In the absence of a unified LTC system in Brazil, LTC services are provided through health and social care systems separately, and in a few instances, jointly. These are mostly delivered through the Family Health Strategy (FHS). For example, those who are bed bound may receive home visits from healthcare professionals and community health workers routinely. LTC may also be provided via high and medium complexity home care services through the program “It is better at Home” (Melhor em Casa). Those who are registered with this service have continuous support from the care home teams via routine appointments and via telephone if needed. Services offered to older people should follow the guidance stated in a document that establishes an integrated care pathway for older people in the SUS (Brazilian Ministry of Health, 2018e, 2019d, 2019h).

As part of SUS, people living with disabilities should receive integrated healthcare such as rehabilitation, basic and complex treatments, etc. (Brazilian Ministry of Health, 2019q). SUAS provides LTC within long-term institutions for people aged 60 years and over who are independent, or who have some degree of dependence, who do not have the means to live in a family environment, in their own home, or who have suffered abuse, violence, negligence, or abandonment. However, moving to those institutions are considered by the government a measure of last resort and the number of bed available are very limited (Brazilian Ministry of Citizenship, 2015).

The SUAS also provides the “Special Social Protection Service for Disadvantaged People, Older People, and their Families” (Serviço de Proteção Social Especial para Pessoas com Deficiência, Idosas e suas Famílias). This service aims to help older people with some degree of dependence, people living with disabilities, their carers, and those who have suffered violation of their rights (for example: lack of proper care from their carers, discrimination from family members, high level of stress from the carer etc.). The service aims to identify the needs of the older persons and their carers and make it feasible for them to access cash transference programmes, cultural and leisure activities, and public policy services. The service is offered by professionals and may be delivered in patients’ homes, day centres, Special Reference Centre for Social Assistance (CREAS) or Referenced Units. The service can be accessed following spontaneous demand or by referral from other social-assistance services (Brazilian Ministry of Citizenship, 2014). We could not identify data on the proportion of the population uses the public long-term care system. However, it is known that in 2014, 53,600 older people were living in long-stay institutions affiliated to SUAS (Alcantara et al., 2016).

In Brazil, very often family members are the main providers of care (unpaid care). However, private options such as paid carers, day care centres (getting quite popular in the last years) and long-stay institutions (the most traditional model of long-term care in Brazil, after the provision of care by family members) are available in the country (Alcantara et al., 2016). Data about the size of the private sector could not be found. However, according to data from the Institute for Applied Economic Research (IPEA), in 2017 there were 2,163 long-stay institutions in Brazil (33% were philanthropic, 64% were private and 0.03% were public/mixed) (Camarano, 2017). There are differences in the characteristics of people using public and private institutional long-term care. While some older people live in public long-stay institutions usually because of lack of financial and family support, older people with better financial resources are institutionalized in private institutions mainly when they present more severe health situation (Camarano, 2017).

References:

Alcantara, A. de O., Camarano, A. A., & Giacomin, K. C. (2016). Política Nacional do Idoso: Velhas e Novas Questões. http://repositorio.ipea.gov.br/bitstream/11058/9146/1/Institui%C3%A7%C3%B5es%20de%20longa%20perman%C3%AAncia.pdf

Brazilian Ministry of Health. (2018e). Orientações Técnicas para a Implementação de Linha de Cuidado para Atenção integral à Saúde da Pessoa Idosa no Sistema Único de Saúde—SUS. Ministério da Saúde do Brasil.

Brazilian Ministry of Health. (2019d). Estratégia Saúde da Família (ESF).

Brazilian Ministry of Health. (2019h). Programa Melhor em Casa.

Camarano, A. A. (2017). Cuidados para a população idosa: Demandas e perspectivas.