IFA – International Federation of AgingPragha, 28 May 1 June - 2012

29 May 2012

“Aging, poverty and policy intervention in Portugal”

Maria Irene Carvalho – ULHT – Lisbon

Isabella Paoletti – CLUN – UN - Lisbon

Aims and metodology

Aims • Discuss critically policy intervention to facing poverty among the elderly in Portugal;

• Present the road map of elderly policies and discuss some good practices in relation to social inclusion.

Methodology• This paper is part of an ongoing research project: Aging, poverty and social exclusion: a

interdisciplinary study on innovative social services.• It aims at providing evidence of the efforts done at policy level and of good practices in

services provision in order to address inequalities and social exclusion, in relation to older people living in poverty.

• The data collected so far include: • 1) 50 semi-structured interviews to social workers, services coordinators, presidents of older

people´s associations, coordinators of civil societies initiatives; • 2) Ethnographic documentation of social intervention involving older people;• 3) Relevant documents and legislation – This presentation is about this policies analyses

                                                                                                                                                                                                              

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Censo, 2011

Increasing Aging Population - Demografic trends

19,1%15%

Increasing Dependency - racio

Gráfico –1960-2060 Dependency

Poverty amongst older people in Portugal(limiar: 60% do rendimento mediano por adulto equivalente após transferências sociais)

Fonte: Eurostat [SILC: At-risk-of-poverty rates by age and gender (ilc_li02); actual. 15-06-2011]

Link: Eurostat (com dados actualizados)

Inequalities – Income distribution, 2011

(razão da proporção rendimento da pop . quintil maior e menor rendimento)

Fonte: Eurostat [SILC: S80/S20 income quintile share ratio by gender and selected age group (ilc_di11); actual. 15-06-2011]

Multidimension of aging poverty

Desengagement;

Decrease in economic resources, poverty

Increased loneliness, isolation;

Chronic diseases, dependency;

Need for social and health care specialized services;

Need for formal and informal caregivers;

Risk of violence and discrimination;

Difficulties in accessing services and social benefits;

Risk of violation of human rights and dignity;

Local authoritiesMunicipalitiesLocal authoritiesMunicipalities

MunicipalitiesMunicipalities Municipal AssemblyMunicipal Assembly

Parish CouncilsParish Councils Parish AssemblyParish Assembly

Social network Social network

Platform above district councilPlatform above district council

Parish Social CommitteeParish Social Committee

Central Institute of Social Security IPCentral Institute of Social Security IP

Local servicesLocal Services of the Institute of Social Security IP

Local servicesLocal Services of the Institute of Social Security IP

Pensions and other accessories

Social benefits and supplementsFunding for Social ActionSocial services

Pensions and other accessories

Social benefits and supplementsFunding for Social ActionSocial services

Civil Society Civil Society - Law 1983 and other

Civil Society Civil Society - Law 1983 and other

non-profit organizationsPSS - relationship with the state, financing and protection:SCM, Associations, Community Centers, Social Solidarity Cooperatives

non-profit organizationsPSS - relationship with the state, financing and protection:SCM, Associations, Community Centers, Social Solidarity Cooperatives

OngsFoundations, otherOngsFoundations, other

Social facilitiesNursing homes, Home care day centers and night, living, home support services, integrated responses.Projects to combat poverty. University senior, senior tourism.Call center, food bank, senior citizen online, social emergency, other

Social facilitiesNursing homes, Home care day centers and night, living, home support services, integrated responses.Projects to combat poverty. University senior, senior tourism.Call center, food bank, senior citizen online, social emergency, other

National Inclusion Plan

National Action Plan for Inclusion

National Inclusion Plan

National Action Plan for Inclusion

Social Security SystemMinistry of Labour and Social Solidarity - Law on Social Security 2007Social Security and Labour)

Social Security SystemMinistry of Labour and Social Solidarity - Law on Social Security 2007Social Security and Labour)

3 - Community

level

2 - Local level

1 - National

level

Road map of social policies in Portugal (social inclusion exemple)

In the last 15 years social policies

Policy interventions in Portugal have been focused on:

Increasing the minimum pensions, (solidarity supplement for the elderly),

Improvement and promotion of quality of live for older people, specific programs on housing,

Development a variety of specific services (day centres, home care assistance, residential/nursing care etc.),

Promote integrated care facilities with health and social services - Integrated continuing health and social care;

Some strategic programs have been developed…

In order to create safety social nets, participation and effective health care, programs such as:

PAII (Plan for Integrated support services for the elderly, 1994, 1998 – until 2006 – Continuing Care Act – 101/2006)

PNAI (National Plan of Action for Social Inclusion- 2001, 2003, 2005, 2006, 2008-2010),

These programs involved several stakeholders at national, local and community level.

PAII - configuration

PAII includes a financial scheme and the main technical procedures for the creation of support services for older people. The main areas of intervention of PAII are:

• Integrated Home care support services - “Serviço de Apoio Domiciliário integrado” (SADI);

• Temporary centres for disabled older people -“Centro de Apoio Dependentes” (CAD);

• Training activities for voluntary helpers and for professionals - Formação de Recursos Humanos (FORHUM);

• Help line, leisure and reduced pay schemes for public transport.

PNAI- configuration

Several measures relating to income, housing, social integration, consolidating network of services have been developed, for example:

• Solidarity supplement for the elderly (MTSS) ;

• Programme for housing comfort for the elderly (MTSS) (PCHI);

• Improving home conditions for older people;

• Reinforcing facilities for the elderly: – Social services and equipment network programme (PARES)– Re-qualification and safety programme for social facilities

• National network for integrated long term care (RNCCI) MTSS/MS

Current financial crises have put an end to these two programmes – PAII and PNAI, and the following cuts have also been put in place:

Cuts pensions and allowances;

Reduction of tax exemptions for medicines and transport;

Rationing access to social and health services ;

Increased health fees – medical appointments and medical exams;

Policies intervention are now focused:

1- Reconfiguration on welfare services - restricting access to the social security and health system;

2 – Ideia of “commissioning” to promote health and well-being– the state contracts these services to private and third sector organizations;

3 - Individual responsibility - Every individual has to plan for the risk of old age and illnesses through private schemes, such as PPR and Health Insurance;

4 – The state intervenes only in the most problematic cases – like ex cumulative issues: poverty, dependency, isolation.

Evidences

• Despite all the above policy measures, poverty remains widespread among older people in Portugal.

• Such measures address only basic needs of older people (food, housing, health, etc), but underestimated the importance of their involvement in decision making processes - taking into account the rights of older people;

• Measures that aim to bring people out of poverty have to look at the specific conditions that maintain the person in that situation. There is a need for the development of integrated and individualized care plans supported by well coordinated interventions;

• It is necessary to look not only to what extent services are provided, but how they are provided in practical terms.

Concluding, to face poverty in financial crises…

Develop policies that are geared to the needs of people –oriented by - multiservice partnerships and intervention in networks;

Consider the expectations and needs of older people in the intervention, promote their empowerment and participation in decision making;

Develop legal mechanisms and social protection for older people with dementia and chronic illnesses;

Promote the adaptation of the new technologies to improve the quality of life of older people - Assistant Living Conditions;

Value the work of formal and informal carers for older people and develop appropriate training and information processes;

Provide adequate training to all the professionals that work with older people in terms of values , theories and methodologies.

Thanks