Demographic aging of population and the social protection system in the Republic of Macedonia

The process of demographic aging has been observed in many of the European countries as well as in the Republic of Macedonia. Based on the UN projections for participation of the elderly in the Republic of Macedonia, it is expected that the number of elderly persons at the age group older than 60 years will increase from 16.5% in 2009 to 33.0% in 2050 and for the elderly aged over 80 years from 2% in 2009 to 6.8% in 2050.This process affects almost all segments of society, but its impact is particularly evident on the system of pension insurance, healthcare as well as on social protection. Adopted international documents and harmonisation with national legislation lead to complete transformation of the system of social protection of the elderly. New scientific knowledge, changes of economic conditions and demographic realities lead to introduction of new social protection principles such as pluralism, decentralization, and inclusion.This paper analyzes both international and national legal framework of social protection of elderly through the segments of introduced innovations, with special emphasis on the rights and services as well as on the assessment of the development of social services in accordance to the needs of elderly people, their availability and efficiency in meeting of individual needs of elderly. Expansion of the programs and implementation of the new scheme of social protection in the area of elderly care represents a convergence to the concept of active aging and to the holistic approach in the process of planning and provision of social services.


Introduction
In the last two decades, the process of demographic aging of the population had serious impact on the population structure in the Republic of Macedonia.The process of population aging has not just been a result of the drastically decreased natural growth but has been also associated with the tremendous growth of the emigration of predominantly young population.According to the latest census of population, dwellings and households (2002), Macedonia 1 has 2,022,547 inhabitants, which is 3.9 percent more than in the previous census (1994).In the period between 1994 and 2010 the birth rates in Macedonia decreased from 16.1 to 11.8 live births on 1000 residents.On the other hand the rates of mortality for the same period have increased to 8.0 to 9.3 on 1000 residents.According to projections (medium variant) of the United Nations (UN) the population is expected to decrease and in 2015 to amount to 2.037 million, to 2.001 million in 2025 and in 2050 to 1.746 million residents.Measured with average population growth from 2010 expected negative growth of 0.04 percent, which continuously will continue in the coming period as the expected decrease in population in the period from 2007 to 2050 by 14.4 percent.
However, in terms of population structure, in 1994, the share of the population aged 0 to 14 years dropped from 33.2 percent to 19.2 percent in 2006, with predictions for a continuous decreases to 15.4 (2020) and 14.4 percent (2030).In contrast, the share of the elderly population increases, from 8.5 percent (1994) and (2006) to 11.2 percent (Chart 1).
Based on the UN estimates the elderly population will increase from 14.0 percent in 2010 to 17.9 percent in 2020 and 22.5 percent in 2030.
Chart 1: Structure of population in the Republic of Macedonia according to age groups Source: Strategy for demographic aging in the Republic of Macedonia 2008Macedonia -2015 Based on the estimates on the structure of population for 2014 it was expected that the share of young population (0-14 years) was 16.8%, while the share of old population (65 and over) was 12.5%.
The changes in the age structure of the population reflect in the number of deaths in the country.In 2014, the number of deaths increased by 2.7% compared to the previous year and amounted to 19,718 deaths.The average age of death for males is 69.9 years and 74.8 years for female.
The decrease in the youth population represents is a serious problem for future demographic, economic, social and technological development of the country and for this purpose the Republic of Macedonia in the near future should comply the economic, social and technological criteria in line with the demographic processes that are taking place in the country.

National legal framework for protection of elderly persons
The current structure of the social security system is a result of the reform processes that have taken place in the Republic of Macedonia over the past few decades, primarily as a consequences of the new created conditions caused by the change in the political and economic system in the early nineties of the last century.
Constitutionally, the Republic of Macedonia is declared as a social state.The constitution incorporates humanism, social justice, and solidarity as its fundamental values, manifesting the state determination and commitment for creating human Social protection of elderly is a complex field, a network of various areas and different levels of actors and service providers, hence legislation covers a series of laws and bylaws among which are the following: Law on social protection, Family Law, Law on prevention and protection of domestic violence, Law on local self-government, Law on facilities, Law on civil associations and foundations, Law on general administrative procedure, etc.
Social protection is provided within the Law on Social Protection which sets forth the basic social risks to which the citizens, throughout life are facing, reduces poverty and social exclusion and strengthens their capacity for personal protection, rights and services of social protection and beneficiaries covered by social protection system.Social protection allowances for the vulnerable families whose overall income reaches bellow the level of decent life, were introduced with the Program for socially endangered population adopted in 1992.Heavy financial constraints due to the economic decline and the rise in unemployment were the serious factors to open a debate on the effectiveness and efficiency of welfare coverage.This debate shifted policy focus from traditional care policies to questions on the poverty-line.The Law attained redefinition of social rights regarding improved realization of social protection programs, in order to ensure better standardization of conditions and procedures in achieving social protection cash transfers rights, better targeting of the most endangered categories of social rights beneficiaries.Also, the process of deinstitutionalization and development of community based services continued with introduction of new types of social services such as independent living support and small group homes.After 2009, a number of amendments were made in regards of social protection legislation.The changes were under the influence of neoliberal doctrine with emphasizing on individual responsibility.In that context the focus was shifted on welfare to workfare approach or from passive to active labor measures and conditional cash transfers were implemented (Bogoevska, Trbojevik, 2014).
The adoption of the Law on family in 1992 set up the family on legal ground for systematic regulation of issues concerning marriage and family.The Family Law is of particular importance for provisions of protection for elderly within the family, more precisely envisages certain obligations for children to provide care to old and incapable parents, in terms of the children's obligation to support their parents who are incapable to work, do not have sufficient means for living or cannot generate sufficient means for living from their property.This law regulates guardianship with the special provision of protection for adults who have been striped or limited legal capability.
Law on prevention and protection of domestic violence (Official Gazette no.138/14) determines measures undertaken for prevention and protection of victims of domestic violence, provides respect for essential human freedoms and rights, life, personal integrity, non-discrimination, gender equality, with particular attention to the interests and needs of the victim.This Law stipulates the measures for prevention and protection of victims of domestic violence, and multi-sectoral cooperation of the relevant institutions and citizen's associations that address this problem.
According to the Law on Local Self -Government, besides the State, the municipalities, the city of Skopje and municipalities of Skopje are the carriers of the social protection.They may, by its own decision, in according to their financial capabilities determine other rights in the area of social protection, rights with greater extent than the scope of the rights determined with the Law on social protection and with better conditions for their implementation as well as other forms of social protection.The Citizens Association that is registered by the MLSP and individuals that have work permits issued by the Minister of Labour and Social Policy, may perform activities of social protection, under conditions and in a manner determined by the Law for Social Protection.Faith-based and religious groups and their associations that are registered in the Republic of Macedonia can assist people who are in need of certain types of social protection.In addition to public, the realization of the system of social protection is accomplished through establishment of private institutions for social protection (Bogoevska, Trbojevik, 2014).
Apart from the above mentioned laws and bylaws, a series of strategic documents covering various aspects of social protection were adopted: National Strategy for Older Persons in Macedonia 2010-2020 is the basic document that identifies priority areas and objectives of action that are going to improve the quality of life of elderly.The Strategy represents a basic framework for the development of measures to implement the concept of active aging and inclusion of elderly.The aim of the strategy is to create an integral and coordinated policy for the protection of elderly in the country Republic of Macedonia regardless of gender, age, place of residence and ethnicity, while observing the right for an individual life.The strategy contains three specific strategic objectives, one of which refers to the improvement of elderly social protection with incorporated measures and activities.The realization of activities envisages inclusion of the different subjects that are to act in compliance with the principles of independence, social activity, self-realization, protection and dignity.
Nationwide, the National Strategy for Alleviation of Poverty and Social Exclusion is the only document that directly addresses the situation of vulnerable groups and priorities for their more comprehensive coverage by the measures and services in the social protection system.
The Program for the realization of social protection in 2015 (Official Gazette no.202/15) determines the areas of social protection, the needs of protection and care, social prevention and means for realization of social protection.This program is harmonizing social protection with the needs of citizens for improvement and development of services and social protection measures, activities related to the harmonization of legislation on social protection with the EU legislation.

Decentralization and pluralism in social care
Profound reforms of social protection system in the Republic of Macedonia were launched through the Ministry of Labor and Social Policy in 2004.The reforms aimed at improvement of quality of social services, inclusion of different stakeholders in provision of social services, which should have provided competitiveness in social service provision and should increased the efficiency of protection of the most vulnerable categories of citizens.
Decentralization of social protection was one of the reform priorities.The decentralization included promotion of noninstitutional forms of protection, promotion of alternative social services, approximation of social services to citizens, thus enabling different legal entities and individuals, including citizens associations to become providers of certain social services in the social protection system.
The Law on Social Protection is supportive for local self-governments to establish institutions for social care for the elderly.The Law enables establishment of centers for daycare and temporary care.The attainment of these functions is based on the establishment of inter-municipal cooperation in terms of establishment and management of common facilities and daycare centers.The Law assumes the possibility of municipality to delegate the responsibilities to other legal entities and individuals, including the civil society organizations active in the area of social protection.
The process of decentralization of social protection institutions for elderly was implemented in the municipalities of Bitola, Prilep, and Kumanovo.In 2005, these social protection institutions that were under the authority of the state were transferred to municipalities, operating as a public social welfare institutions for the elderly.Along with the authority transformation, a permanent fiscal decentralization of facilities for the elderly was conducted.The above mentioned municipalities entered into the second phase of fiscal decentralization, meeting all the statutory prerequisites for financing transfers through block grants.
In order for municipalities, the City of Skopje and municipalities in Skopje to provide services for social protection for the elderly they are required to adopt annual social development programs for the specific needs of the citizens in their municipality, for provision of social prevention, institutional and non-institutional protection and for raising public awareness for the needs of social protection.
The pluralism in the social protection system enabled involvement of private individuals and associations of citizens to establish privately owned institutions for provision of social care and daycare centers for the elderly.This legal incentive initiated establishment of number of private institutions for social protection of the elderly by private entities.
The involvement of these stakeholders in the provision of social protection services assumes: • Development of alternative non-institutional forms of social protection and enrichment in the types of services; • Improvement of social protection for elderly, especially those for which the state failed to provide adequate protection;

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Greater access to all socially disadvantaged individuals, families and population groups; • Convergence of social services to the citizens and involvement of family and civil support in provision of social protection; and • Introduction of competition and improvement of services quality.
The current legislation stimulates multisectoral collaboration in provision of protection of elderly.Namely, the Law on Social Protection stipulates that preventive work is conducted in the Centers for social work (CSW) in cooperation with municipalities, health care institutions and other public bodies, individual and legal entities and citizens' associations.The CSW can direct citizens at risk to use some of the forms of non-institutional care provided by civil associations and private entities.

Social protection for the elderly persons
Social protection for the elderly is provided in the system of social protection through social prevention, institutional care, non-residential care and the right to material assistance within the social protection system.
Social prevention is aimed at taking measures to prevent social risks through educational and counseling activities, developing forms of self-help, voluntary work, and with application of other methods that correspond to needs of the beneficiaries of social protection.
Based on the Social Protection Law institutional care is provided to elderly person that has inadequate living conditions in their biological family or if due to other reasons when any other form of social protection is inapplicable and the person needs to be placed in an institution for social protection.
An Institution for protection of elderly persons can be public or private.Institutions for protection of elderly persons provide accommodation for elderly, adult persons with disabilities and persons with intellectual disabilities that are not capable to take care of themselves and due to the family and housing conditions cannot be provided with other forms of protection.
The institutions for social protection of elderly provide accommodation, food, assistance, care, health care, cultural and recreational activities, social work services, and other services related to the needs, capabilities and requirements of the elderly.The Institutions can organize and non-residual forms of protection such as provision of assistance in the homes and daycare protection for retired persons.The institutional public social protection of elderly persons in the Republic of Macedonia is provided in the following four public institutions: JI nursing home ,, Sue Ryder "-Bitola, JI nursing home "Zafir sites "-Kumanovo; JI nursing home "Kiro Krstevski-Platnik"-Prilep, and the Department "Mother Teresa "-Skopje, which operates within the PHI Gerontological Institution "13th November" -Skopje and operates under the jurisdiction of the Ministry of Labor and Social Policy (Table 1)1 .These institutions have different capacity in terms of provision of protection.Until 2006 these public institutions for social protection of elderly worked under the state authority, but due to the above mentioned process of decentralization were transferred to municipalities retaining the same social function as public social protection institutions for elderly.In regards of funding they receive funds from the following sources: budget of the Republic of Macedonia; charges for the administered services to beneficiaries and funds that are designated from the budget of the Ministry of Labor and Social Policy for protection of beneficiaries accommodated by the Centers for Social Work.
Currently, there are 16 licensed private institutions that provide accommodation of elderly.Licenses are issued by the Ministry of Labor and Social Policy.Professional supervision for the work of public and private social protection institutions for elderly is carried out by the Public Institute for Social Affairs -Skopje.
The involvement of the private sector contributed to significant improvement in the institutional protection of elderly.The accommodation in the public institutions for elderly had capacity of 611 beneficiaries and was insufficient and incompatible with the ever growing demand.So far, with the establishment of the private social protection institutions the accommodation capacity in the country has been enriched for additional 464 places, which adds-up to total of 1075 beneficiaries (Pavlovski, 2013).
Non-residual protection of elderly provided by the center for social work assumes: • Provision of immediate social service to elderly persons at different king of risks; administration of services and material resources as well as referral to available institutions that can adequately address the need of elderly person; • Provision of assistance to individuals administered in a form of professional advice and counseling that will assist the elderly person to acquire additional information and will enable independent decision making, retention and development of personal potentials; • Right on acquiring home care and assistance for elderly, persons with disabilities, persons with moderate, severe and profound mental disabilities who are unable to care for themselves and need care and assistance in meeting their basic existential needs; • Right on acquiring daycare protection for elderly through services such as provision of meals,daycare, cultural and leisure activities, and hygiene activities; • Right to placement in foster care for elderly and adults with physical disabilities and people with mental disabilities who are unable to care for themselves that due to family situation and housing conditions cannot provide protection otherwise.
The Social Work Center is established as a public institution for social protection with public competences for performing works on social protection.SWC are established on the territory of one or more municipalities.In the scope of its public authority SWC, according to the Law on Social Protection, decides on rights envisaged by the Social Protection Law and in terms of implementation of social protection as well as in terms of professional work, the center: Implements and conducts programs and other general acts of social protection, adopted and financed by the municipality, the City of Skopje, and municipalities in Skopje.
Other forms of non-residual protection defined by law are: daycare centers for the elderly, foster care, centers for provision of assistance at home, clubs for the elderly and support for independent living.
The involvement of municipalities, civil society organizations, and municipality branches of Red Cross of Republic Macedonia in the area of social protection of elderly resulted in establishment of seven day centers for elderly people and five centers for providing social assistance services at home for the elderly.
Daycare centers for the elderly are needed for elderly who have health and psychological problems associated with aging process.These beneficiaries have families that due to their work obligations cannot provide fulltime care for them.
The establishment of daycare centers is mainly a result of the established cooperation between the municipalities and the Ministry of Labor and social policy.Such collaboration contributed to establishment of daycare center in the municipality of Vevcani (2013), Gazi Baba (2012), Cair (2012), Centar (2012) and Cashka (2012).It is worth to note that the daycare centers in the municipalities of Cair and Centar are supported by the Red Cross of Skopje and city of Skopje.This form of the non-residential support is applied in the settlements of: Buchim, Bogomila, and Samokov.
The Program for Social Protection in 2015 (Official Gazette br.202/14) envisages enlargement of the network of daycare centers for the elderly in the municipality of Kisela Voda and Novici, as well as additional development of social services for the elderly and disabled persons in places where there is a need and possibility to establish centers for providing assistance in the homes of beneficiaries.
Centers providing assistance in the home of the beneficiary work within the daycare centers in the municipality of Centar and Chair, and center organized by the Red Cross in Kriva Palanka.These Centers apply a more individual approach in their work with the beneficiaries but their work is organized with participation of multidisciplinary team work.
Services in the centers that provide assistance in the home of beneficiaries aimed at: purchasing groceries, preparing food or distributing prepared meals, feeding assistance, assistance for dressing, hygiene maintenance assistance, assistance for timely and appropriate use of medication, care during illnesses, and transportation and assistance for conducting medical checkups at healthcare institutions.
Right to placement in foster care families for the elderly as a non-residual form of protection requires further development.
The right to financial assistance in the system of social protection for older people is realized through:

Conclusion
The Republic of Macedonia is facing serious changes in population structure.The share of the elderly population in the total number of population is at continuous growth causing demographic aging of population.The process of demographic aging increases the need for the main stakeholders within the social protection system to provide social services that are in line to the needs of elderly.
The reform processes of social protection, in the Republic of Macedonia, were initiated in 2004.Predominantly the reforms were focusing on decentralization and pluralization of social protection system.The process assumed improvement in the legal framework for social protection, increasing the efficiency of protection for elderly, continuous promotion of non-residual protection, and enabling various physical and legal entities, including citizen associations, to emerge as providers of certain social services.
These processes have yielded modest positive results regarding the improvement in protection of elderly persons.There is evident need for improvement of social services in social protection for elderly on municipal level, especially in provision of institutional and non-residual protection for elderly.Participation of private legal entities in establishing institutions for social protection of elderly mitigates the problem of lacking of institutional protection for the elderly but there is a need for expansion of existing and establishing new public institutions.
Assessment on needs and develop non-residual forms of social protection for elderly both in rural and urban areas is required.The Program for social protection (2015) assumes opening of new daycare centers for elderly.Daycare centers for elderly, clubs for elderly and centers providing assistance at home should be opened in several cities in the country and should work in partnership with the Red Cross of Macedonia and citizens' associations.
The non-residual forms of social protection of elderly such as protection in foster families and independent living with support are not sufficiently developed.The Ministry of Labor and Social Policy through Social Work Centers and the civil society should engage more intensively in establishing housing units for independent living for older people with support and should stimulate emergence of foster families that should provide protection of elderly.
With the decentralization process in the system of social protection, local self governments should have played a key role in application of the concept of active aging and in strengthening and developing institutional and non-residual forms of social protection for the elderly.They were expected to incorporate more initiatives in their local action programs for social protection and allocate more funds for their implementation.
Multi-sector cooperation between stakeholders in social protection for the elderly should be strengthen through improved mutual coordination and implementation of joint social programs and development of non-residual forms of social services and services for elderly in community.

Bibliography
[1] Analysis of the system of institutional care for the elderly in the Republic of Macedonia for the period 2012-2013 year, the Institute for Social Affairs -Skopje [2] Constitution ("Official Gazette" no.52/1992) ..
[3] Family Law (Official Gazette no. Thus, the establishment of a national poverty line in 1996 was the outcome of a continuous World Bank technical assistance programme which set the conditions to regulate social policies from a macro-economic point of view.Until 1997, the social sector in Macedonia functioned in accordance to the inherited on Law on Social Protection from ex-Yugoslavia, passed in 1978.Changes and amendments of this law were made in 1985, 1991 and 1995, all referring to information and administrative aspects of the provision (Bogoevska, Trbojevik, 2014).In 1997, a new Law on Social Protection was passed which established new approached in dealing with social problems and marked the entry into the next, institutional development phase.The Law on Social Protection passed before the Parliament in September 1997 was the cornerstone for the establishment of a modern social welfare system that took into account both the European principles on social protection and national specifics and needs.The 1997 Law on Social Protection contained a stipulation giving right to the Government to regulate the conditions for the social financial assistance (SFA) by a Governmental Decree.The most significant reforms in the area of social welfare were commenced in 2004 with the changes and amendments effectuated to the existing Law on Social Protection.
National programme for development of social protection 2011-2021, National Strategy for Older Persons (2010-2020), National strategy for reduction of poverty and social exclusion 2010-2020, National deinstitutionalization strategy 2008-2018, National strategy for equality and non-discrimination on the grounds of ethnicity, age, mental and physical disability and sex, National strategy for prevention and protection against domestic violence 2012-2015, National strategy for housing,National strategy for equalization of the rights of disabled persons (revised) 2010-2018 which are fundamental in the provision of social protection for elderly.

Table 1 :
Accommodation facilities in the institutions for social protection of the elderly in the Republic of Macedonia