The evidence suggests that the private long-term care sector is growing. Currently, there are no legal frameworks or mandatory standards of care and evaluation, which means that there is very little information about the types of services provided, their quality, the professions working for them, and their overall impact on the health and wellbeing of the people that live there. Therefore, the actual number of people that use these services and the size of the private sector is unknown, even though it is larger than the public sector.

Private non-profit institutions

Through the 2015 Social Assistance Housing Census, CAAS^[1] (Censo de Alojamientos de Asistencia Social) (INEGI, 2015a), 4,517 permanent housing institutions could be identified. Among these, almost 23% (1,020) are identified as permanent homes or residences for older adults. Regarding the average number of residents per facility, 37% of the total reported an average between 11-20 residents, 23% between 21-40 residents and the remaining 22% reported having between 5-10 residents. Regarding their legal nature, 75% are private non-profit facilities, 8% are public (government funded), 2.3% religious associations, and 2% private for-profit. Most non-profit institutions combine multiple financing sources: user fees (78%), personal donations (56%), private sector donations (32%), donations from faith-based organisations (28%), government funds (38%), and selling products made by the residents (3%).

Most non-profit institutions work under mixed schemes in which they offer free accommodation services for those older people who do not have resources, or a family network that supports them and for those who have some economic capacity. The group consisting of people without resources generally represents most of their residents. For those with economic capacity, recovery fees depend on the available resources of the older person (their relatives can also be charged). Fees are established according to the financial situation of the resident through a socio-economic assessment of the older person and their responsible family members, if there are any.

Private for-profit institutions

There are also private for-profit institutions that offer care to older people. While people become older and very likely disabled during their time in the institution, most have strict admission requirements that up front only admit “independent” older adults with no severe illnesses or disabilities. Their scale, type of services and quality are not documented. The services of private institutions vary in quality and costs. While there are institutions that offer common accommodation services in very small spaces, others offer spacious single rooms with an integrated bathroom. Similarly, non-professional caregivers and auxiliary nursing personnel constitute most of the personnel, with very few licensed nurses being hired. For more specialised and personalised nursing care, some institutions allow the resident or family member to hire external personnel for their care when needed, incurring in an additional cost. In addition, nursing or other specialised care services contracted out (and paid) by family members are sometimes also allowed. Some institutions offer a wide range of additional recreational services and amenities, such as cable television, internet, movies, access to a gym, climate and controlled ventilation or beauty salons.

According to the DENUE, there are 603 private institutions identified as nursing homes and private homes for the care of the elderly. However, there is no additional information to identify if these are private lucrative or non-profit organisations and as a result, the precise number of private for-profit institutions in the country is unknown. Great diversity was found in the total number of private institutions registered in each state of the country (INEGI, n.d.-b).

Private Community Care

There is an increasing market of private day centers and incipient services for care aides at home. However, since no regulatory framework or agency establish care standards, monitor, or evaluate the services which are in place, little information on their number and how they operate is known. There are some at-home personal assistance (not qualified medical care) services provided by private for profit companies. The range of services usually cover from basic personal company services (inside and outside the home), support with activities of daily living such as feeding (but not cooking), bathing, basic nursing activities and physical therapy or rehabilitation. While these services are being offered in Mexico’s largest cities, the costs are very high and only accessible to a very small percentage of those who can benefit from them (López-Ortega & Aranco, 2019). On the other hand, the lack of regulation and standards to overlook these services generates a wide variety with respect to the quality of services provided (including the training and skills of hired personnel), from highly standardised and monitored U.S. franchises operating in Mexico, to agencies/individuals that gather a group of “carers” and act as placement services. While the former use highly professional advertising campaigns, services with the latter are usually known from word of mouth.

Services provided in day centers are usually focused on independent and highly functional individuals. These are mostly social and recreational centers which aim at maintaining the independence and participation of the elderly, mainly providing occupational therapies, crafts, health promotion and information, training in information and communication technologies (ICTs), physical activation, and, in some occasions, general medical and dentist consultations. That is, they focus primarily on functional people and, for the most part, do not consider dependency care as care strategy or model them (López-Ortega & Gutiérrez-Robledo, 2015). Except for around 15 day-centers for people with dementia in the country, no other day care services are in place for older adults (or any other age groups) with disabilities or care dependent.

Finally, while it is common practice for domestic workers (by the day and live-in), to provide care on a needs-basis (infants, young children, older adults, people with disabilities), no information is publicly available on how many and how much of their time is dedicated to care for each of these population groups.

[1] The objective of CAAS was to collect information on the conditions and services offered by public, social and private establishments that house vulnerable populations, along with their characteristics and those of the people who work in these centres (INEGI 2015). It focuses on all types of social assistance institutions, such as care homes and residences for the elderly, but also others as rehabilitation (drug & alcohol) centres, homes for orphans, etc.

References:

INEGI. (2015a). Censo de Alojamientos de Asistencia Social. https://www.inegi.org.mx/programas/caas/2015/

INEGI. (n.d.-b). Directorio Estadístico Nacional de Unidades Económicas. DENUE. Retrieved March 16, 2020, from https://www.inegi.org.mx/app/mapa/denue/

López-Ortega, M., & Aranco N. (2019). Envejecimiento y atención a la dependencia en México. Nota técnica del BID. https://publications.iadb.org/publications/spanish/document/Envejecimiento_y_atención_a_la_dependencia_en_México_es.pdf

López-Ortega, M., & Gutiérrez-Robledo, L. M. (2015). Percepciones y valores en torno a los cuidados de las personas adultas mayores. In L. Gutiérrez Robledo & L. Giraldo (Eds.), Realidades y expectativas frente a la nueva vejez. Encuesta Nacional de Envejecimiento. (pp. 113–133). Instituto de Investigaciones Jurídicas, Universidad Nacional Autónoma de México.