DESK REVIEWS | 07.02.01.11. Are home care services available? Are there differences in availability by location? What kind of services are provided in people’s homes?
DESK REVIEW | 07.02.01.11. Are home care services available? Are there differences in availability by location? What kind of services are provided in people’s homes?
Yes. Regarding community-based services, the provision of home care services is offered by the SUS in terms of (1) home care visits through the Primary Care Program (that provides orientations about family structure, home infrastructure etc.), and (2) through the program “Better at Home” (Melhor em Casa) that provides domiciliary health care to people who need equipment and other health resources. It is noted, however, that the provision of these services are less available in small towns and rural areas (Brazilian Ministry of Health, 2019a, 2019j). The family health strategy incorporates primary healthcare teams which are composed at least of one doctor (GP), one nurse, and several general health workers. General health workers visit all households under their responsibility for monitoring and education. Doctors and nurses can make visits to patients with mobility difficulties for a general health assessment, monitoring, or for a specific situation identified by the team. Home care services are also provided by private companies, such as formal care by demand (hourly paid), nursing care, home-based invasive treatment (intravenous antibiotics, oxygen therapy), physiotherapy (respiratory and motor), nutritional assessment, among other services. The family may also hire a formal care independently and pay for it informally (per hour) or formally as domestic employee (through formal employment that includes all the constitutional rights).
Brazilian Ministry of Health. (2019a). Atenção Domiciliar.
Brazilian Ministry of Health. (2019j). SAGE – Sala de Apoio à Gestão Estratégica. http://sage.saude.gov.br/
There are few domiciliary care services available, which are provided by non-governmental organisations (ARDSI, 2010). As part of these services, volunteers or social workers visit families at their homes, providing support to caregivers in the form of counselling, guidance, and sometimes also aid persons with dementia to carry out activities of daily living such as grooming or bathing (ARDSI, 2010). For example, 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.
Alzheimer’s and Related Disorders Society of India. (2010). THE DEMENTIA INDIA REPORT 2010: Prevalence, impact, cost and services for dementia. New Delhi. Available from: https://ardsi.org/pdf/annual%20report.pdf
PUSAKA (Pusat Santunan dalam Keluarga, or “home-based care centre”) programs have been available since 2002 (Do-Le & Raharjo, 2002). PUSAKA is a community-based scheme that provides assistance and services for disadvantaged and/or poor older people within a neighbourhood. Each PUSAKA served approximately 45-60 older people. Services include home visits for older people who are too frail to visit PUSAKA centres, provision of meals, distribution of medicine and vitamins, and improvements in residences of older people including the provision of clean water, ventilation, and repair works. Most recently in 2020, there is a forum for PUSAKA staff in Jakarta for 2020-2025, indicating the program’s ongoing operation (Media Purna Polri, 2020).
In addition, unrelated to PUSAKA, The Ministry of Social Affairs’ programmes provide home care services for neglected and/or poor older people. As of 2014 there were 1,100 older people in 18 locations across Indonesia benefitting from the home care services (Media Purna Polri, 2020). (Please note that there is no information regarding the locations where this service is provided). Home improvement projects were done for 514 older people in 2013 and 644 people in 2014.
On the other hand, private home care services have grown immensely over the past few years to accommodate the increasing demand of the public. One of the private home care providers is Rukun Senior Living which has been providing an array of services for older people since 2011, including home care. RUKUN Home Care provided services such as daily living assistance, wound management, medical management, and so on, to improve the health condition and maximise the quality of life and wellness of the elderly. As of now, the services are available in certain areas of Jakarta, Bogor, Depok, Tangerang and Bekasi (Alzheimer’s Indonesia, 2019a).
Alzheimer’s Indonesia. (2019a). 10 Gejala Awal Demensia Alzheimer. https://alzi.or.id/10-gejala-awal-demensia-alzheimer/
Do-Le, K. D., & Raharjo, Y. (2002). Community-Based Support for the Elderly in Indonesia: The Case of PUSAKA. “Southeast Asia’s Population In A Changing Asian Context,” June, 10–14.
Media Purna Polri. (2020). Kukuhkan Kepengurusan FK-Pusaka 2020-20215, Kadis Sosial DKI: Siapkan Program Bermanfaat Bagi Lansia.
According to an audit of residential institutions of older members of society in selected counties of Kenya (National Gender and Equality Commission, 2016), the available home-based care programmes are managed by faith-based organizations and provide basic services such as;
- Livelihood services e.g., feeding programmes,
- Counseling and psychosocial support services provided by nurses. This type of counseling includes giving hope and encouragement and providing entertainment to relieve stress,
- Healthcare services for chronic diseases such as pneumonia provided by resident nurses who refer cases to hospitals for advanced management.
The care and rehabilitation services are designed for senior citizens who live by themselves, are unwell or handicapped, or cannot properly look after themselves (National Gender and Equality Commission, 2016).
National Gender and Equality Commission. (2016). Audit of Residential Institutions of Older Members of Society in Selected Counties of Kenya. Nairobi, Kenya. https://www.ngeckenya.org/Downloads/Audit%20of%20Residential%20Homes%20for%20Older%20Persons%20in%20Kenya.pdf
No public or private specialised dementia care home services are available.
As explained in Part 3, since 2016, Mexico City has operated the program ‘The Doctor in your House’ (‘Medico en tu Casa’). The goal of the program is to provide primary care for vulnerable population who, due to their disease conditions or disabilities, cannot attend medical services, with the help of a multidisciplinary team at home. However, under the new federal government administration, this program is being modified and its specific attributions and scope are still unknown. Mexico does not have a publicly funded national long-term care system; however, care is being provided in different ways. First, unpaid informal care at home, provided by family members, is the main source of care and in some cases, when economic resources are available, with support from domestic paid workers.