DESK REVIEWS | 07.02.01.01 Does the country provide health and long-term care services to support people with dementia in community-based settings?
DESK REVIEW | 07.02.01.01 Does the country provide health and long-term care services to support people with dementia in community-based settings?
Health and long-term care in community-based settings are provided through SUS and SUAS for all people who need them in the country. People living with dementia may access these services the same way people without dementia do. Health (SUS) is a right by the Brazilian constitution, whereas social care (SUAS) is means/needs tested.
Yes. For healthcare services, the Hospital Authority provides Community Nursing Service and Community Psychiatric Nursing Service delivered by qualified community nurses. These services aim at providing nursing care during home visits and at equipping people with dementia and their families with self-care ability and carer skills to cope with their needs.
For long-term care services, community care service as a whole aims at providing “personal care, nursing care, rehabilitation training, and social activities in a familiar home and community environment to frail elders who cannot receive care from their family members during day-time” (Social Welfare Department, 2020e). There are currently 41 District Elderly Community Centres (DECCs), 76 Day Care Centres/Units for the Elderly (DEs/DCUs), 34 Enhanced Home and Community Care Services (EHCCS), and 60 Integrated Home Care Services Teams (IHCSTs) providing services for elderly and family in need. All these services cover people with dementia.
Social Welfare Department. (2020e). Introduction of Community Care Services. Retrieved from https://elderlyinfo.swd.gov.hk/en/ccs_introduction.html
Dementia organisations like NMT and private attender agencies like Portea, Life Circle Elder Care and more, run few home-based care programs primarily in urban areas where paid attenders are available to support home-based care.
Few studies have also examined the effectiveness of community-based interventions for people with dementia and their families. Dias and colleagues (2008) conducted randomised controlled trials to examine the impact of a community-based intervention consisting of home care advisors on caregivers of people with dementia in Goa, India. The authors found that this intervention led to improvement in caregiver mental health (Dias et al., 2008).
Dias, A., Dewey, M. E., D’Souza, J., Dhume, R., Motghare, D. D., Shaji, K. S., …& Patel, V. (2008). The Effectiveness of a Home Care Program for Supporting Caregivers of Persons with Dementia in Developing Countries: A Randomised Controlled Trial from Goa, India. PLoS ONE, 3(6), e2333. https://doi.org/10.1371/journal.pone.0002333
Persons with dementia are mostly taken care of by family members at home. The only services in community-based settings are at referral county hospitals at the mental health clinics and delivered by mental health nurses or psychologists. This involves counseling services mainly to the caregiver on the best ways of taking care of their loved ones. Little emphasis is made on the care of the carers and to people with dementia unless they are able to engage in a conversation. The mental health workers receive the person at advanced stage making it difficult to speak directly with persons with dementia (Musyimi et al., 2019; Musyimi et al., 2021).
Musyimi, C. W., Ndetei, D. M., Evans-Lacko, S., Oliveira, D., Mutunga, E., & Farina, N. (2021). Perceptions and experiences of dementia and its care in rural Kenya. Dementia. https://doi.org/10.1177/14713012211014800
Musyimi, C., Mutunga, E., & Ndetei, D. (2019). Stigma and dementia care in Kenya: Strengthening Responses to Dementia in Developing Countries (STRiDE) Project. In World Alzheimer Report 2019: Attitudes to dementia (pp. 121–122). London, UK: Alzheimer’s Disease International. https://www.alzint.org/u/WorldAlzheimerReport2019.pdf
South Africa has moved towards community-based care services for older persons in general (not dementia-specific). Although the Older Person’s Act, along with its suggested amendment recommendations to have all caregivers be registered with the Department of Social Development (SAHRC, 2017b, see p.3), these services remain largely unregulated (Prince et al., 2016a). Community-based care is also divided along two tiers, i.e. profit-based private care that is usually urban-biased as well as non-profit care that is resource-constrained and typically offered by faith-based organisations (FBOs), NGOs (Prince et al., 2016a), civil society and public welfare bodies (WHO, 2017). South Africa has examples of multi-purpose centres that provide housing, support services, carer training, community outreach programmes, as well as frail care (e.g., the Centurion Council for the Aged) (Lombard & Kruger, 2009). However, the vast majority of South Africans do not have access to these pockets of comprehensive care (Lombard & Kruger, 2009), with very few formal/organised services for most older persons in South Africa that do not have access to the two tiers of care mentioned here (WHO, 2017).
Lombard, A., & Kruger, E. (2009). Older persons: The case of South Africa. Ageing International, 34(3), 119–135. https://doi.org/10.1007/s12126-009-9044-5
Prince, M., Comas-Herrera, A., Knapp, M., Guerchet, M., & Karagiannidou, M. (2016a). World Alzheimer Report 2016: Improving healthcare for people living with dementia. In Alzheimer’s Disease International (ADI). https://doi.org/10.13140/RG.2.2.22580.04483
SAHRC. (2017b). South African Human Rights Commission Older Persons Amendment Bill. Available from: https://www.sahrc.org.za/home/21/files/SAHRC%20Submission%20on%20Older%20Persons%20Bill-%20Dept%20Soc%20Dev-%2030.6.17.pdf
WHO. (2017). Towards long-term care systems in sub_Saharan Africa: WHO series on long-term care. Available from: https://www.who.int/publications/i/item/9789241513388