DESK REVIEWS | 07.04. Health and long-term care facilities
DESK REVIEW | 07.04. Health and long-term care facilities
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
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”.
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.
In 2014, there were 1,451 long-term care facilities registered with the Brazilian Ministry of Citizenship (Camarano & Barbosa, n.d.). Approximately 33% of these institutions are philanthropic, 64% are private, and 6.6% are public or mixed. No information about the number of beds was found. It has been mentioned by the Ministry which regulates care homes in Brazil that there are several care homes who are currently ‘clandestine’ or unregistered nationally (CNMP, 2016). Moreover, the Ministry of Health webpage shows the distribution of officially registered care homes around the country and indicates a higher concentration of these institutions in the South and South-Eastern regions.
Camarano, A. A., & Barbosa, P. (n.d.). Instituições de Longa Permanência para Idosos no Brasil: Do que se está falando? (pp. 479–514). Retrieved July 17, 2019, from http://repositorio.ipea.gov.br/bitstream/11058/9146/1/Institui%C3%A7%C3%B5es%20de%20longa%20perman%C3%AAncia.pdf
CNMP. (2016). Manual de Atuação Funcional—O Ministério Público na Fiscalização das Instituições de Longa Permanência para Idosos—Conselho Nacional do Ministério Público. https://www.cnmp.mp.br/portal/publicacoes/245-cartilhas-e-manuais/9984-manual-de-atuacao-funcional-o-ministerio-publico-na-fiscalizacao-das-instituicoes-de-longa-permanencia-para-idosos
There are few facilities available across the country, which are run by public, private, and NGO sectors. However, the total number is unknown. Please refer to Table 7.5.
Table 7.5 provides an overview of 41 long term care centres for dementia in India (some centres are not listed).
|Serial Number||Location||Name of the centre/facility||Number of beds in the centre/facility||Number of centres/facilities|
|2||Bangalore||Nightingales Centre for Ageing & Alzheimer’s (NCAA)||98 bed||9|
|Nightingales Trust Tanya Mathias Elder care Centre||25 bed|
|AdvantAGE Senior Care||12 bed|
|Nikisa Dementia Village||50 bed|
|Smile Elderly Care|
|3||Chennai and Coimbatore||Grandworld Elder Care||2|
|Anandam Old Age Home|
|4||Delhi/ NCR||Chronic Care Dementia Facility (at Faridabad, an ARDSI Delhi franchise)||5|
|Vardaan Senior Citizen Centre (Malviyanagar)|
|Guru VishramVriddh Ashram (Gautampuri)||10 special care units
|Vermeer House (Epoch Elder Care)||12 (single or double and twin sharing and a suite room)|
|Frida House (by Epoch Elder Care)||13 rooms (single or double and twin sharing and a suite room)|
|5||Ernakulam district, Kerala||Cochin Harmony Home (by ARDSI Kochi)||3|
|Smruthipadham (joint ARDSI and Kerala Govt)|
|Signature Aged Care|
|6||Hyderabad||Golden Oak (at Shamshabad)||49 bed||2|
|Kshetra of Heritage||100 bed|
|7||Kolar||ETCM-Nightingales Dementia Care Centre||48 bed||1|
|8||Mumbai and nearby areas||Aarambh-Powai, Aarambh-Khargar and Aarambh-Thane (by Aaji Care)||11|
|A1 Snehanjali-D’Silva and A1 Snehanjali-Rajodi (Silver Innings)|
|A Silver Amore||14 bed|
|Dignity Lifestyle Neral||Has a Special Care Block for dementia care|
|Jagruti Rehab, & Shree Rajendrakumar Agarwal Hospital (Anand Rehabilitation)||100 bed|
|Golden Care Retirement Homes|
|Prof. Ram Kapse Senior Citizen Care Centre (Palghar)||14 bed|
|9||Pune||Jagruti Dementia Care (from Jagruti)||5|
|Monet House (of Epoch Elder Care)||7 rooms(single or double and twin sharing and a suite room)|
|Tapas Elder Care.|
|Madhurbhav (AJ Foundation)||60 bed|
|Chaitanya Mental Health Care Centre||Capacity for 60 persons|
|10||Kozhikode/ Calicut district, Kerala||Malabar Harmony Home||1|
|11||Thrissur district, Kerala||Dementia Respite Care Centre (Harmony Home)||1|
|12||Trivandrum district, Kerala||Snehasadanam||9 bed||1|
Source (Kishore, 2019a)
Kishore, S. (2019a). Dementia Caregiver Resources across India | Dementia Care Notes. Available from: https://dementiacarenotes.in/resources/india/
As mentioned in part 3, there is no national registry of LTC facilities and therefore data comes from diverse sources. With respect to non-specialised facilities, a first try at generating a Census of institutions was the 2015 Social Assistance Housing Census, CAAS (INEGI, 2015a), as 4,517 permanent housing institutions were identified. Of these, almost 23% (1,020) are identified as permanent homes or residences for older adults. The average number of residents per facility is 11-20 (37% of the total), followed by 21-40 (23%) and 5-10 (22%). Regarding their legal nature, 75% are private non-profit facilities, 8% are public (government funded), 2.3% are run by religious associations, and 2% are private for-profit. There are no specialised LTC dementia facilities.
 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.
INEGI. (2015a). Censo de Alojamientos de Asistencia Social. https://www.inegi.org.mx/programas/caas/2015/
We could not find this information specifically for people living with dementia. However, it has been estimated that around 100,000 people live in such facilities, of which 84,000 are older people, and the remaining are younger people with mental illness or disabilities (Camarano & Kanso, 2010).
Camarano, A. A. & Kanso, S. (2010). As instituições de longa permanência para idosos no Brasil. Revista Brasileira de Estudos de População, 27(1), 232–235. https://doi.org/10.1590/S0102-30982010000100014
There is no indication of hospitals allocating their beds specifically for dementia patients. For instance, even in Rumah Sakit Pusat Otak Nasional (National Brain Hospital), the way the beds are allocated are based on level of amenities and whether it is for emergency or normal wards (Rumah Sakit Pusat Otak Nasional Prof. Dr. dr. Mahar Mardjono Jakarta, n.d.).
Rumah Sakit Pusat Otak Nasional Prof. Dr. dr. Mahar Mardjono Jakarta. (n.d.). Rumah Sakit Pusat Otak Nasional Prof. Dr. dr. Mahar Mardjono Jakarta. https://www.rspon.co.id/bed.php
There is no data about number of geriatric-specific beds from Indonesian Health Profile 2018, which details statistics of hospitals and their beds in the country (Kementerian Kesehatan Republik Indonesia, 2019b). Ministry of Health’s Rule No. 79/2014 specifies what a geriatric service in hospitals needs in terms of types of beds and other specifications, but there is no guideline on how many geriatric beds are needed or must be provided in the hospitals’ geriatric wards (Ministry of Health Regulation No. 79/2014 on Geriatric Services in Hospitals (Permenkes No. 79/2014 Tentang Pelayanan Geriatri Di RS), 2014; International Association for Hospice & Palliative Care, n.d.).
International Association for Hospice & Palliative Care. (n.d.). Global Directory of Palliative Care Institutions and Organizations.
Kementerian Kesehatan Republik Indonesia. (2019b). Profil Kesehatan Indonesia 2018 [Indonesia Health Profile 2018]. http://www.depkes.go.id/resources/download/pusdatin/profil-kesehatan-indonesia/Data-dan-Informasi_Profil-Kesehatan-Indonesia-2018.pdf
Ministry of Health Regulation No. 79/2014 on Geriatric Services in Hospitals (Permenkes No. 79/2014 tentang Pelayanan Geriatri di RS), (2014) (testimony of Ministry of Health Republic of Indonesia).
The health information systems in Brazil track the number of people living with dementia who have been hospitalised nationally via SUS. The notification of dementia-related admissions is not mandatory, which means that people living with dementia are likely to have their secondary causes for hospitalisation registered, such as infection, stroke, or dehydration, for example, instead of dementia as being the main cause. This creates an underestimation of the number of people living with dementia who have been hospitalised. In addition, the high number of people living with dementia who are currently undiagnosed (77%) (Nakamura et al., 2015), and the difficulty in differentiating acute delirium from dementia, might also have an effect on the absolute numbers of hospitalisation related to dementia.
The more advanced the age group is, the higher the number of admissions related to dementia. For instance: in the age group 50-59, a total of 50 admissions occurred; between 60 and 69 years old, this number increased to 293, in the age group 70-79 the number was 835, and for the age group 80 plus, the number reached 1,769 admissions. A total number of 13,723 admissions occurred between January 2008 and November 2019 (Brazilian Ministry of Health, 2019n). The study from Santos et al. (2017) using data from the same public source shows an even smaller number – a total of 9,843 hospitalisations of older people (aged 60+) living with dementia over the period between 2008 and 2014 nationally. In this study, dementia was the main cause of hospital deaths (33%) compared to other mental disorders.
Brazilian Ministry of Health. (2019n). TabNet Win32 3.0: Morbidade Hospitalar do SUS – por local de internação—Brasil. http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sih/cnv/niuf.def
Nakamura, A., Opaleye, D., Tani, G., & Ferri, C. P. (2015). Dementia underdiagnosis in Brazil. The Lancet, 385(9966), 418–419. https://doi.org/10.1016/S0140-6736(15)60153-2
Santos, D. F. B. dos, Carvalho, E. B. de, Nascimento, M. do P. S. S. do, Sousa, D. M. de, & Carvalho, H. E. F. de. (2017). ATENÇÃO À SAÚDE DO IDOSO POR CUIDADORES INFORMAIS NO CONTEXTO DOMICILIAR: REVISÃO INTEGRATIVA. SANARE – Revista de Políticas Públicas, 16(2). https://doi.org/10.36925/sanare.v16i2.1181
Some hospitals do track dementia related admissions. Only a few tertiary referral hospitals maintain dementia registries that record and report on the dementia patients that have been seen in these specialist memory/cognitive disorders clinics. These centres typically conduct scientific studies that report on clinical profiles and risk factors of dementia or specific subtypes of dementia (Alladi et al., 2011; Alladi et al., 2014; Bharath et al., 2017; Nair et al., 2012; Tripathi et al., 2012). However, these registries do not periodically report the numbers of persons with dementia evaluated in the clinics.
Alladi, S., Mekala, S., Chadalawada, S.K., Jala, S., Mridula, R., Kaul, S., 2011. Subtypes of Dementia: A Study from a Memory Clinic in India. Dement. Geriatr. Cogn. Disord. 32, 32–38. https://doi.org/10.1159/000329862
Alladi, S., Shailaja, M., Mridula, K.R., Haritha, C.A., Kavitha, N., Khan, S.A., Divyaraj, G., Kaul, S., 2014. Mild Cognitive Impairment: Clinical and Imaging Profile in a Memory Clinic Setting in India. Dement. Geriatr. Cogn. Disord. 37, 113–124. https://doi.org/10.1159/000354955
Bharath, S., Sadanand, S., Kumar, K.J., Balachandar, R., Joshi, H., Varghese, M., 2017. Clinical and neuropsychological profile of persons with mild cognitive impairment, a hospital based study from a lower and middle income country. Asian J. Psychiatr. 30, 185–189. https://doi.org/10.1016/j.ajp.2017.10.007
Nair, G., Van Dyk, K., Shah, U., Purohit, D.P., Pinto, C., Shah, A.B., Grossman, H., Perl, D., Ganwir, V., Shanker, S., Sano, M., 2012. Characterizing Cognitive Deficits and Dementia in an Aging Urban Population in India. Int. J. Alzheimers. Dis. 2012, 1–8. https://doi.org/10.1155/2012/673849
Tripathi, M., Vibha, D., Gupta, P., Bhatia, R., Srivastava, M.V.P., Vivekanandhan, S., Bhushan Singh, M., Prasad, K., Dergalust, S., Mendez, M.F. (2012). Risk factors of dementia in North India: a case–control study. Aging Ment. Health 16, 228–235. https://doi.org/10.1080/13607863.2011.583632
While all hospitals are required to track and register the main causes of hospitalisation, most of the times dementia is not stated as a main cause and therefore tend not be registered. This creates a situation where it is likely that dementia-related hospital admissions are considerably underestimated.
Long-term care institutions for older people are not evenly distributed throughout the country. In the South-eastern region of Brazil there are 57.6% of the institutions, followed by the Southern region with 20% of them (Camarano & Barbosa, n.d.).
Camarano, A. A. & Barbosa, P. (n.d.). Instituições de Longa Permanência para Idosos no Brasil: Do que se está falando? (pp. 479–514). Retrieved July 17, 2019, from http://repositorio.ipea.gov.br/bitstream/11058/9146/1/Institui%C3%A7%C3%B5es%20de%20longa%20perman%C3%AAncia.pdf
The Global Directory of Palliative Care Services and Organizations lists 12 hospice organisations or associations in Indonesia (Abikusno, 2007). Some hospices are specialised for children and others for cancer. These are spread across Surabaya, Jakarta, Yogyakarta, Talangsari, Bali, and Makassar. In addition, there are about 250 panti jompos and 20 panti wredha nationally, as discussed above.
Abikusno, N. (2007). Long term care support and services for older persons : Case study of Indonesia. ESID/SPAG/4. http://libprint.trisakti.ac.id/145/1/2007%287%29-Abikusno.pdf
Generally, social centres offer activities for people from childhood to older ages. The services provided are aimed to promote a sense of citizenship, so the services are: cultural activities, sports, courses that may promote a source of income (sewing, cooking), and social assistance according to the National Policy for Social Assistance (Brazilian Ministry of Citizenship, 2005).
Brazilian Ministry of Citizenship. (2005). Política Nacional de Assistência Social PNAS/2004 Norma Operacional Básica NOB/SUAS. http://www.mds.gov.br/webarquivos/publicacao/assistencia_social/Normativas/PNAS2004.pdf
To date, we are only aware of one research project carrying out dementia specific interventions. However, some residential LTC facilities, even when not specifically or exclusively designed for people with dementia but older adults in general, try to provide person-centred care.
Yes, in a small proportion. The psychiatric reform in Brazil that happened in the last few decades reduced substantially the number of psychiatric hospitals, especially those that kept patients living there for many years. However, there are still some mental hospitals that continue to serve as residence for people with mental health that may include people living with dementia.
There are dementia patients in mental hospitals in Indonesia (PERDOSSI, 2015), although mental hospitals are not explicitly stated to be in the care pathway for dementia in the national clinical guideline (Wijayanto, 2019). For instance, in 2018 an older person was not allowed to embark on a pilgrimage trip to Mecca because of their dementia symptoms and was referred to a mental hospital (BPJS Kesehatan, n.d.).
BPJS Kesehatan. (n.d.). Panduan Praktis Pelayanan Alat Kesehatan. 2938.
PERDOSSI. (2015). Panduan Praktik Klinik: Diagnosis dan Penatalaksanaan Demensia. PERDOSSI.
Wijayanto. (2019). Mengidap Demensia Berat, JCH Asal Gagal Berangkat.