Promoting Active Ageing in Lithuania

3. Integrating older people in social life

Lithuania scores poorly on the Active Ageing Index (Figure 1.2.) which provides a general picture of older people’s capacity for participating in all areas of life. It has the lowest score of all European OECD countries in the social participation domain. Moreover, it is also among the lowest-ranking countries in the domains assessing the preconditions that need to be fulfilled for older people to be able to realise participation, that is, the domains of independent, healthy and secure living, and of capacity and enabling environment.

The improved social participation of older people is an important policy priority in Lithuania as it is included as a policy goal in several strategic policy documents. Implementation is co‑ordinated across ministries through implementation plans, each covering only a couple of years of the full period covered by the strategy. These implementation plans contain a more detailed set of initiatives and connected indicators and targets. Yet, targets often refer to procedural outputs (e.g. the number of people enrolled in a programme) whereas outcome indicators are essential to assess effectiveness and efficiency of an intervention, and therefore are key to developing evidence‑based policies. In addition, the situation of older people is not always monitored separately, making it difficult to assess the progress being made in improving their lives in some areas. The wide variation in initiatives in the area of active ageing, often situated at the local level and in the form of temporary and relatively small-scale projects, offers an opportunity to assess the effectiveness of various types of interventions.

3.1. Healthy ageing and resilience

Bad health is an important barrier to older people’s social participation. However, older Lithuanians are in relatively poor health while services and assistive devices that allow older people with disabilities to lead active and independent lives remain underused.

Older people in Lithuania are in poor health compared to those in other OECD countries. Life expectancy at age 65 is among the lowest and is even the lowest for men. Older Lithuanians have the poorest perceived health in the OECD as only one in ten people aged 65 or older declares to be in good or very good health. The share of older people reporting that they are limited in their daily activities due to health problems is higher in Lithuania than in the OECD on average. Around a quarter of older Lithuanians report having difficulties in executing activities of daily life or instrumental activities of daily life, which is around the OECD average (OECD, Forthcoming[9]). Yet, these difficulties are more likely to translate into a loss of capacity in Lithuania as half of the older population reports an unmet need, meaning that they do not receive the help they need with an issue, compared to four in ten older people on average across 22 OECD countries (Figure 3.1).

Figure 3.1. Half of older people have unmet long-term care needs, substantially more than in most other countries

Note: A need is considered unmet if a person reports difficulties with activities of daily life (getting dressed, bathing, eating…), instrumental activities of daily life (cooking, shopping, using public transport,…) or other basic activities (walking, sitting, climbing stairs,…) and declares either to receive no help with these activities or to receive help that does not meet their need all the time. The green bar represents the unweighted average of the 22 OECD countries shown.

Source: OECD calculations based on the Survey of Health, Ageing and Retirement in Europe (wave 8).

Older Lithuanians’ lifestyles are relatively unhealthy and half of deaths in Lithuania are linked to lifestyle factors. The share of overweight older people is elevated because of comparatively less healthy diets and lower levels of physical activity. Older men are also much more likely to smoke in Lithuania than in the OECD on average. Moreover, one in five older people fell in the last six months – the highest share in the OECD – and one‑third is afraid of falling, which can discourage people from living active lives, particularly when pavements are uneven or slippery due to weather conditions. Local public health bureaus are active in lifestyles and preventive health, although they have taken few initiatives in relation to falling prevention in recent years.

While the use of medical specialists and dentists is below average, hospitalisation rates of older people are very high despite older people generally preferring other forms of healthcare. Insufficient availability and affordability of health and dental care services do not form major obstacles to using these services.

Through provision of services, adaptions of the physical environment and provision of aids, the impact of disability and disease on a person’s functioning and capacity to live independently can be reduced. Although steadily rising, the use of long-term care services at home – personal care, domestic help and meals-on-wheels – remains very low despite a commitment to facilitating people to stay in their own homes for as long as possible (Figure 3.2). Prices of specific long-term care services differ strongly between municipalities. In addition, the use of assistive devices is limited in Lithuania compared to the other OECD countries included. Few older people with walking difficulties use a wheelchair or mobility scooter, although canes and walking frames are widely used. However, walk-supporting and walk-replacing aids are not substitutes, but rather complements providing mobility in different situations. Personal alarms, which provide easy access to help for people living independently, are barely used.

Figure 3.2. Limited use of personal care and domestic help at home

ADL: Activities of Daily Life, IADL: Instrumental Activities of Daily Life.

Note: A limitation refers to any difficulty a person has in executing a one activity from a list of 14 activities as a result of a physical, mental, emotional or memory problem. The 14 activities cover six ADL (getting dressed, walking across the room, bathing, eating, getting in/out of bed, going to the toilet) and eight IADL (cooking, shopping, making a call, taking medicine, doing work around the house or garden, managing money, leaving the house independently and using public transport, doing laundry). The green bars represent the unweighted average of the 19 OECD countries shown.

Source: OECD calculations based on the Survey of Health, Ageing and Retirement in Europe (wave 8).

3.2. Housing and transport

To meet with others, people must be able to move around in their own homes, their neighbourhoods, and the wider environment. However, very few older Lithuanians live in adapted homes despite their relatively poor health, and public transport in rural areas is not accommodating to older people’s needs.

Living alone is very common among older people, and in particular older women, in Lithuania. Of all people 65 and over, 42% live alone, and even 50% of women in this age group. At the same time, the share of older people living in multi-generational households is also above average at 20%.

Home ownership rates are very high among older Lithuanians, but homes are not very adapted to older people’s needs. Of people aged 65 and over, 96% own their own dwellings. At the same time, over ten percent lack basic sanitation in their homes, such as a bath or shower or an indoor flushing toilet. In terms of adaptations, Lithuania is consistently among the countries with the lowest shares of older people living in houses with certain adaptations among 22 European OECD countries, and it has the lowest use of kitchen adjustments, door and corridor adjustments, ramps and stair lifts (Figure 3.3). Moreover, few homes are equipped with warning systems such as alarms, sensors and buttons. While, in principle, housing adaptations are free of charge, the low take‑up rates may be linked to administrative requirements and the long procedure via a municipal commission even for rather simple adaptations and by a lack of knowledge about the possibilities for housing adaptations.

Figure 3.3. Few older people live in adjusted homes

Note: The green lines represent the unweighted average of 22 OECD countries, those shown with the addition of Austria, Belgium, the Czech Republic, Denmark, Greece, Israel, Italy, Luxembourg, Poland, Slovenia, the Slovak Republic and Switzerland.

Source: OECD calculations based on the Survey of Health, Ageing and Retirement in Europe (wave 8).

Older Lithuanians feel very unsafe in their own neighbourhoods. Of people aged 65 and over, 44% declare feeling unsafe or very unsafe walking alone in their local area after dark, double the average of 24 European OECD countries and a significantly higher rate than in any other country included in the analysis. Feeling unsafe is unlikely to be related to criminality as older Lithuanians generally perceive their neighbourhoods as being free from problems of crime, violence or vandalism and personal experiences with burglary or assault are limited in international comparison. Hence, feeling unsafe is more likely to be related to quality and accessibility of infrastructure and the high rate of older people having recently experienced a fall. Hence, providing more benches may help older people feel safer going out, alongside accessible pavements, street lighting and public toilets.

Lithuania has a rather large bus fleet and the cost of bus travel is heavily discounted for older people, but access and timetables are likely important obstacles for older people to use public transport. Access to public transport stops for those aged 65 and over is lower in Lithuania than in any other OECD country, with older people in rural areas being much less likely to have a bus stop within walking distance. Moreover, timetables in rural areas are particularly designed for people commuting to work and for school children, with services in the morning and the late afternoon, but are less accommodating to the needs of older people who often do not need to be at their destination for a full day (e.g. traveling for a medical appointment, for shopping or for a social gathering).

3.3. Financial and social resources

Social participation requires both financial and social resources. Basic needs must be fulfilled before people can use available financial resources for participation in social activities. Moreover, a social network not only provides people with opportunities for personal contact, it can also help people access benefits or services.

Older people in Lithuania have very low disposable incomes and a very high risk of relative poverty compared to other OECD countries. The average income of those aged 66 and over is 71% of that of the total population, and it is only 66% among people aged 76 and over. In comparison, these rates are 88% and 80%, respectively, for the OECD on average. Among people 66 and over, 25% live in relative poverty, measured as having an equivalised disposable income below 50% of the median, compared to 14% in the OECD on average and compared to 16% in the total Lithuanian population. Older women have an elevated relative poverty rate (32%, more than double the OECD average), whereas relative poverty of older men (11%) is around the OECD average (Figure 3.4). Women’s higher likelihood of living alone explains about half the gender difference in relative poverty rates, with 57% of older women living alone having an equivalised disposable income below the relative poverty threshold. Material deprivation rates confirm this picture as 26% of Lithuanians aged over 66 are unable to afford at least three items of a nine‑item list compared to 11% among European OECD countries.

Figure 3.4. Lithuania has the largest gender gap in relative income poverty among older people

Note: OECD is a weighted average, excluding Colombia. Data are for 2018 with the following exceptions: 2019 (France, Sweden), 2017 (Denmark, Hungary, Switzerland) and 2016 (Netherlands).

Source: OECD (2021[10]), Pensions at a Glance 2021: OECD and G20 Indicators, Table 7.2, https://doi.org/10.1787/ca401ebd-en.

The Lithuanian pension system consists of a complex combination of separate benefits. In addition to a points-based earnings-related scheme, first-tier benefits include a contribution-based basic pension, a minimum pension (the pension supplement), several safety-net benefits and a supplement for single pensioners. The pension supplement plays a very small role: due to increases in other pension benefits and different indexation rules, the top-up it provides has eroded and the supplement is likely to become obsolete. A modest supplementary benefit is paid to all single people who reached the statutory retirement age. The social-assistance old-age pension is only available to people who reached the statutory retirement age but cannot claim a contributory pension, although the benefit exceeds that of social assistance benefits provided under the Law on Cash Social Assistance for Poor Residents. The combination of the social assistance old-age pension and the supplementary benefit for single people together result in a benefit of 13% of gross average earnings, while on average across the OECD, non-contributory benefits equal 21% of gross average earnings.

Contributory pension build-up is modest for low-income earners. The future net replacement rate of a person working a full career from age 22 in 2020 at half of average earnings (i.e. about the minimum wage) equals 44%, the second lowest in the OECD and 30 percentage points below the OECD average. For a person on average wages, the future net replacement rate in Lithuania is 31%, the lowest in the OECD and less than half the OECD average. The pension does not build up linearly in line with career length: no pension entitlements are built up for careers shorter than 15 years; upon reaching 15 years there is a hike in pension entitlements; pension build-up is modest between 15 and 32.5 years worked; and build-up accelerates after 32.5 years. After 45 years of working at the minimum wage, the pension still falls below the poverty threshold.

Participation in cultural or sport activities is low across all age groups in Lithuania, although the fall in participation between those aged 50‑64 and those aged 65‑74 is comparatively high, especially for women, where the decline is the sharpest in the EU. The share of people aged 65‑74 visiting live performances is similar to the EU average, although older Lithuanians are less likely than older people in the EU on average to participate in cultural visits, cinema and sporting events. The most important reasons older people in Lithuania give for not participating are cost, a lack of interest and no availability in the neighbourhood, with 22‑23% of respondents in each of the three categories. Compared to non-participants in other EU countries, older people in Lithuania appear more willing to participate in the activities but have greater availability and cost difficulties.

Older Lithuanians have comparatively few in-person contacts but compensate for this through contacts over the telephone or the internet, which illustrates the importance of telephone and internet connections to tackle social isolation and loneliness. More than 40% of those aged 65 or over are living alone in Lithuania, compared to 32% for the 23 European country average (Figure 3.5). One‑third of older people sometimes feel lonely in Lithuania and one in ten say they often feel lonely, which is around the average of 22 European OECD countries. Older Lithuanians have limited regular contact, with under 30% of older people getting together with family or friends at least weekly, compared to over half of older people in the EU27. Typically, older people meet with family or friends only a couple of times per month. However, when also including interactions through telephone, mail or e‑mail, older Lithuanians typically have interactions with their close network several times per week, among the highest levels in the OECD. Despite the importance of virtual contacts, high-speed internet access in Lithuania is poor in comparison to other OECD countries, both in general and for those living in rural areas. Only 63% of households in Lithuania have access to internet with fast broadband compared to an average of 87% across 26 European OECD countries; in rural areas 28% of Lithuanian households are covered compared to 64% on average in these OECD countries.

Figure 3.5. A high proportion of older people are living alone in Lithuania

Note: The green bar represents the unweighted average of the 23 European OECD countries shown.

Source: European Social Survey wave 9.

Older Lithuanians have fairly small and homogenous close networks. On average there are fewer than two people with whom older people often discuss things that are important to them, and the age diversity of their networks is below-average. Age‑diverse personal networks better protect older people against social isolation and loneliness as they limit the occurrence of close contacts passing away. Moreover, increased intergenerational contact is a good antidote to ageism.

3.4. Integrating services to improve access

Uptake of several types of assistance provided by Lithuanian municipalities is low, despite existing needs and municipalities usually granting assistance when older people apply for them. Taken together, these findings point at non-take‑up of social services resulting from older people not applying. In close consultation with the Lithuanian Ministry of Social Security and Labour, the integration of social services was selected as the focal point for the collection of good practices, with the aim of reducing the non-take‑up of services among older people. This would improve active ageing as it would facilitate older people to live longer in their own homes and participate in the community. The good practices analysed are preventive home visits in Denmark (Hjørring), customer guidance in Finland (Tampere) and reablement in Sweden (Eskilstuna).

Having a single contact point for older people to request assistance is vital to service access. In all three good practices, a single contact point provides information on services available and eligibility conditions and forwards the case to a case manager as needed. The contact point in the three countries has separate procedures to deal with people seeking information or assistance for themselves and to deal with others, such as friends or neighbours, expressing concern about someone. Subsequently, a single case manager is assigned who follows the individual needing assistance. This way, the case manager can build a trustful relationship with the older person which allows for a more open conversation about needs and preferences. The case manager then develops a service plan together with the older person, with both agreeing on an integrated service package consisting of both social services and housing adaptations, and its price. Once the service package is agreed upon, the case manager acts as an intermediary between the older person and the service providers, and co‑ordinates service delivery.

A home visit allows the case manager to develop a better overview of the needs of the older person. Not only can the case manager see the conditions the person lives in, and therefore see which types of assistance are needed, but the home also provides a more personal and private environment for an open conversation about needs and preferences. When an older person seeks any form of assistance, a home visit contributes to the development of a comprehensive support package that overcomes different obstacles to independent living and social participation. Home visits can also be used preventively, in which case they are targeted to specific vulnerable groups (e.g. people who recently widowed or returned from a stay in hospital, or people who have sought assistance before) or offered to a broader section of the older population, such as all people over a specific age (e.g. 80 and over). The level of targeting of specific sub-populations for preventive home visits determines both the staffing resources required and the extent to which people with needs can be identified.

Setting up a system with a one‑stop shop, a single case manager and home visits requires some resources. First, there is a need for training of the administrators working at the single contact point and the case managers. As these workers will be covering multiple areas of an older person’s life, they should know the various services that may be useful to older people in the municipality, their application procedures and their eligibility criteria. Furthermore, some Danish educational institutions offer courses specifically on executing home visits, training the case managers involved among others in recognising not only care needs but also risk factors for loneliness or other more complex needs. Second, the system requires more financial resources at the first moment the older person contacts the municipality for support. All three good practices entail higher costs at first but are estimated to start generating savings as of one to three years later due to the needs being detected earlier on and assistance therefore being more effective in preventing or slowing down deterioration of the older person’s condition. Third, an integrated IT system is needed that facilitates not only the evaluation of an older assistance‑seeker’s application for various types of social services but also the monitoring of the person’s condition and needs once receiving assistance. That would allow for an earlier detection of new needs in service recipients, an easier application procedure to expand service delivery and therefore a faster intervention.

The co‑ordination of eligibility criteria across services and housing adaptations offered facilitates their integration into a single service package. A single eligibility check is used across services, which facilitates the compilation of the service package and simplifies the procedure to add extra services to the service package as needed. This also implies simplifying the procedure for housing adaptations at least for minor adaptations (see Section 3.2). One way to improve the co‑ordination of eligibility criteria is through “nesting” meaning that for some services specific eligibility criteria are added to a basic set of eligibility criteria applying to other services.

Public Health Bureaus provide a wide range of preventive health programmes for older people. Both the lectures and activities they provide offer opportunities for social service representatives to engage with older people and inform them of the types of assistance that are available. Using these events as a platform for informal contact between older people and social service representatives may reduce the threshold for applying for support.

Box 3.1. Key recommendations to improve the integration of older people in social life

Key policy recommendations to strengthen evaluation procedures:

• Evaluate initiatives based on outcomes to assess their effectiveness and efficiency.

• Compare outcomes across initiatives, making use of the wide variation in initiatives to evaluate which ones work better than others.

• Treat older people as a separate group in evaluations, assessing whether initiatives are effective to improve active ageing.

Key policy recommendations to reduce the negative impact of health and unmet needs on social participation of older people:

• Boost local public health bureaus’ efforts to promote healthy lifestyles and reduce falling. This can be done by providing more funding, developing an evaluation framework to assess the effectiveness of health bureaus’ interventions and sharing evidence‑based good practices between public health bureaus.

• Provide a procedure for healthcare workers to flag whether an older person may need support services. This could happen through an integrated platform for social service delivery accessible to healthcare and social services staff involved in the care for a person, or an online tool where healthcare workers can express their concern about an individual to the municipalities’ social services staff.

Key policy recommendations to eliminate barriers to social participation of older people in the areas of housing and transport:

• Allow for minor housing adaptations without municipal commission approval.

• Ensure some public transport connections outside commuting periods.

Key policy recommendations to reduce financial and social barriers to social participation:

• Increase pensions of low-income earners and simplify the pension entitlement structure.

• Organise activities that explicitly aim to bring people across generations together.

Key policy recommendations to improve the take‑up of the various types of support available to older people:

• Create a one‑stop shop for social services and housing adaptations for older people.

• Assign a case manager to make a service plan and monitor the older person.

• Perform a home visit for a full assessment of the life situation when an older person seeks any form of assistance.

• Co‑ordinate eligibility criteria and application procedures for social services and housing adaptations.

• Proactively contact older people at critical moments in their lives to check if they need assistance.