Instituto Nacional de Geriatría

Populations in the region of the Americas and some areas of the Asia Pacific region are aging with a high burden of chronic disease and disability, which implies an increase in long-term care needs. It is projected that the prevalence of severe disability in Latin America and the Caribbean will almost triple between 2000 and 2050.

Apart from the demographic and socio-cultural heterogeneity in countries, a significant increase in the demand for care services, and a decrease in their supply is expected. In many countries, like Mexico care services have been traditionally based on unpaid care, mainly provided by family members.

Despite the implementation costs for long term care systems, the fact of not having integrated solutions to respond to these needs generates even higher costs. The economic impact for unpaid care providers is enormous, and the generation of a long-term care system can provide economic benefits through the creation of jobs as formal caregivers.

The issue of long-term care is of high relevance for health systems because the health sector plays a fundamental role in the prevention of disability with the consequent containment of dependency and there are significant costs for the health system, due to the non-covered care services, such as the so-called socio-sanitary beds, in addition to the costs of solving the attrition-related diseases of unpaid caregivers.

In this context, care dependency arises when the low functional ability of an individual makes him unable to undertake the basic tasks of daily living without the assistance of a third person. It reflects decrements in capacity that cannot be compensated for by other aspects of the older person's environments or the use of available assistive devices. Long-term care services are the activities developed by people to ensure that the care-dependent population can maintain a level of functionality that allows them to live their lives in accordance with their basic rights, autonomy, fundamental freedoms, and human dignity.

Community-based long-term care emerges as an option aligned with the "ageing-in-place" strategy, which consists in providing social and health care while the older adults stay in their homes and communities safely and comfortably, regardless of age, socioeconomic status or health status.

The General Health Council of Mexico has reached consensus on the definition of long-term care as a variety of services required by those who present functional, physical or cognitive limitations, and who, consequently, depend on a third person and for an extended period of time, and need support or assistance in the basic and instrumental activities of daily life. The Council has agreed on the design and implementation of a public health policy that can grant long-term care by public institutions of the National Health System. Based on such agreement, the National Institute of Geriatric Medicine of Mexico is preparing a diagnosis of the needs and current offer of the provision of long-term care at the national level by public institutions of the National Health System. The result will be applied during the development of public policy on the subject; and, consequently, a community-based long-term care model, framed in the vision of a comprehensive long-term care system for the nation/ economy.

The objective of the meeting was to analyze the experiences of design and implementation of community-based long-term care from the Asia-Pacific and the Americas. Besides, the National Institute of Geriatrics proposed the foundations for the development of a long-term care system that can be potentially useful to different international contexts.

The presentations and discussions during the meeting provided valuable inputs for the National Institute of Geriatrics (INGER). The INGER will use these inputs to strengthen its advocacy role as two parallel processes are taking place: the review and update of the legal framework related to long-term care and the re-designing of the System for Social Security and Health.

This forum was useful to expand the understanding about the science behind the LTC systems but also to learn about good practices for LTC systems from other latitudes.

Achieving the design and implementation of the LTC system in Mexico demands the transformation of some cultural and organizational structures, besides placing the LTC topic on top of the public agenda; and changing the perception of LTC as a charity- or family-based activity, for a paradigm of LTC as a right. It is about decreasing the burden to the families and help the caregivers. Also, recognizing the social value of caregivers who should receive compensation and social acknowledgment for the tasks performed.

This meeting provided crucial elements to update and re-think the roadmap of the actions needed to achieve a fully-functional LTC system in Mexico.

FORUM PRESENTATIONS

Presentations October 23
Panel 1