Care homes in Brazil are recognised by the National Health Surveillance Agency (ANVISA) as ‘living settings’ (Brasil, 2005). They have strong links to social assistance policies and come less under the ‘health-systems radar’. The offer of health services often varies according to the legal nature of the institutions, meaning that care homes do not need to have health professionals as part of the staff team by the law. Even though every care home should inform the municipal health surveillance of its operation and licensing, many institutions work in informality and clandestinely, particularly small not-for-profit and private institutions. In addition, care home workers’ profession is not secured by law, meaning that anyone could work in care homes, regardless of their preparedness to carry out that role.

Each profession involved within the LTC workforce has its own regulatory body, except for the ‘informal care workers’, as explained in the previous item. Such professional councils regulate, inspect, and establish the necessary basic training, staff/user ration, quality monitoring, etc. for the overall role of each profession within any area of care. With regards to care for older people, in specific, there is the Brazilian Society of Geriatrics and Gerontology (https://sbgg.org.br/) and the National Academy for Palliative Care (https://paliativo.org.br/) which provide specialist knowledge, training, and accreditation for those working in LTC. However, there is no national council or guidelines which are specific for the LTC workforce. Though not recognized as a profession, there are formal dedicated spaces to try and formalize, inform, and support informal care workers, such as the Association for Carers of Older People of the Metropolitan Area of Sao Paulo (ACIRMESP – https://www.acirmesp.org.br/).

The National Surveillance Agency – ANVISA regulates the minimum staff and infrastructure within care homes in Brazil, as described in the law RDC nº 283 published on 26 September 2005 (Brasil, 2005). For care workers, for example, this document states the staff/user ratio according to the older people’s level of care dependence:

Level I (low dependence): one care worker for 20 older adults per 8h/day.

Level II (medium dependence): one care worker for every10 older adults per shift.

Level III (high dependence): one care worker for every 6 older adults per shift.

This ANVISA document also details key quality monitoring and compliance variables (page 11), which can be used to fine or close down an institution for poor standards, for example (e.g., mortality rates, prevalence of dehydration and undernutrition, infection, pressure injuries, etc.) (Brasil, 2005). A single annual report detailing such variables are sent to ANVISA by the care home managers. ANVISA can make unannounced visits for inspection voluntarily or in case there is a formal complaint from anyone. However, ANVISA does not monitor the quality of the day-to-day care and interactions with older people (e.g., outside visits, person-centred care, eye contact, etc.). 

References:

Brasil. (2005). Legislação—Anvisa. http://antigo.anvisa.gov.br/legislacao/?inheritRedirect=true#/visualizar/27647