Transparency data

Monitoring report 2: Minimum quality standards for the delivery of 'personal assistance' social services

Published 3 March 2025

Chișinău, 2022

This report was developed by Keystone Moldova within the project ’Civil Society Organisations Act for Better Social Services’ financed by the European Union and co-financed and implemented by the Soros Foundation Moldova in partnership with I.P. Keystone Moldova and AO Institute Virtutes Civilis.

1. Methodology for monitoring the process of providing ‘Personal Assistance’ Social    Services

The second stage of the monitoring process was carried out between 11 January 2022 and 9 March 2022.  During the process of monitoring the provision of ‘Personal Assistance’ social services, 33 monitoring visits were carried out (22 urban and 11 rural). In the case of 3 UATs, the visits did not take place due to non-employment of APs by the second level APL (Dubăsari, UTA Găgăuzia, Cantemir). From the discussions with the heads of the STASs from the 3 UATs, APs are going to be employed in the next period. The situation in STAS Dubăsari, is unclear, which motivates the non-employment of APs by the fact that they do not have financial resources to maintain the previously employed units, so the hiring of other new units would make the AP service even more difficult. STAS Cantemir will approve the new AP units at the District Council meeting, which is planned for 24.03.2022, but, after approval, they intend to maintain these units.

In the process of organising the monitoring visits, the geographical area was taken into account, so that each trip included a maximum of 3 UATs. The first visits were carried out in the STASs which employed APs until 31 December 2021 or in January 2022. Thus, until 09.03.2022 visits were made to all 30 STASs in which they employed APs from seized sources. As in the first stage, the monitoring process took place under the conditions of the state of emergency in public health, the ‘Red Code’ level of alert being established in some UTAs. For these reasons and at the request of the heads of STAS, fewer visits were made between 13.01.22 -10.02.22.

Home visits were carried out, taking into account the pandemic situation, so in some cases the discussions took place only with the APs, in order to reduce the risks in relation to the beneficiaries. During these visits, the Keystone Moldova consultant was accompanied by at least one STAS representative (usually the head of the AP service). In order to succeed in monitoring at least 1 AP from each UAT, locations near the district centre were selected and an hour was reserved for each visit. During the monitoring process of the provision of the ‘Personal Assistance’ social services, the following methods and techniques were applied:

1) Analysis of documents – analysis of the files of newly hired APs and of the beneficiaries of the Service, of the minutes of the multidisciplinary team of specialists regarding the approval of the admission to the service of the beneficiary and the AP ^{[footnote 1]}, other relevant documents. A total of 33 files were analysed.

2) Interviews with STAS specialists (STAS heads and/or heads of the ‘Personal Assistance’ Social Service). A total of 33 interviews were conducted.

3) Interviews with the APs and the beneficiaries of the Service to monitor the correctness of establishing the number of hours in accordance with the needs of the beneficiary, the type of service provided by the personal assistant, the number of weekly and daily hours for the provision of services, the record of number of hours worked, presentation of monthly reports by APs, etc. A total of 40 interviews were conducted, of which 33 interviews with APs and 7 interviews with beneficiaries.  

4) The record sheet of the monitoring visits – includes the basic information regarding the most important findings and recommendations regarding the provision of services by APs (Appendix 2).

5) Observation sheets - 33 sheets were completed (appendix 3).

2. The situation of the beneficiaries within the ‘Personal Assistance’ Social Services

2.1. Profile of the beneficiaries

Monitoring visits were carried out to 33 beneficiaries of AP services (one AP beneficiary  AP from each STAS). The youngest beneficiary is 3 years old, and the oldest – 87 years old. Out of the total number of beneficiaries visited, 13 are children and 20 are adults. 17 beneficiaries are female and 16 are male. Among the elderly (60+) – 12 beneficiaries are more than 64 years old.

2.2. Beneficiaries’ files

The analysis of the files of the 33m beneficiaries confirms that in all cases the files include documents according to point 19 of HG 314/2012 for the approval of the Framework Regulations on the organisation and functioning of the ‘Personal Assistance’ Social Services and the minimum quality standards. At this stage of the visits, all STASs had the AP service accredited by the National Council for the Accreditation of Social Service Providers. Thus, all the beneficiaries’ files were completed in accordance with the minimum quality standards.  

At the same time, some gaps were identified regarding the completion of files:

(1) Some files lacked court decisions for the beneficiaries, which require a form of judicial protection (Hîncești, Soroca, Dondușeni, Edineț, Cahul, Strășeni, Criuleni).

(2) Monitoring reports regarding the visits conducted by the head of the service were missing in some files (Hîncești, Drochia, Dondușeni, Soldănești, Nisporeni, Leova, Basarabeasca). These have been replaced by registers of the beneficiaries’ status as a result of telephone conversations or groups created on Viber. During the pandemic period, these forms of monitoring were applied in all STASs, therefore fewer visits were made by the head of AP.

(3) Irrelevant documents were identified in some files. For example, additional medical certificates  (the disability certificate and the Individual Rehabilitation and Social Inclusion Programme issued by the National Council for Determining Disability and Working Capacity are sufficient); the family structure certificate, which is actually part of the social survey issued by the community social worker (Briceni, Cahul, Criuleni).  Additional documents require extra effort on the part of the beneficiaries; therefore, it is not recommended to collect documents which have no relevance.

2.3.  Admission procedures in the AP service

In the AP admission process, each STAS was guided by the request register. Individual discussions were held with each beneficiary or legal representative of the beneficiary and with the candidate for the AP position. This was necessary given the fact that admission to the service was to take place only for 4 months. Many beneficiaries or legal representatives refused this term. In such situations, these STASs kept the beneficiary on the request list, in order to identify the next beneficiary (Bălți, Cimișlia, Drochia). Only in situations where, at the time of employment, the STASs identified  sources from the local budget, the admission of the AP service was carried out strictly in accordance with the request register, and the APs were hired for a period of 1 year with the possibility of extending the work contract of the AP for an indefinite period  (Ialoveni, Anenii Noi, DGPDC Chișinău, DGAMS Chișinău, Nisporeni, Ungheni, Briceni).   

In the case of children (up to 18 years old), the community social worker used the methodology of case management applied for children, approved by the MMPSF order no. 96 of 18.05.2016, and for adult beneficiaries, the tools of case management for adults, approved by the  MPSFC order no. 71 of 3 October 2008. Confusion appears regarding the complex assessment of the beneficiary’s needs, which must be carried out by the service provider. Some service providers have developed a needs assessment tool (the STASs from Ialoveni, Anenii Noi, Dondușeni, Briceni, Drochia, Fălești, Edineț, Cimișlia), applied by the heads of the AP service, and the other STASs are based on case management tools applied by the community social worker. The needs assessment is carried out by the community social worker, and the tool used is the beneficiary’s complex assessment form, which does not include the beneficiary’s specific needs.

From the discussions with the heads of the AP service, the need to develop a standardised tool for assessing the needs of the beneficiaries was recognised. The main focus would be on a social approach to needs assessment, which would later help in the development of the PIA.

2.4.  The beneficiaries’ opinions regarding the ‘Personal Assistance’ Social Services

Of the 20 adult beneficiaries visited, only 10 of them discussed with the Keystone Moldova consultant regarding the service provided. With the other 10 adults, discussions could not take place due to serious health problems. In the case of children (up to 18 years old), discussions took place with the children’s legal guardians (mothers employed as APs). It was found that in 7 cases the beneficiaries of AP services are husbands, the wives provide them with the necessary support, being employed as APs.  From the observations and interviews with the beneficiaries, it was concluded that beneficiaries feel good in the company of the APs, and usually during the monitoring visits made by the service provider, the well-being of the beneficiary is monitored.

Adults with disabilities find it uncomfortable to talk, many of them were active people, and their condition puts them in an inferior situation (some of them are still depressed)

3. The situation regarding the provision of services by personal assistants

3.1. The profile of personal assistants

The framework regulation on the organisation and operation of ‘Personal Assistance’ social services establishes that the AP can be any person, including family members. As a result of the visit, it was found that, of the 33 APs employed, 30 are members of the family and only 3 are from outside the families.

When asked if they would accept a person from outside the family as an AP, the answers were: “I only trust my wife, I don’t want a stranger”, or” I can’t imagine leaving my child with someone else or to leave him / her at ‘respiro’ overnight”, or “I tried to leave my mother with a stranger, but they didn’t take care of her”. In this context, we note that the family does not accept anyone other than family members as APs.

If we refer to the age of the APs, 21 of the 33 APs are between 26 and 59 years old, and 12 are older than 60. It was also found that most APs are women (26 people) and only 7 are men.

According to Law no. 270/2018 regarding the unitary salary system in the budget sector, the personal assistant is assigned the lowest salary category (secondary education) with the lowest coefficient. Only if the AP has a contribution period in the medical, pedagogical or social assistance fields, can the salary band, salary class and coefficient be changed. Out of a total number of 33 APs that were discussed, 10 APs have higher education studies. It was found that not all APs are paid the same, this is also because they did not contribute to the mentioned fields. These details need to be clarified upon employment with each person hired as an AP.

3.2. Personal assistant files

AP files are kept in the original with the Human Resources specialist within STAS. The files are completed in accordance with HG 314/2012 for the approval of the Framework regulation on the organisation and operation of the ‘Personal Assistance’ social services and the minimum quality standards, as well as with the provision of the Work Code of the Republic of Moldova.

The employee files, in the case of some STASs, also contain other documents. For example, the certificate from the tax inspectorate about the lack of individual enterprise (Bălți), copies of the marriage certificate, divorce papers, military service record, copies of the children’s birth certificates (Telenești), the training staff files were included in the personal file, in the field of work security, copies of  the work record book, supervision agreement, individual professional development plan.

Most of the STASs (22) hired APs for a fixed period (4 months), but in the case of 8 APs the employment period is 1 year (DGAMS Chișinău, DGPDC Chișinău, Briceni, Ialoveni, Anenii Noi, Nisporeni, Ungheni). At the time of the visit, STAS Glodeni had ensured continuity only for the beneficiary where the visit was carried out. It should be noted that 3 STASs did not employ APs, and in the case of 2 STASs, who employed APs for 4 months (Criuleni, Căușeni) the AP was rehired from the seized sources from those who had been suspended due to lack of financial sources. In the case of a beneficiary from Edinet who was visited, it was found that it was passed for funding from seized sources, and in one case from the  Ocnița province the beneficiary was moved to be employed from seized sources at the insistence of the AP to be employed on an entire unit.

3.3.Service provision schedule / record sheet

APs from 31 STASs have a 40-hour work week (8 hours per day, 5 days per week). The exception to this rule is with the DGPDC Chișinău, which, taking into account the legislation in force regarding parents who educate children with disabilities, decided to establish a shorter work schedule (7 hours per day, and, instead, they included work hours for Saturday (+6 hours). If these parents had a job with other organisations, they would benefit from the 35-hour work week, without having to work 6 hours on Saturday. In the case of employing parents as APs, compliance with this legal provision is limited to submitting monthly reports for 7 hours a day, 35 hours a week. The work week for APs employed for 0.75 units is 30 hours per week (6 hours per day). All the APs within STAS Telenești have this work schedule.

According to the operating regulation of the AP service and the minimum quality standards, the service provider organises the initial professional training before employment. Even if the AP files include the training certificate, the heads of the APs mentioned that the initial training did not take place, taking into account all the subjects of the curriculum, but only on the subjects related to completing the daily, weekly, monthly reports, the responsibilities according to the job description, compliance with the working hours.

Completing the daily, weekly and monthly record sheets represents a real challenge for some APs who experience difficulties in the completion process. It was found that all 33 monitored beneficiaries had in their files the monthly reports completed by the AP, the daily reports completed by the AP in 25 cases and only in the case of 3 STASs are the weekly reports also used (DGPDC Chișinău, Șoldănești, Taraclia). The heads of the APs mentioned that they recognise the formal completion of the weekly sheets, which is why they gave up doing them. The forms developed by the service providers in the 33 UATs are different. The need to discuss this order was mentioned in order to use tools that are easy to fill out by the APs, but which should be developed as appendices to the regulations of the operation of the AP service. The monthly report is presented by the AP to the head of service at the end of each month, this being an opportunity to discuss with the head of service.

Figure 1. Reporting forms used by STASs

Report type	Daily report	Weekly report	Monthly report
Number	25	3	33

3.4. Forms of personal assistance

The framework regulation for the operation of the personal assistance services and the minimum quality standards stipulates that personal assistance services can be provided in the following ways:

1) Partial replacement – when the person can perform part of the activity, but needs help to complete it

2) Complete substitution – when the person cannot perform an activity, and it must be completely performed by the AP

3) Accompaniment – when the person has the physical ability to perform the activity but cannot perform it due to mental or sensory disabilities.

Regarding the form of assistance applied by the service provider, of the 33 beneficiaries admitted to the AP service, the ‘full’ form of assistance is assigned even if the person can perform some activities entirely or with the assistance of the AP.  Often, the AP does not involve the beneficiary in the tasks that they can do, under the mistaken understanding that the AP has to do all the tasks. The AP’s responsibilities are to encourage, involve the disabled person in carrying out those tasks, or parts of the tasks that they can carry out.   From the conclusions reached as a result of the discussions with the beneficiaries, we find that, at least for 17 beneficiaries, the form of full replacement must be replaced with partial replacement and accompaniment. Thus, the service provider will emphasise the involvement of the beneficiary in carrying out the tasks and accompanying the beneficiary in the community. From the interviews with the heads of the AP service, we find that there is confusion in assigning the forms of personal assistance. The establishment of the replacement form according to the observation sheet applied to 33 cases is reflected in Figure 2.

Fig. 2 Forms of personal assistance

Form	Partial replacement and accompaniment	Total replacement
Number	11	22

An accurate assessment of the beneficiary’s needs helps determine the support services included in the individualised support plan. In this regard, the heads of the AP service need training, in order to correctly prepare the documents related to the AP service.  Thus, during the monitoring process, it was noticed that the services planned and reflected in the report sheet do not correspond to reality. For example, the beneficiary immobilised for 3 years who needs 24/24 personal care services, only 2 hours of care (food, dressing, hygiene) are indicated in the report instead of 3 hours of household tasks, one hour of mobility, 2 hours of supervision of the beneficiary’s behaviour. There is a gap between what the person reports and what the AP achieves. In another situation, for example, with the beneficiaries in Glodeni, Drochia, blind people are treated as immobilised people, for whom the AP carries all the activities.

Regarding the place of provision of AP services, 5 cases of inclusion in general education institutions can be mentioned, of which, at the time of the visit, 3 beneficiaries were included in the educational process with support teaching staff, and the personal assistants were not with the beneficiaries.

3.5. The opinions of the Personal Assistants regarding the services provided

As a result of the discussions with newly employed APs, the main conclusion is that they know their duties and responsibilities, because even before employment they did the same thing, taking care of the disabled person in their family. The only difference is that the AP has to fill in the timesheets.

The training they had on hire helped them better understand how to complete the record sheets for the AP services provided and the actual time spent on them.

From the interviews conducted with the APs, the STAS specialists identified various difficulties in the process of providing AP services, as follows:

• insufficient knowledge and skills regarding the management of the problematic behaviours of the beneficiaries
• lack of knowledge about the methods for preventing bedsores
• lack of rehabilitation services (for people who have suffered strokes)
• lack of social services (for example, Day Centres for disabled children, etc.)
• concern about the lack of funding to continue providing the service
• disagreement with the withdrawal of the carer’s allowance in general, even during the AP’s leave

In general, APs have expressed an understanding with reference to being employed for only 4 months, but they hope that financial sources will be identified to ensure continuity. For mothers who are employed as APs to their own children, it is important that the family budget increases and that these resources are used for the needs of the beneficiaries. The parents do not agree with the withdrawal of the care allowance given the fact that the child is also given assistance after the considered working hours, including on days off. An AP mentioned “… it seems incorrect to me that the care allowance in withdrawn, because the person is in the family 24/24, 7 days a week, and during the AP’s leave, the care allowance is not restored”.

Mothers value their status as an employee because it gives them more opportunities: the right to a pension plan, health insurance policy.

Adult beneficiaries who require support have greater trust in those close to them, and the AP salary represents a financial addition to the family.

At the same time, there are cases where family members turn to STAS with the request to hire an AP from outside the family, citing the state of exhaustion the family is going through: “When I was taking care of my wife, I couldn’t do anything in the household. Now I am looking for a job and the AP is taking care of her”. Another AP states: “The personal assistant status gives me the opportunity to attend seminars, to meet other parents”.

4. Main findings and recommendations

The monitoring visits, analysis of documents and interviews conducted prove the following:

• The majority of the STASs (22) hired APs for a fixed period of time (4 months), only in the case of 8 APs was the employment period of 1 year (DGAMS Chișinău, DGPDC Chișinău, Briceni, Ialoveni, Anenii Noi, Nisporeni, Ungheni, Glodeni).
• The beneficiary files and the AP files correspond to the framework regulation and minimum quality standards. AP heads know what documents these files must contain, but sometimes they also provide other documents which are not relevant, and this involves additional effort on the part of the APs,
• All the STASs follow the procedure of admission to the AP service, involving multidisciplinary teams of specialists from both level I and level II. At the same time, it is noted that the approach to disability remains medical. In the AP admission process, the order from the request register was adhered to, and the 4 – month period created difficulties for the service provider, to obtain the agreement from the provision of service for a fixed period (4 months), without a guarantee of continuity.
• Out of the 33 monitored cases, only 3 APs are from outside the families with disabled people (AP beneficiaries), and in the case of 30 AP beneficiaries’ family members were employed (mothers – 15, wives – 7, husbands – 3, daughters – 3, sons – 2). In some cases, the age of the AP is higher than 64 years old, which influences the health status of the AP.
• 32 APs were employed per unit, the exception being STAS Telenești, which hired APs for 0.75 units, arguing that the other units employed within the STASs were employed under similar conditions.
• APs from 31 STASs have a 40-hour work week (8 hours per day, 5 days a week). The exception to this rule is within DGPDC Chișinău, which, taking into account the legislation in force regarding parents who educate children with disabilities, decided to establish a working schedule reduced by 1 hour (7 hours per day) instead they established hours of work for Saturday (+6 hours). In this case, as well, 40 hours are worked per week. The work week for AP employees for 0.75 is 30 hours per week.
• In the process of discussions with employees (head of service, APs) it was found that the terminology used in relation to people with disabilities is devaluing. Most of the time the approach to disabled people is medical, the person is seen as ‘sick’, ‘bedridden’, ‘vegetable’, the person’s diagnosis is discussed, but not their abilities.
• The discussions carried out highlighted the need for training both the heads of the AP service and the personal assistants. The answers to many questions accumulated in the process of providing the service (regarding legal aspects, assessment of needs, completion of daily, monthly, weekly forms, preparation of PIA etc.) can be clarified following the training.
• AP training is the responsibility of the heads of the AP service, but they are experiencing difficulties regarding the initial and ongoing training of the personal assistants, due to the fact that they themselves have not taken part in training since 2016, and some of them have never taken part in any training at all.
• The environment in which the disabled person lives is not adapted to their needs and the beneficiary is not provided with the necessary devices to assist them. During the visits, situations were identified when the beneficiaries lacked certain devices, which would help them to be more independent, and for the AP this would ensure safer work conditions.

As a result of the monitoring of the situation regarding the provision of the AP social services and the analysis of the observation sheets, and interviews with the interested parties, the following recommendations were given:

• ensuring the continuity of AP services created from seized sources by the allocation by ANAS of additional financial resources
• development of a set of standardised tools for assessing the needs of people with disabilities, monitoring, etc., to ensure a more efficient operation of the AP service
• informing the APs about the legal framework regarding payroll, the use of holidays
• planning of financial resources by service providers to ensure the initial and continuous training of specialists, who will ensure the functionality of the AP service, including the APs
• organizing initial and continuous training courses for AP service managers
• organising initial and continuous training courses for APs, based on the curriculum and course support approved by MMPS
• involvement in carrying out the training of practical trainers from the social and medical fields, which meet the training needs of the APs
• compliance with the procedure for admission to the AP service, based on case management, assessment of needs by the provider and the involvement of the multidisciplinary team of specialists
• informing and encouraging parents, who take care of children with disabilities and who are employed as APs, to approach the state bodies to ensure their rights are considered;
• involvement of APL in accommodating the space and providing devices to assist people with disabilities

Abbreviations

ANAS: National Social Assistance Agency

ASC: Community Social Assistance

AP: Personal Assistance

APL: Local Public Administration

CMC: Chișinău Municipal Council

CR: District Council

MMPS: Ministry of Work and Social Protection

STAS: Territorial Structure of Social Assistance

UAT: Administrative - Territorial Unit

DGPDC: General Directorate for Protection of Children’s Rights

DGAMS: General Directorate of Medical and Social Assistance

Footnotes

1. Note: The eligibility of the person with severe disabilities for the service is determined by the service provider based on the recommendation of the National Council for the Determination of Disability and Work Capacity, as well as the assessment carried out by the multidisciplinary team of specialists ↩