DESK REVIEWS | 07.04.01. Are the following types of health and long-term care facilities available?
DESK REVIEW | 07.04.01. Are the following types of health and long-term care facilities available?
The numbers of “panti jompo” or “panti werdha” or homes for older people in Indonesia are minimal (Redaksi KOPI Pewarta Indonesia, 2019). There are only about 250 panti jompo (capacity 200,000 older people) and 20 panti werdha (capacity 2,000 older people) in the whole nation. The number is unlikely to increase significantly, as the Minister of Social Affairs had emphasised more on family-based caring model for older people instead of through the pantis (Tempo.co, 2016).
Redaksi KOPI Pewarta Indonesia. (2019). Hasil Survey YPI, Jababeka Senior Living Merupakan Panti Werdha Terbaik di Indonesia.
Tempo.co. (2016). Menteri Sosial Imbau Lansia Tak Dirawat di Panti Jompo.
Yes, the majority of these are managed by either faith-based organizations or private organizations. There are no government-owned facilities offering residential care in Kenya (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
So far, to our knowledge (including FEDMA), there are only four residential LTC facilities specialised in people with dementia available in the country, two in Mexico City, one in the state of Morelos, and one in the state of Querétaro.
As noted above, while (for-profit and non-profit) private care homes usually have as their main requirement for entry that the older adult is “functional and independent”, those who develop dementia will usually remain under their care, while others will have to return to the care of a family member. As a result, most older people with dementia in receiving care in LTC institutions will receive sub-standard care or care that is not optimal as most of the managers and carers are not trained, nor the institutions are equipped to provide dementia care and management.
Yes, hospice care is available, but is not covered under any medical insurance, and it is mostly for cancer patients. There are about 138 organisations across the country providing hospice and palliative care services, and these are concentrated in large cities (Khosla et al., 2012). The state of Kerala is an exception, as it has 60 hospice units for a population of more than 12 million (Kumar, 2007).
Khosla, D., Patel, F. D., & Sharma, S. C. (2012). Palliative care in India: current progress and future needs. Indian Journal of Palliative Care, 18(3), 149–154.
Kumar S. K. (2007). Kerala, India: a regional community-based palliative care model. Journal of pain and symptom management, 33(5), 623–627. https://doi.org/10.1016/j.jpainsymman.2007.02.005
In 2016, there were two National referral Hospitals in Kenya with integrated palliative care services. In addition, the Kenya Hospices and Palliative Care Association (KEHPCA) had integrated palliative care services (Palliative Care Units) in 11 provincial hospitals across the country and was working towards expanding these services to 30 other county hospitals. The process of integrating the hospital-based palliative services involved the following (Ali, 2016):
- Advocacy both at the national and at the hospital level;
- Capacity building through training and mentorship;
- Establishment of palliative care units through the renovation of an identified building/room and equipping them;
- Ensuring supply of morphine and other essential palliative care medicines and;
- Providing palliative care services to patients and their families
In 2019, there were 31 government hospitals with palliative care (Hospice Care Kenya, 2018), 15 free standing hospices, 11 hospices and palliative care services in the Mission hospitals, 8 in the rural community (FBO), 6 in private institutions and two in teaching and referral hospitals (i.e., Kenyatta National Hospital and Moi Teaching and Referral Hospital – Palliative Care Unit, housed in the Oncology Department – AMPATH) (Kenya Hospices and Palliative Care Association (KEHPCA), 2019).
Ali, Z. (2016). Kenya Hospices and Palliative Care Association: Integrating Palliative Case in Public Hospitals in Kenya. Ecancermedicalscience. 10:655. https://doi.org/10.3332/ecancer.2016.655
Hospice Care Kenya. (2018). Paving the way for universal access to palliative care in Kenya. https://www.hospicecarekenya.com/other-news/paving-the-way-for-universal-access-to-palliative-care-in-kenya/
Kenya Hospices and Palliative Care Association (KEHPCA). (2019). Hospices. https://kehpca.org
For hospice facilities, according to the Hospice Palliative Care Association of South Africa (see https://hpca.co.za/province/western-cape/), there is a total of 97 hospice facilities across the nine provinces. The table below illustrates the total facilities in each province, with a noticeable bias towards urban areas:
As with LTC-sector, there is no information available that indicates the total bed availability across these facilities and how many (if any) are available for dementia.
We are aware of examples of private day care provision; however, this may only be offered to small groups of the population. (RSJ Dr. Radjiman Wediodiningrat, 2016; RUKUN Senior Living, n.d.-a).
RSJ Dr. Radjiman Wediodiningrat. (2016). Psikogeriatri – Klinik Daycare ADIYUSWA. http://rsjlawang.com/main/fasilitas/psikogeriatri
RUKUN Senior Living. (n.d.-a). Dementia Day Program. Retrieved September 7, 2019, from https://rukunseniorliving.com/dementia-day-program/
No publicly funded day centres specialised in people with dementia are available. The only centres available belong to the private sector, both profit and not-for-profit. There is no data available to document if people with dementia attend non-specialised day centres; however, it is highly unlikely as these cater and require that older adults attending the centre are “functional and independent”.
For adult day centres or respite care services, some LTCFs offer these services in South Africa although it’s unclear how many do. According to an online search directory named ‘Fyple’ (see www.fyple.co.za), there are 4 adult day care centres in the private sector in South Africa (see https://www.fyple.co.za/category/organisations-government/adult-organization/adult-day-care-center/). However, this excludes any community, lifestyle, and social centres (e.g., luncheon clubs, faith-based organisations) that host daily or weekly services where older adults from communities gather to socially engage and participate in group activities. These data do not exist.
Some Posyandu Lansia offer social activities, however, these activities may depend on the availability of volunteers (Pratono & Maharani, 2018).
Pratono, A. H., & Maharani, A. (2018). Long-Term Care in Indonesia: The Role of Integrated Service Post for Elderly. Journal of Aging and Health, 30(10), 1556–1573. https://doi.org/10.1177/0898264318794732
The concept of outpatient (community) social centres does not exist in Kenya. There are social halls built by the counties to support social activities for community members. Sometimes these are rented out for social activities to NGOs and private organizations. None are specifically meant for long-term care.
Public sector: Outpatient health clinics in the South African public health system are not dementia-specific, offering general reproductive and maternal health, and the clinical management of communicable (e.g., HIV/AIDS and TB) and non-communicable diseases at 3500 primary health clinics and health centres across the country (McKenzie et al., 2017). The extent to which the clinical management of dementia occurs at these clinics are unknown (no dementia surveillance in South Africa).
Private sector: By 2013, there were approximately 3500 private outpatient clinics and 314 private hospitals with a total beds capacity of 34,572 (hospitals and clinics combined) (Econex, 2013). Since there is no dementia surveillance in South Africa, it’s unclear how many (if any) are dementia-specific.
Community Mental Health centres: There are 3460 outpatient mental health facilities and 80 day treatment facilities across South Africa’s public sector (WHO, 2007). In the private sector, there is the Life Healthcare care group that has a division for Mental Health with 9 facilities across 4 provinces with selected facilities (not disclosed how many) offering a neuro-geriatric wellness programme that includes a mental gymnasium for elderly patients (see https://www.lifehealthcare.co.za/patient-information/patient-services/complementary-services/life-mental-health/ ). Life Esidimeni centres are a subsidiary of the private Life Healthcare group and are contracted by the National and Provincial Department of Health to provide out-of-hospital health and care services to public service users (see https://www.lifehealthcare.co.za/about-us/clinical-and-support-functions/out-of-hospital-services/ ). Life Esidimeni has 10 facilities across 5 provinces, of which 7 are centre-based and include frail care with provisions that include dementia care (see https://www.lifehealthcare.co.za/about-us/life-esidimeni/ and https://www.lifehealthcare.co.za/about-us/life-esidimeni/frail-care-services/). This list of private mental health centres is not exhaustive and may include more private facilities that were not found in the time desk review period.
Memory clinics: This desk review found that there were 5 memory clinics based across the country’s two capital provinces, (Western Cape and Gauteng), with only 1 in Cape Town based at the public healthcare system.
- MemoryCare (Johannesburg), see https://www.memorycare.co.za/about-us/
- The Albertina and Walter Sisulu Institute of Ageing in Africa, Groote Schuur Hospital (Public): http://www.instituteofageing.uct.ac.za/sites/default/files/image_tool/images/126/IAA/Facilities/Memory%20Clinic%20Brochure.pdf
- Cape Town Mind and Memory, (Cape Town) (Private): http://ctmindandmemory.co.za/about-us/
- Panorama psychiatry and memory clinic (Cape Town) (Private): see https://mentalhealthsa.org.za/mental-health-service-providers/3646/panorama-psychiatry-and-memory-clinic/
- Specialist geriatric and memory clinic, Vincent Pallotti Hospital, Pinelands (Cape Town) (Private): http://sgmclinic.co.za/
Outpatient (community) social centres: South Africa relies heavily on the NGO-sector to provide services to persons with dementia and their families within their homes, with 2 dementia-specific care organisations identified (i.e. Alzheimer’s South Africa with 9 branches across the country [see https://alzheimers.org.za/services-and-activities/] and Dementia South Africa [see https://www.dementiasa.org/help-and-support/#family-interventions] located within the Western Cape province). Other NGOs also exist, for example, the Care Company that provides outpatient care services to older persons in general, with specific services also catering for dementia home care needs. The Care Company has 2 expert teams across 2 provinces (see http://www.carecompany.co.za/dementia-care/), but the total amount of NGOs that offer dementia-specific social care is unknown (i.e., minimum of 12).
Econex. (2013). The South African Private Healthcare Sector: Role and Contribution to the Economy. https://econex.co.za/wp-content/uploads/2016/09/Econex_private_health_sector_study_12122013-1.pdf
McKenzie, A., Schneider, H., Schaay, N., Scott, V., & Sanders, D. (2017). Primary Health Care Systems (Primasys). In World Health Organization and Alliance for Health Policy and Systems Research. Available from: https://apps.who.int/iris/bitstream/handle/10665/341145/WHO-HIS-HSR-17.38-eng.pdf?sequence=1
WHO. (2007). WHO-AIMS Report on Mental Health System in South Africa. In World Health Organisation and the Ministry of Health South Africa. Available from: https://pmhp.za.org/wp-content/uploads/2015/01/WHO-2007-AIMS-report.pdf