - show me how you sign!
10.7. Able to and knows how to use a telephone. Control question: Do you have a telephone? Whom do you usually call? Show me how you use a telephone!
10.8. Able to and knows how to use a computer. Control question: Do you have a computer? Do you use a computer in order to find out how your friends or relatives are? Show me how you use a computer!
The number of points 21/24
The maximum number of points 45
Notes
11. Orientation in time
11.1. Has understanding of time (the client knows or is able to inform). Control question: What is now - a morning, noon, afternoon or evening?		-		-
11.2. Able to understand the concepts (the client knows or is able to inform) of date, day, year, month, season. Control question: What is today's date, day of the week? What month? What year? What season?		-
11.3. Able to understand the calendar (the client knows or is able to inform). Control question: Please show me in the calendar how today is marked?		-		-
11.4. Able to and knows how to tell the time on a clock (the client knows or is able to inform). Control question: Please tell me what time it is.
11.5. Able to and knows how to use an alarm clock. Control question: Show me how to use an alarm clock.
11.6. Able to understand the need to be in time, not to be late (the client knows). Control question: Tell me at what time do you usually wake up. At what time do you usually have breakfast?		-		-
The number of points 18/6
The maximum number of points 24
Notes
12. Use of money and shopping
12.1. Able to and knows how to use money: recognises and uses notes and coins (the client knows or is able to inform). The client is shown pre-prepared images of notes and asked: What coins or notes do you use most often?
12.2. Understands the value of money, knows how to keep money safe (the client knows). Control question: Why do you need money in general? Where do you keep your money?	-		-
12.3. Able to and knows how to use a bank payment card (the client knows). Control question: Tell me what a bank payment card is? What do you do with it?
12.4. Able to and knows how to shop independently, buy the things necessary on a daily basis. Control question (the client knows or is able to inform): Tell me how you shop in a store! Who helps you to shop? What do you usually buy in a store?
12.5. Able to and knows how to plan and rationally use personal monies. Control question (the client knows or is able to inform): How do you know what to buy when you are in a store? How often do you go to a store to make purchases?
The number of points 12/15
The maximum number of points 27
Notes
13. Communication
13.1. Able to communicate verbally (the client is able to inform): express himself or herself in a comprehensible language, make a conversation, hold a dialogue. The client is observed during the evaluation interview.		-		-
13.2. Understands different non-verbal signals (the client knows or is able to inform): facial expressions, meaning of tone of voice, gestures, and poses. Control question: How does a happy person usually look, sound? What about a sad person? And an angry one?	-		-
13.3. Able to and knows how to express his or her wishes and feelings clearly. Control question (the client knows or is able to inform): Tell me what makes you happy! What would you like to have?
13.4. Able to understand and respect needs of other people (the client knows). Control question: What do you do when your relative has fallen asleep?		-		-
13.5. Able to and knows how to solve conflict situations in an adequate manner. Control question (the client knows): What do you do when you have fallen out with your relative?
13.6. Able to and knows how to react according to the situation, information or instructions. Control question (the client knows or is able to inform): Tell me what would you do if you saw someone taking a thing which is not his/hers (stealing)? What do you do when someone asks for your help but you do not want to do it?
13.7. Able to establish contacts with other people. Control question: Do you have any friends?		-		-
13.8. Able to recognise the persons he or she knows, establish contacts with his or her relatives. Control question (the client knows or is able to inform): What is the name of .....?		-		-
The number of points 21/12
The maximum number of points 33
Notes
14. Behaviour
14.1. Able to and knows how to behave according to his or her age and gender. The client is observed during the evaluation interview.
14.2. Able to and knows how to follow basic decency rules (greet someone, say thank you, approach someone etc.). Control question (the client knows): How do polite people behave? The behaviour of the client is observed during the evaluation interview.
14.3. Able to and knows how to act according to the situation. Control question (the client knows or is able to inform): Tell me what do you do when you see that someone trips and falls.
14.4. Has a sense of humour. Control question (the client knows or is able to inform): Tell me how you understand the expression "good sense of humour".		-		-
14.5. Able to and knows how to evaluate and control his or her behaviour. Control question (the client knows): How do you react when someone asks you to wait, be patient?
14.6. Able to act prudently, not to react impulsively. Control question (the client knows): What do you do when something happens not the way you want? When someone does not allow you to do what you want?		-		-
14.7. Able to and knows how to act purposefully, meaningfully. Control question (the client knows or is able to inform): Do you read? Why do you do it? (the question corresponds to the information which the person has given about his or her leisure activities and performed works)
The number of points 21/15
The maximum number of points 36
Notes
15. Pair and group relationships
15.1. Able to work in pairs and groups. Control question (the client is able to inform): In what rehabilitation activities or classes do you like to participate? Who else participates in them?		-
15.2. Able to work in group, accepts group behaviour norms. Control question (the client knows or is able to inform): Have you participated in different activities? Tell me what do you do during these activities. What rules do you have to follow during the activities?		-
15.3. Able to establish friendly relationships with the persons of his or her gender and of the opposite gender. Control question (the client knows or is able to inform): Tell me what friendship is. What does it mean to be friends with someone?		-
15.4. Able to and knows how to adapt to a new situation or changes. Control question (the client knows or is able to inform): How do you live with your............?
15.5. Able to and knows how to express his or her sexuality appropriately and satisfy his or her sexual needs. Control question (the client knows or is able to inform): What is important when a person has a girlfriend/boyfriend, when they have an intimate relationship?
The number of points 15/6
The maximum number of points 21
Notes
16. Cognitive functions
16.1. Able to perceive reality. Control question: Where are we at the moment? What is happening right now?		-		-
16.2. Able to focus his or her attention on a specific task, situation. The client is observed during the evaluation interview, is he or she focused on the interview?		-		-
16.3. Able to hold attention in a specific situation when performing a specific task. The client is observed during the evaluation interview - does the client hold attention to the performance of the task.		-		-
16.4. Able to direct attention from one object to another and then return to the previous task. The client is observed during the evaluation interview.		-		-
16.5. Able to apply logical, abstract, action thinking. The client is observed during the evaluation interview - what the client's answers are (ability to inform), do they correspond to the question asked, does the client express himself or herself (is able to inform) clearly, does he or she use figurative expressions, does he or she mostly use the present tense in the conversation?		-		-
16.6. Able to recall recent events. The client is observed during the evaluation interview - does the client speak (is able to inform) about today's events, what has happened in the morning. Possible questions: What did you do this morning? What did you have for breakfast this morning?		-		-
16.7. Able to recall old events in the past. Control question (the client knows or is able to inform): Tell me where you lived before admission to this institution. The client may be observed during the evaluation interview - does the client speak about his or her past?		-		-
The number of points 21/0
The maximum number of points 21
Notes
17. Working skills and abilities
17.1. Able to express interest in working activities. Control question (the client is able to inform): What are you most interested in? What kind of job are you interested in?		-		-
17.2. Shows interest in new working activities (able to inform). Control question: What are the possibilities for doing something interesting?		-		-
17.3. Able to and knows how to plan and consecutively perform the assignment to be carried out. Control question (the client knows or is able to inform): When did you start performing your assignments? How long have you been working? How many breaks are necessary during work?
17.4. Able to and knows how to use tools and equipment according to the assignment. Control question (the client knows or is able to inform): Tell me what tools, instruments you usually use to do the job.
17.5. Able to seek help if there is uncertainty as to performance of the specific assignment. Control question (the client knows or is able to inform): What do you do when you do not know how to carry out the assigned task, for example, weed a bed.		-		-
17.6. Able to assume responsibility for the assigned task, work. Control question (the client knows or is able to inform): How do you evaluate your work (for example, there are no weeds in a flowerbed)? What works have you carried out recently?		-		-
17.7. Able to and knows how to arrange and maintain in order his or her workplace. Control question (the client knows or is able to inform): Tell me what do you do with tools, instruments when you finish working.
17.8. Able to accept criticism and correct the mistakes made during performance of the assignment. Control question (the client knows or is able to inform): What do you do when someone says that you are doing something wrong or that you have made a mistake?		-		-
17.9. Knows and follows work safety rules. Control questions (the client knows or is able to inform): Tell me how to use, for example, a spade (or another tool). What is important when using a hoe?	-		-
17.10. Able to cooperate with others during performance of the assignment, work. Control question (the client is able to inform): Whom do you help to carry out the work? Who helps you?		-		-
The number of points 27/12
The maximum number of points 39
Notes
18. Leisure time
18.1. Able to and knows how to spend the leisure time efficiently, constructively, according to the age, interests. Control question (the client is able to inform): Tell me what do you do in your free time. How do you spend your mornings, afternoons, evenings?
18.2. Able to show initiative and plan, organise his or her leisure time independently. Control question (the client knows or is able to inform): At which time of the day do you prefer doing things of your interest, for example, read, watch TV, play board games etc. (according to the client's interests)?		-		-
18.3. Able to use the offered possibilities of spending his or her leisure time. Control questions (the client is able to inform): In what leisure activities do you like to participate?		-		-
The number of points 9/3
The maximum number of points 12
Notes
The total number of points (the maximum - 588)

The determined level of care*
Signature of the specialist**

Notes.

1. *Breakdown of points by levels of care:

Care level	%	Points
Level 1	99 %-75 %	588-438
Level 2	74 %-50 %	437-291
Level 3	49 %-25 %	290-145
Level 4	24 %-0 %	144-0

2. Self-care, independence, and independent living abilities and skills of an adult shall be assessed by specialists of an interprofessional team according to their professional competence.

3. The control questions indicated in this Annex shall serve as a supporting tool intended for a specialist to assess the client. The use thereof shall be within the competence of the specialist. Control questions shall be formulated, supplemented, and clarified according to the abilities of a client to perceive and understand questions without changing the criteria and their maximum percentage value in the relevant sections.

4. ** The detail of the document "Signature of the specialist" shall not be completed if the document has been prepared in conformity with the laws and regulations regarding the drawing up of electronic documents.

Minister for Welfare R. Petraviča

 

Annex 4
Cabinet Regulation No. 138
2 April 2019

State Capital Companies Which Provide State-financed Long-term Social Care and Social Rehabilitation Services

1. Valsts sabiedrība ar ierobežotu atbildību "Rīgas psihiatrijas un narkoloģijas centrs" [State limited liability company Riga Centre of Psychiatry and Narcology].

2. Valsts sabiedrība ar ierobežotu atbildību "Strenču psihoneiroloģiskā slimnīca" [State limited liability company Strenči Psychoneurological Hospital].

3. Valsts sabiedrība ar ierobežotu atbildību "Slimnīca "Ģintermuiža"" [State limited liability company Hospital Ģintermuiža].

4. Valsts sabiedrība ar ierobežotu atbildību "Daugavpils psihoneiroloģiskā slimnīca" [State limited liability company Daugavpils Psychoneurological Hospital].

Minister for Welfare R. Petraviča

 

Annex 5
Cabinet Regulation No. 138
2 April 2019

The Number and Qualification of the Personnel Involved in the Provision of the Service of a Long-term Social Care and Social Rehabilitation Institution Which is Financed from the State Budget

I. The number of specialists working in a long-term social care and social rehabilitation institution for adults on average per one group of clients
Position/ qualification	Level of care/number of workloads								Comment
	1.	2.	3.		4.	In institution in total
	per group of 20-24 clients on average	per group of 16-20 clients on average	per group of 12-16 clients on average		per group of 8-12 clients on average	8 groups (2 groups in each level) in an institution for adults, each containing 18 clients of one level on average
Social worker	0.25	0.25	0.1		0.1	1.0			Specialist manages 4 groups of clients on average
Social carer/ social rehabilitator	0.75	0.75	1.00		1.00	7.0			Levels 1, 2: 0.75 workloads per one group on average. One specialist per two groups of clients a day, 7 days a week (8.30-17.00). Levels 3, 4: 1.25 workloads per one group on average. One specialist per four groups of clients a day, 7 days a week (8.30-17.00), one specialist per two groups of clients during working days (8.30-17.00) additionally.
Carer/nurse's assistant	0.75	0.75	4.5		5.25	22.5			Levels 1, 2: 0.75 workloads per one group on average. One specialist per 50 clients (2 groups) on average during night, 7 days a week (22.00-6.00). Level 3: 4.5 workloads per one group on average. One specialist per one group of clients 24 hours a day, one specialist per one group of clients during working days (8.30-17.00) additionally. Level 4: 5.25 workloads per one group on average. One specialist per one group of clients 24 hours a day, one specialist working 16 h a day on average, 7 days a week (8.30-22.00) per two groups additionally.
Specialist responsible for organisation of cultural and sporting events	0.09	0.09	0.09		0.09	0.75			0.75 workloads in an institution. If the number of clients in the institution is less than 50, then it is 0.5 workloads in the institution.
Interest education specialists	0.5	0.5	0.25		x	2.5			Levels 1, 2: 1.0 workload per two groups on average. Level 3: 0.25 workloads per one group on average.
Certified doctor1	0.08	0.12	0.14		0.16	1.0			1.0 workload in an institution. If the number of clients in the institution is less than 50, then it is 0.5 workloads in the institution.
Certified registered nurse2	0.4	0.5	1.00		1.35	6.50			5.5 workloads in an institution. Levels 3, 4: 0.25 workloads per one group on average. One specialist manages 4 groups of clients on average
Certified physiotherapist	0.13	0.13	0.13		0.13	1.0			1.0 workload in an institution.
Certified occupational therapist	0.13	0.13	0.13		0.13	1.0			1.0 workload in an institution.
Certified art therapist	0.09	0.09	0.09		0.09	0.75			0.75 workloads in an institution. If the number of clients in the institution is less than 50, then it is 0.5 workloads in the institution.
Speech therapist	0.06	0.06	0.06		0.06	0.5			0.5 workloads in an institution.
Certified masseur	0.13	0.13	0.13		0.13	1.0			1.0 workload in an institution.
Certified doctor's assistant3	0.04	0.06	0.07		0.08	0.5			0.5 workloads in an institution.
Psychologist4	0.13	0.13	0.13		0.13	1.0			1.0 workload in an institution. If the number of clients in the institution is less than 50, then it is 0.5 workloads in the institution.
TOTAL (per 1 group on average)	4	4	8		9	x
II. The number of specialists working in a long-term social care and social rehabilitation institution for children per 24 clients (on average)
Position/qualification				Number of workloads in a group			Total	Comment
Social worker/social counsellor				0.25			1.0	Specialist manages 3 groups of clients on average
Social carer/social rehabilitator				3.0			9.0	3.0 workloads per one group on average. One specialist per one group of clients a day, 7 days a week (8.30-22.00).
Certified registered nurse2				x			5.5	Workloads are not calculated per group, the institution requires 5.5 workloads on average to ensure care 24 h a day.
Certified doctor1				0.05			0.5	0.5 workloads are recommended in an institution.
Certified physiotherapist				0.15			0.5	0.5 workloads are recommended in an institution.
Certified occupational therapist				0.15			0.5	0.5 workloads are recommended in an institution.
Certified art therapist				0.15			0.5	0.5 workloads are recommended in an institution.
Speech therapist				0.15			0.5	0.5 workloads are recommended in an institution.
Certified masseur				0.15			0.5	0.5 workloads are recommended in an institution.
Certified doctor's assistant3				0.05			0.25	0.25 workloads are recommended in an institution.
Psychologist4				0.15			0.5	0.5 workloads are recommended in an institution.
Specialist responsible for organisation of cultural and sporting events				0.15			0.5	0.5 workloads are recommended in an institution.
Interest education specialists				0.25			0.75	0.25 workloads per one group on average.
Carer/social teacher				7.5			22.5	7.5 workloads per one group on average. One specialist per one group of clients 24 hours a day, one specialist working 16 h a day on average, 7 days a week (8.30-22.00) additionally.
TOTAL (per 1 group on average)				12.3			x

Notes.

¹ Speciality of a doctor providing service to the clients shall be determined by a head of a long-term social care and social rehabilitation institution depending on the type and level of severity of functional disorders, as well as the age of the clients.

² Speciality and position of a nurse (for example, a senior nurse) shall be determined by a head of a long-term social care and social rehabilitation institution depending on the type and level of severity of functional disorders, as well as the age of the clients.

³ Doctor's assistant shall manage the health centre in a long-term social care and social rehabilitation institution if a doctor cannot do it.

⁴ A psychologist working with children shall comply with the requirements laid down in the Law on the Protection of the Children's Rights but in other cases a psychologist must be certified in clinical and health psychology.

Minister for Welfare R. Petraviča

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Translation © 2019 Valsts valodas centrs (State Language Centre)