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Health systems in transition
Portugal
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5.8 Long-term care
State provision of community care services in Portugal has been characterized
as scarce, including long-term care, day centres and social services for the
chronically ill, older people and other groups with special needs, such as
people with mental and physical disabilities. There is a traditional reliance on
the family as the first line of care in Portugal, particularly in rural areas (see
section 5.9). However, demographic changes, such as an increase in female
employment and a breakdown in the extended family due to migration to urban
centres (see sections 1.1 and 1.3), mean that many people are no longer able
to rely on such informal care. As in many other European countries, Portugal
faces a growing older population and the pressure to provide social as well as
medical care is increasing.
The
Misericórdias
, and other independent charitable organizations are the
key providers of long-term care services. Day centres, nursing homes and
residences for the elderly provide a range of services including activities, meals,
food to take home, laundry services, bathing and even assistance obtaining
medication and attendance at primary care centres (Ministry of Labour,
Solidarity and Social Security, 2015). A small means-tested contribution is
usually charged.
Home care is expanding as a result of a joint project between the Ministry
of Health and the Ministry of Labour, Solidarity and Social Security, as part of
the Integrated Support Plan for the Elderly. In some regions, an infrastructure
to deliver support to the elderly has been developed in partnership with RHAs,
municipalities and private providers, such as
Misericórdias
.
As part of this inter-ministerial project, the state is facilitating vocational
training opportunities in areas such as domiciliary care and informal health
care as part of a job-creation scheme. The division of payment between the
NHS and the social security department depends on the type of care provided
by the project, e.g. nursing care or home help. Although there are regulations
for nursing homes, these are not evaluated or managed on a regular basis.
Nursing homes in the private sector are very expensive and the majority of the
population does not have the resources to pay for them.
The RNCCI (
Rede Nacional de Cuidados Continuados
) was created by
Decree-Law No. 101/2006, of 6 June 2006, within the scope of the Ministry
of Health and the Ministry of Labour, Solidarity and Social Security due to
evidence of a clear lack of resources in long-term and palliative care as a result
of an increase in the number of people with incapacitating chronic diseases (see