DESK REVIEWS | 09.01. Please describe whether any of the following social protection mechanisms are available for those living with dementia:

DESK REVIEW | 09.01. Please describe whether any of the following social protection mechanisms are available for those living with dementia:

The Rules of the Ministry of Social Affairs No 19/2012 on Guidelines for Social Services for Older People dictates the social programs in the country, but there is no specific commitment for people with dementia. Programs include provisions of basic needs, home care services for 20,000 older people in 2019, family support (caregivers’ benefits) for 7,000 families in 2019, formal caregivers assigned from the Ministry of Social Affairs, and social rehabilitations at local centres.

  • Progres LU (Program Rehabilitasi Sosial Lanjut Usia) aims to help older people to rehabilitate and develop their social functioning ability. Progres LU consists of:
    • non-cash assistance worth Rp. 200,000 per person per month,
    • social care within families/community halls, in the form of social assistance of Rp. 1,200,000 per person per year through LKS-LU,
    • support for relatives who are taking care of older people, in the form of non-cash social assistance of Rp. 3,000,000 per person per year.
    • therapy, in the form of social assistance Rp. 1,350,000 per person per year through LKS LU.

Social Professional Assistant for Seniors: for community social workers who coordinate and assist in older people social rehabilitation programs at all levels (national, provincial, district/city-level, rehabilitation centres). For paid Social Assistant for older people, the payment is Rp. 2,500,000 per person per month (Komalasari, 2014).

References:

Komalasari, R. (2014). Domain Fungsi Kognitif Setelah Terapi Stimulasi Kognitif. Jurnal Keperawatan Indonesia, 17(1), 11–17.

Ministry of Social Affairs Republic of Indonesia. (2012). Ministry of Social Affairs Regulation No.19/2012 on Guideline on Social Service for Older People (Permensos No. 19/2012 tentang Pedoman Pelayanan Sosial Lanjut Usia).

There is the Continuous Cash Benefit (Benefício de Prestação Continuada – BPC) which is an income transfer benefit for people of any age with disability or for people aged 65 and over with long term cognitive or physical impairments. The value of the BPC reflects one national minimum wage. In order to receive this benefit, the monthly per capita household income must be equivalent to up to ¼ of the value of the monthly national minimum wage (Rodrigues, 2019a).

References:

Rodrigues, A. (2019a). Benefício de Prestação Continuada—BPC [Capa]. MINISTÉRIO DA CIDADANIA Secretaria Especial do Desenvolvimento Social.

There are no social protection mechanisms that are solely dedicated to persons with dementia, but there are recognised schemes for persons with disabilities and senior citizens.

The implementation of the Right of Persons with Disabilities Act (2016) is carried out largely through schemes run by the Department of Empowerment of Persons with Disabilities (DPED), Ministry of Social Justice and Empowerment (MSJE). Two of the major schemes that influence the lives of persons with disabilities living in rural areas are summarised in Table 1 (Gupta, Witte and Meershoek, 2021). However, the implementation of these schemes has been found to be low in rural areas (Gupta, Witte and Meershoek, 2021).

Table 1. Overview of Few Major Disability Schemes

Disability Schemes Description
Assistance to Disabled Persons for Purchase/Fitting of Aids and Appliances (ADIP)

 

Makes assistive devices including those needed to meet activities of daily living for low income families (Gupta,Witte and Meershoek, 2021).
District Disability Rehabilitation Centres (DDRCs) Establishment of centres that provide comprehensive rehabilitation services (Gupta,Witte and Meershoek, 2021).

Source: (Gupta, Witte and Meershoek, 2021).

Furthermore, the National Social Assistance Programme (NSAP) under the Indira Gandhi National Disability Pension Scheme provides pension to persons aged 18 and above with a disability level of 80% an amount of Rs 300 per month (Vikaspedia, n.d.-c; Ministry of Rural Development, 2014). Persons above the age of 80 receive Rs 500 per month (Vikaspedia, n.d.-c; Ministry of Rural Development, 2014).

In addition, the Mahatma Gandhi National Rural Employment Guarantee Act (2005) (NREGA) mentioned in Part 1 Section IV on Social Protection is also applicable to persons with disabilities residing in rural areas.

Old age grants, pension or assistance schemes

These are schemes under the National Social Assistance Programme (NSAP), which can be availed if the applicant falls under the BPL category as per the Government of India (Vikaspedia, n.d.-c; Ministry of Rural Development, 2014).

Indira Gandhi National Old Age Pension Scheme (IGNOAPS): Provides senior citizens over the age of 60 with no other sources of income and who fall below the poverty line with a monthly pension of Rs 200 (60+ years of age) and 500 (80+ years of age) (Vikaspedia, n.d.-c; Ministry of Rural Development, 2014).

Indira Gandhi National Widow Pension Scheme (IGNWPS): Provides the widowed, living below the poverty line, with an amount of Rs 300 per month (Vikaspedia, n.d.-c; Ministry of Rural Development, 2014). Persons above the age of 80 will receive Rs 500 per month (Vikaspedia, n.d.-c; Ministry of Rural Development, 2014).

National Family Benefit Scheme (NFBS): Provides a lumpsump of Rs 20,000 to a household in which the main breadwinner has passed away (Vikaspedia, n.d.-c; Ministry of Rural Development, 2014).

Annapurna scheme: Provides Rs 10kg of food grains per month free of cost to senior citizens living below the poverty line that are nor receiving pension under IGNOAPS (Vikaspedia, n.d.-c; Ministry of Rural Development, 2014).

The amount received under the pension schemes vary across states as state governments are urged to contribute at least an equal amount to the central government amounts mentioned above (Ministry of Rural Development, 2014).

References:

Gupta, S., de Witte, L. P., & Meershoek, A. (2021). Dimensions of invisibility: insights into the daily realities of persons with disabilities living in rural communities in India. Disability &Society36(8), 1285-1307.

Ministry of Rural Development (2014). National Social Assistance Programme: Programme Guidelines. Ministry of Rural Development, Government of India. Available from: https://nsap.nic.in/Guidelines/nsap_guidelines_oct2014.pdf

Vikaspedia. (n.d.c). National Social Assistance Programme. Ministry of Electronics and Information Technology. Government of India. Available from: https://vikaspedia.in/social-welfare/rural-poverty-alleviation-1/schemes/national-social-assistance-programme#:~:text=National%20Family%20Benefit%20Scheme%20(NFBS)%20%3A%20Rs.,the%20family%20eligible%20for%20assistance

The government of Kenya, through the National Development Fund for Persons with Disabilities, has set aside funds for persons with disabilities including cognitive disabilities through cash transfers (National Council for Persons with Disabilities (NCPWD), 2019). People who qualify for this cash transfer are those who are from extremely poor households and residing in a particular location for more than a year but are not enrolled in any other cash transfer program (Ministry of Labour and Social Protection, 2019a). The transfer value per month for each eligible person is 2,000 Kenya shillings (20USD).

  1. According to the National Social Security Fund (NSSF) act no.45 of 2013, subsection 38, a member is entitled to invalidity pension if he/she suffers physical or mental disability of a permanent nature as certified by a medical board established under the Act and has made at least 36 monthly contributions immediately preceding the date of invalidity (Republic of Kenya, 2013). Retirement benefits are paid from the retirement age of 60 years with earlier retirement being at age 50 (Republic of Kenya, n.d.).
  2. The government of Kenya provides Older Persons Cash Transfer (OPCT) for a Kenyan who is above 70 years and residing in a particular location for more than a year but neither receiving pension nor enrolled in any other cash transfer program (Ministry of Labour and Social Protection, 2019a). The transfer value per month for each eligible person is 2,000 Kenya shillings (20USD).
References:

Ministry of Labour and Social Protection. (2019a). FAQs. https://laboursp.go.ke/faqs/

National Council for Persons with Disabilities (NCPWD). (2019). National Development Fund. https://ncpwd.go.ke/ndfpwd-funding-summary/

Republic of Kenya. (2013). The National Social Security Fund Act, 2013 No. 45 of 2013. 27 December. Nairobi, Kenya. http://kenyalaw.org/kl/fileadmin/pdfdownloads/Acts/NationalSocialSecurityFundAct2013.pdf

Republic of Kenya. (n.d.). Legal provisions of the Pensions Act, Cap 189. The National Treasury Pnesions Department. Nairobi, Kenya. https://www.treasury.go.ke/wp-content/uploads/2020/11/Pensions-Act-CAP-189.pdf

There is one program at the Federal level of government that supports people with disabilities called the Pension Program for the Welfare of People with Disabilities. However, potential beneficiaries are only children and adolescents as well as young people (0 to 29 years old) who have permanent disabilities, and for indigenous population with disabilities from 0 to 64 years old. Since 2016, following the initiatives in most of the states, the federal government established a universal old age pension. Eligibility sets minimum age of 68 years (65 years if living in indigenous municipalities) and who do not receive any public or private sector old age pension or any similar program from their state of residence.

Persons with dementia, if eligible, can receive an old age grant (R1780 per month as of 2019) as well as an additional grant-in-aid (R420 as of 2019) to pay for a carer if they cannot care for themselves any longer. If under the age of 60 years, persons living with dementia can apply for a disability grant (also R1780 per month) – which will transfer into an old age pension when the person reaches the age of 60.

Regarding employment protection, there is no specific mechanism for people living with dementia. However, both the Older People’s Statute and the People with Disability’s Statute guarantee the right to perform any type of job as long as the person manages to carry out her or his duties. No discrimination is tolerated in relation to age or impairment, the person has the right to an inclusive and adapted work environment and to receive the same opportunities and wages as the other workers. In cases of a tie in a public selection for a job, for instance, older people have priority to be hired for the vacancy (Presidency of Republic of Brazil, 2003).

References:

Presidency of Republic of Brazil. (2003). Estatuto do Idoso. Presidency of Republic of Brazil; National Congress of Brazil’s Information System. http://www.planalto.gov.br/ccivil_03/leis/2003/l10.741.htm

This section to be updated soon.

Mexico does not have any policies that protect employment or support workers in case they are fired, etc.

No dementia-specific policy/legislation was found that protects employment in the case of a dementia diagnosis. However, South Africa has sound policies on employment equity and employing persons with disabilities (including mental impairment). Although these policies are limited in its reference to persons living with dementia, the following employment protection legislation are relevant:

  • Employment Equity Act (no.55 of 1998) provides rules and guidelines to make the workplace free of discrimination for persons with disabilities, including physical and mental impairment (see (Employment Equity Act No.55 of 1998.Pdf, 1998);
  • The Employment Equity Act (no.55 of 1998)’s Code of good practice on the employment of people with disabilities provide a framework on the reasonable accommodation and retaining of employment for people with disabilities. In the event where termination of employment becomes an operational requirement (due to the disability), employers are expected to provide employees with the opportunity to apply for any disability benefits available from the organisation (see Government Gazette, 1998).
References:

Employment Equity Act No.55 of 1998.pdf, 1 (1998).

Government Gazette. (1998). EMPLOYMENT EQUITY ACT 55 OF 1998: Code of good practice on the employment of people with disabilities. https://gestaltconsult.com/wp-content/uploads/2017/02/Employment-Equity-Act-People-with-Disabilities.pdf

There are no specific mechanisms for carer’s benefits. However, currently being a carer of an older person is recognized as an occupation and as such, it has the benefits according to each type of signed contract/regimen (CLT, self-employed caregiver, domestic caregiver, or volunteer caregiver) (Brazilian Ministry of Economy, 2019). Besides, the norms that will regulate the caregiver as a proper profession have been approved (under the Law Project N. 11, 2016) by the Congress House but they were then refuted by the current president of Brazil. The matter is awaiting for a final decision by the Congress House (Brazilian Chamber of Deputies, 2016). If sanctioned by the president, the profession will incorporate the labour rights as other formal professions. Unpaid carers are not entitled to receive any specific social protection benefit.

References:

Brazilian Chamber of Deputies. (2016). Projeto de Lei da Câmara n° 11, de 2016—Pesquisas—Senado Federal. https://www25.senado.leg.br/web/atividade/materias/-/materia/125798

Brazilian Ministry of Economy. (2019). Classificação Brasileira de Ocupações—Relatório da Familia—4.0.15. http://www.mtecbo.gov.br/cbosite/pages/relatorio/relatorioTemplateWordFamilia.jsf

There is no financial carers’ benefit if the person with disability is above the age of 18. The laws in Kenya under the Persons with Disability Act, state that, “beyond the age of eighteen on the allowances payable under this regulation shall be paid directly to the person with disability and such person may be treated in his own right under the other regulations for Cost, Care and Maintenance, and the Council may recommend the person to whom such allowance may be made” (Legislation, 2010). Other than this, there is no other benefit that the carer is entitled to.

References:

Legislation, S. (2010). Persons with Disabilities Act, (14). https://www.un.org/development/desa/disabilities/wp-content/uploads/sites/15/2019/11/Kenya_Persons-with-Disability-Act.pdf

Mexico does not have any policies that support carers.

See 09.01.01, the older person with dementia can apply for a grant-in-aid (R420 as of 2019), and if eligible, can use this to pay for a carer (although the amount is too little to support a full-time carer per month).

No protection mechanisms regarding this matter exist.

No specific to dementia.

According to the Employment Act, an employee is entitled to sick leave of no more than seven days with full pay and thereafter to sick leave of seven days with half pay, in each period of twelve consecutive months of service if the employee has been in service for at least two consecutive months with his employer. The employee is required to present a certificate of incapacity to work that has been signed by a duly qualified medical practitioner or a person acting on the practitioner’s behalf in charge of a dispensary or medical aid centre (Republic of Kenya, 2012). This applies to all employed persons with or without a disability.

References:

Republic of Kenya. (2012). Employment Act: Chapter 226. The National Council for Law Reporting with the Authority of the Attorney-General. http://kenyalaw.org/kl/fileadmin/pdfdownloads/Acts/EmploymentAct_Cap226-No11of2007_01.pdf

Mexican labour legislation does not include care leave as a benefit, no programs are in place.

Paid leave is a temporary condition of service as long as the person is employed. Once the person is living with dementia, his/her capacity deteriorates and is no longer employed, the need for long term care/absence from work is not supported under the employment conditions. The organisation’s policy on special leave arrangements will apply while still employed, whereas for extended periods of absence beyond policy prescriptions or permanent absence (e.g., resignation or termination of employment), the Employment Equity Act’s (no.55 of 1998) Code of good practice on employment of people with disabilities will apply (Government Gazette, 1998). Medical boarding is a further option as a way for the person to retire.

References:

Employment Equity Act No.55 of 1998.pdf, 1 (1998).

Government Gazette. (1998). EMPLOYMENT EQUITY ACT 55 OF 1998: Code of good practice on the employment of people with disabilities. https://gestaltconsult.com/wp-content/uploads/2017/02/Employment-Equity-Act-People-with-Disabilities.pdf

No protection mechanisms regarding this matter exist.

The important contributory schemes include the Employees’ State Insurance Scheme and the schemes run by the Employee Provident Fund Organization (EPFO) (e.g., Employee Provident Fund Scheme (EPFO), Employee Pension Scheme (EPS)). (Details on each scheme is available at: https://labour.gov.in/general-overview).

Following the National Social Security Fund (NSSF) ACT No. 45 of 2013, employers are advised to make arrangements to submit their contributions in accordance with the new NSSF Act where pension contribution would be 12% of the pensionable wages made up of two equal portions of 6% from the employee and 6% from the employer subject to an upper limit of KES 2,160 for employees earning above KES 18,000. The Upper Earning Limit (UEL) is KES. 18,000 while the Lower Earnings Limit (LEL) is KES 6,000 (National Social Security Fund (NSSF), 2019). This applies to all employees and is not specific to persons with dementia.

References:

National Social Security Fund (NSSF). (2019). New NSSF Member Contributions. https://www.nssfug.org/about-us/membership/

Mexican social security legislation (covering social security institutions IMSS, ISSSTE, and other federal and state level institutions) includes disability, work related accidents pensions, but does not contemplate any credited contributions in case of unemployment, illness, etc.

There is no mechanism in place specifically for persons living with dementia.

No tax allowances have been found, apart from the income tax payment waiver.

Senior citizens have a higher tax exemption limit in comparison to regular taxpayers (Vikaspedia, n.d.-a). In addition, the Income Tax Department also provides some tax deduction to individuals caring for relative with disability under Section 80DD (Department of  Revenue, 2019).

References:

Department of Revenue. (2019). Tax benefits due to life insurance policy, health Insurance policy and expenditure on medical treatment.

Vikaspedia (n.d.-a). Concessions and Facilities given to Senior Citizens. Government of India. Available from: https://vikaspedia.in/social-welfare/senior-citizens-welfare/concessions-and-facilities-given-to-senior-citizens

Mexican Income and Taxation legislation does not contemplate tax allowances (understood as exemptions that reduce how much income tax an employer deducts from an employee). Employer taxation is fixed given different income gaps and the only deductions in place are at the individual (employee) level, given different fiscal regimes.

There is no mechanism in place specifically for persons living with dementia. Pensioners (i.e., 60 years and over) in South Africa, however, enjoy discounted municipal rates on their property (should they own property) between 40 and 100%.

There is the Law Project N. 61 (2017) which is under consideration and establishes that people with Alzheimer’s disease will receive income tax waivers (Brazilian Federal Congress, 2017). While this matter has not been decided in court, many people living with Alzheimer’s disease have pleaded for the tax waiver in court and have obtained it.

References:

Brazilian Federal Congress. (2017). Projeto de Lei do Senado n° 61, de 2017—Pesquisas—Senado Federal. https://www25.senado.leg.br/web/atividade/materias/-/materia/128350

There are no universal tax rebates in place in Mexico; however, some local governments have special tax rebate programs for older adults. For example, Mexico City has a 30% reduction in property tax (paid yearly) for pensioners and older adults (60 years and older).

There is no mechanism in place specifically for persons living with dementia. Pensioners (i.e., 60 years and over) in South Africa, however, enjoy discounted TV-licence rebates.

Older people (aged 65 or plus, regardless of living with dementia) are entitled to use urban and semi-urban collective public transportation free of charge. In relation to interstate collective transportation system, there is the “Free Pass” (Passe Livre) program. It is a national program that guarantees free fares for people who have proven to be in financial need (total household per capita monthly income lesser than one national minimum wage) and who live with disability (mental, physical etc.) (Brazilian Ministry of Infrastructure, 2019).

References:

Brazilian Ministry of Infrastructure. (2019). Passe Livre—Como Pedir. http://portal.infraestrutura.gov.br/passelivre/passe-livre/?como-pedir

While there are no discounted transportation fares for persons with dementia, a few state governments provide concessions to senior citizens using the state transport buses (Vikaspedia, n.d.-a). In addition, the Indian Railyways and airlines for domestic flights provide fare concessions to senior citizens as well (Vikaspedia, n.d.-a).

References:

Vikaspedia (n.d.-a). Concessions and Facilities given to Senior Citizens. Government of India. Available from: https://vikaspedia.in/social-welfare/senior-citizens-welfare/concessions-and-facilities-given-to-senior-citizens

No universal transportation discount programs are in place in Mexico. However, older adults can register in the National Institute for Older Adults and get a wide variety of discounts (amount and type) with public and private institutions that have collaboration agreements with INAPAM[1]. Thus, they could get specific transportation fares/discounts (airlines, coaches) if agreements are in place. On the other hand, there are some states/localities that offer transportation benefits, for example, Mexico City where older adults do not have to pay for public transportation (buses, underground, etc.).

[1] INAPAM publishes a directory of all the services/institutions they have established agreements with in their webpage. Information is presented by categories of discounts: food, legal and accounting consultancy, education, culture, recreation, and sports; property tax and water services; health; transport; dress and home. For each category, there is a downloadable directory with information by state. Available at: https://www.gob.mx/inapam/acciones-y-programas/beneficios-test

There is no mechanism in place specifically for persons living with dementia. Pensioners (i.e., 60 years and over) in South Africa, however, enjoy discounted municipal rates on long-distance travel transportation (train and bus liners), as well as discounted access fees to public national parks (Qukula, 2019).

References:

Qukula, Q. (2019). 30 discounts , freebies and rebates for pensioners to take advantage of. Cape Talk. http://www.capetalk.co.za/articles/338645/30-discounts-freebies-and-rebates-for-pensioners-to-take-advantage-of

There is no regulation about free fares for people accompanying older people in urban and semi-urban regions. Some people file a lawsuit to get this benefit. The interstate collective public transportation (the Free Pass program) warrants free companion fares once one proves not having financial means for paying the companion’s tickets. When a medical report states the need of a companion, the accompanying person is entitled to receive free fares (Brazilian Ministry of Infrastructure, 2019).

References:

Brazilian Ministry of Infrastructure. (2019). Passe Livre—Como Pedir. http://portal.infraestrutura.gov.br/passelivre/passe-livre/?como-pedir

Mexico does not have any policies to support this.

There is no mechanism in place specifically for persons living with dementia.

The Ministry of Citizenship (Social Development) offers a service entitled “Specialized Protection and Support for Families and Individuals” (Proteção e Atendimento Especializado a Famílias e Indivíduos – PAEFI). This service aims to help families and individuals who are at social risk situations (child labour, abandonment, homeless etc.) or who had their rights violated (suffered from physical or psychological violence, prejudice, negligence etc.) through guidance, support, and monitoring. In this service, social assistants, psychologists, and lawyers work to promote access to rights and to strengthen people’s social and family relationships (Rodrigues, 2019b). Another service also offered by the Ministry of Citizenship is the “Special Social Protection Service for People Living with Disabilities, Older People, and their Families” (Serviço de Proteção Social Especial para Pessoas com Deficiência, Idosas e suas Famílias). This service aims to help older people with some degree of dependence, people living with disabilities, their carers, and family members through professional care in their homes, day centres, or Specialized Reference Centre for Social Assistance (CREAS) (Brazilian Ministry of Citizenship, 2014).

References:

Brazilian Ministry of Citizenship. (2014). Tipificação Nacional de Serviços Socioassistenciais. https://www.mds.gov.br/webarquivos/publicacao/assistencia_social/Normativas/tipificacao.pdf

Rodrigues, A. (2019b). Proteção e Atendimento Especializado a Famílias e Indivíduos (PAEFI) [Página]. MINISTÉRIO DA CIDADANIA Secretaria Especial do Desenvolvimento Social.

Food and public distribution: Under the Public Distribution System (TPDS), the Antyodaya Anna Yojana Scheme provides food grains at a highly subsidised price to families living below the poverty line (Department of Food and Public Distribution, n.d.; Vikaspedia, n.d.-a).

References:

Department of Food and Public Distribution. (n.d.). ANTYODAYA ANNA YOJANA (AAY) AAY. Government of India. Available from: https://dfpd.gov.in/pds-aay.htm

Vikaspedia (n.d.-a). Concessions and Facilities given to Senior Citizens. Government of India. Available from: https://vikaspedia.in/social-welfare/senior-citizens-welfare/concessions-and-facilities-given-to-senior-citizens