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Portugal

Home care

Background information about dementia and home care services

In Portugal, until a few years ago, the extended family played a key role in the care of elderly and disabled people. Nowadays, like in other southern European countries, this situation is changing. Demographic and economic changes have led to the increasing isolation of elderly people (especially in big cities) and to a decrease in the number of large families. Also, Portugal has a high percentage of women in paid employment. In the past, these women were the primary carers of elderly and disabled people. The above-mentioned changes have had an impact on policies, as well as on the services provided to elderly people.

There are financial and service-based forms of support but they are still poorly developed. Support provided within the public and non-profit making sector is primarily aimed at supporting the less well-off social groups and elderly people without families. According to Sousa and Figueiredo (2004), promoting individual autonomy is not a central policy aim of the State – “instead assumptions of dependency relationships are pervasive in policy in respect of both cash transfers and care provisions.” They describe Portugal as a country with a strong and explicit ideological commitment to the family, but a low profile as far as family policy is concerned. As caring for the elderly and dependent people is considered a family obligation, there is very little pressure from families to obtain support services from the State.

The large majority of support services for elderly and dependent people exist within the Social Security system, which provides support in the form of money and services. Home care is in the process of expanding due to the Integrated Support Plan for the Elderly, a joint venture between the Ministry of Health and the Ministry of Employment and Social Security.

Legislation relating to the provision of home care services

Article 64 of the Portuguese Constitution states:

“the right to health protection is guaranteed through a national health service (NHS) which is universal, general and, depending on the socio-economic status of citizens, largely free of charge.”

According to article 2003 of the Civil Law Code, descendents (to the 2nd degree) are responsible for providing any indispensable care in terms of sustenance, housing and clothing to their parents. If the family cannot provide such care, the Social Security takes over responsibility.

Home care services are a social solution consisting of individualised care for people and their families, who cannot assure their basic needs and/or daily living activities, in a permanent or temporary way, due to sickness, handicap, advanced age or other reasons (Despacho Normativo n° 62/99 de 12 de November).

Due to demographic changes, the number of people with chronic diseases has increased and the lack of long-term and palliative care is now more visible. Portugal now has new social and health needs which demand new and diverse solutions.

These solutions should be adjusted to different groups of dependent people and to the different stages of the disease. At the same time, they should facilitate the autonomy and involvement of patients. The involvement of families, as well as support for the reconciliation of professional and family obligations, should be reinforced.

Organisation and financing of home care services

Portugal is divided into five Health Regions, each of which is administered and managed by an autonomous Regional Health Administration. Each region provides some social services through the Social Security System. Municipalities are increasingly organising home care services. However, the main providers of services are the Misericórdias (independent charitable organisations) and private welfare institutions, which are financed by the State.

Insofar as informal home care is concerned, the main service providers are women (75%). Men who provide informal home care are usually husbands caring for their wives.

Networks of care exist which are made up of units and teams providing continued healthcare and/or social support and palliative care. These units belong to community services such as hospitals, health centres, social security districts and local services, the solidarity network and local authorities.

There are three main benefits:

  • Dependency Supplement: This is a benefit, granted by the Social Security Department, to pensioners in need of care which can be used to help pay for services or to receive services in kind.
  • Handicap Pension: This is a benefit granted by the Social Security Department to people who are no longer able to work due to a handicap (which has been officially recognised by the “handicap verification services”).
  • Technical Aid Supplement: This benefit, which necessitates a medical prescription, can be granted by the Social Security Department, Misericordias or other institutions for technical aids such as incontinence products, articulated beds and pillows etc
Kinds of home care services available

Out of 3,828 services providers for elderly people, 1,288 are for home care services. 38,022 people benefit from home care services, with an average of 29.5 clients per service provider. Most of these clients are over 74 years old and 57% are women.

Depending on specific needs, services may include meals, cleaning and tidying the home, personal care, company and recreation, small repairs in the home, shopping, transport and laundry, etc. The following table shows the percentage of the afore-mentioned home care service providers providing various home care services:

Activities

%

Meals-on-wheels

98

Personal hygiene and comfort

97

Laundry

95

House cleaning

93

Health care (cooperation)

78

Companion (going outside)

72

Animation

62

Shopping

60

Another form of home care is family accommodation. This consists of temporarily or permanently housing elderly dependent people within families. This service is intended for elderly people who do not have a family or for whom insufficient social support prevents them from being cared for in their own homes.

There are also some temporary centres for emergency accommodation and night centres for elderly people who have sufficient capacity to perform their daily living activities but require some assistance during the night.

Sources

 

 
 

Last Updated: mercredi 15 juillet 2009

 

 
 

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