This chapter covers the integrated and/or joint approach to health and social security through preventative, recuperative and palliative measures; this entails participation and collaboration between various social partners, civil society and the State (which is the key driver).

It also covers the benefit granted to persons in a state of dependency.

In what situation can I claim?

Persons may turn to the units and teams of the Rede Nacional de Cuidados Continuos Integrados (RNCCI) [National Network for Long-term Integrated Care] in the following circumstances:

• Temporary functional dependency resulting from recovery or other dependency;
• Prolonged functional dependency;
• Elderly persons meeting certain vulnerability criteria (dependency and illness);
• Severe incapacity, with severe psychological or social consequences;
• Severe illness at an advanced stage or terminal illness;
• Children with various degrees of dependency not requiring hospitalization but for whom home care is not feasible or not recommended (hospital and ambulatory care units for paediatric care).

The following may claim the Dependency Supplement [complemento por dependência];

• Recipients of disability, old-age or survivor's pensions under the general social security scheme and the voluntary social insurance scheme;
• Beneficiaries of old-age and survivors’ pensions under the non-contributory scheme and equivalent;
• Recipients of the Social Inclusion Benefit
• Non-pensioners in the aforementioned schemes with permanent disability subject to coverage by the special disability protection scheme;

What conditions do I need to meet?

RNCCI

If you are receiving inpatient care at a hospital in the SNS [National Health Service] network ;

Healthcare professionals in the hospital in which you are staying analyse the situation of the patients in view of a potential admission to the RNCCI.

Referral of the patient may be made from the beginning of hospitalisation up to four days before the planned discharge date.

The proposal for a recommendation is sent to the discharge management team (EGA) of the hospital, which must examine and confirm all information at the time of discharge.

Having verified the information, the EGA sends the admission proposal to the local coordinating team (ECL).

If you are at home, in a private hospital or in other institutions or establishments, you are referred to family healthcare units (USF) and personalised health care units (UCSP) whose professionals will carry out the relevant analysis.

The admission proposal is sent to the ECL.

If you are (or know someone who is) in a state of dependency requiring continuous healthcare and/or social support, you should contact the health care units in the community (UCC) in order to report to the USF and UCSP the situation regarding patients who can be referred to the RNCCI.

Dependency Supplement

If you need the assistance of a third person for:

• Household chores;
• Feeding yourself;
• Mobility;
• Taking care of personal hygiene.

The supplement for the first degree of dependency is paid to persons who are unable to perform autonomously essential activities of daily living such as feed themselves, move around or maintain their personal hygiene.

The supplement for the second degree of dependency is paid to persons who, in addition to meeting the above criteria for the first degree of dependency, are bedbound or have been diagnosed with severe dementia.

What am I entitled to and how can I claim?

RNCCI

If you are staying at a Unidade de Convalescença [Convalescence Centre] (UC) or in a Unidade de Cuidados Paliativos [Centre for Palliative Care] (UCP-RNCCI), which are part of the National Network of Palliative Care (RNCP) then you are not required to pay for this service.

If you are staying at a Unidade de Internamento de Média Duração e Reabilitação [Medium-term Rehabilitation Centre] (UMDR) and/or a Unidade de Longa Duração e Manutenção [Long-term Maintenance Centre], you only need to pay the proportion of costs that corresponds to social assistance, which may nonetheless be partially or fully reimbursed by the social security system after assessment of the household income (means-test).

In the UC and UCP-RNCCI the costs of continuing integrated healthcare are covered in full by the Ministry of Health.

In the UMDR and the ULDM the costs of continuing integrated health care are covered in full by the health and social security sectors.

The amount due by the user depends on household income, for which the procedure is carried out by the social security representative of the local coordinating team of the RNCCI.

All expenses not constituting part of the agreed package of care and services are the sole responsibility of the user whenever these additional services are requested by the user.

Dependency Supplement

The amount of the supplement for the first degree and the second degree of dependency differs according to whether the beneficiary is covered by the general social security scheme (50 or 90% of the social pension) or by other social security schemes (45 or 85% of the social pension).

It is paid for as long as the state of dependency lasts and for as long as the associated pension is being received (assuming the person qualifies for the supplement on grounds of the pension).

It may be claimed by dependant beneficiaries themselves or by their family members or by other persons or institutions that are caring for them or intending to care for them.

The claim for the supplement must be submitted to the Social Security Institute's customer service department or to the institutions stipulated in the relevant international social security instruments or, failing this, to the institution that is managing the respective pension fund in the case of beneficiaries who are resident abroad.

Jargon busters

• Long-term integrated care: this is a package of interventions in the areas of health and/or social support resulting from joint evaluation and focusing on overall recovery, which is understood to be the active and continuous therapeutic social assistance process aimed at fostering autonomy and enabling the person in a state of dependency to function more successfully, through rehabilitation, readaptation and reintegration into family life and society.
• Palliative care: this is inpatient care or home care provided by specific units or teams to patients who are suffering from a severe and/or incurable illness that is at an advanced stage and progressing, with the aim of fostering the patient's well-being and quality of life.
• Dependency: this is a state in which the person cannot independently perform activities of daily living, owing to a lack or loss of physical, psychological or mental autonomy, resulting from or aggravated by chronic illness, dementia, post-traumatic sequelae, disability, severe and/or incurable illness at an advanced stage, absent or limited family support, or something similar.
• Chronic illness: this is a prolonged illness with gradually worsening symptoms that may leave the person incapacitated. These illnesses have a very negative impact on the patient and those around them. Although there is no cure, the illness may be improved or counteracted.
• Functionality: this is a person's capacity for performing everyday tasks and for interacting with the surrounding environment, at all times.
• Multidisciplinary: combining complementary measures from different professional specialities in a common approach.
• Home: a private residence, an establishment or an institution where the person in a state of dependency habitually resides.
•  Household: people who share meals and dwelling and who have links between them are considered members of a household.

Forms you may need to fill in

• CCI 1-DGSS: Certificate of Social Security Subsidy for Services provided by the National Network for Long-term Integrated Care
• CCI 2-DGSS:Claim for modification of household income.
• RP5027 - DGSS: Claim for Dependency Supplement/Review of Degree of Dependency,
• RP5074 - DGSS: Declaration on Incapacity Caused by Third Parties when dependency is caused by third parties.

These forms can be found on the Social Security website

Know your rights

The links below define your entitlements in accordance with Portuguese law. They are not European Commission links, nor do they represent the Commission's position.

• Guia prático - Rede nacional de cuidados integrados [Practical guide - National Network of Integrated Care];
• Guia prático - Complemento por dependência [Practical guide - Dependency Supplement].

Commission Publication and Website:

• http://ec.europa.eu/social/main.jsp?catId=849&langId=pt.

Who do you need to contact?

You can obtain further information through one of the following:

Social Security Line: 300 502 502 / 210 545 400

Personalized service: Monday to Friday from 9:00 am to 6:00 pm, excluding public holidays

Automated reply system: 24/24, 7/7

From abroad: +351 300 502 502 / +351 210 545 400

Social Security website: www.seg-social.pt.

Consult Segurança Social Direta [Social Security Direct].