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IFA – International Federation of Aging
            Pragha, 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
Increasing Aging Population - Demografic trends           )]




               15%                                19,1%




 Censo, 2011
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
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;
Road map of social policies in Portugal (social inclusion exemple)
                Social Security System
 1 - National   Ministry of Labour and
                Social Solidarity - Law on
                Social Security 2007
 level          Social Security and
                Labour)
                                                                                                        Pensions and other
                                                 Central
                                                                                                        accessories
                                                 Institute   of    Social   Security   IP
                                                                                                        Social benefits and
                                                                                                        supplements
                                                                                                        Funding for Social Action
                     National
                                                 Local services                                         Social services
                     Inclusion Plan
                                                 Local Services of the Institute of
                     National     Action         Social Security IP
                     Plan for Inclusion




2 - Local        Local authorities                                                                Social network
                 Municipalities

level
                                                                                                  Platform above district
                 Municipalities              Municipal Assembly
                                                                                                  council



                 Parish Councils             Parish Assembly                                      Parish Social Committee




                 Civil Society               non-profit organizations
3-               Civil Society - Law 1983    PSS - relationship with the state,             Social facilities
                 and other                   financing and protection:                      Nursing homes, Home care day centers
Community                                    SCM, Associations, Community                   and night, living, home support services,
                                             Centers, Social Solidarity                     integrated responses.
                                             Cooperatives                                   Projects to combat poverty. University
level                                                                                       senior, senior tourism.
                                                                                            Call center, food bank, senior citizen
                                              Ongs                                          online, social emergency, other
                                              Foundations, other
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

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Maria irene carvalho 29.05.2012

  • 1. IFA – International Federation of Aging Pragha, 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
  • 2. 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
  • 3. Increasing Aging Population - Demografic trends )] 15% 19,1% Censo, 2011
  • 4. Increasing Dependency - racio Gráfico –1960-2060 Dependency
  • 5. 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)
  • 6. Inequalities – Income distribution, 2011
  • 7. 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;
  • 8. Road map of social policies in Portugal (social inclusion exemple) Social Security System 1 - National Ministry of Labour and Social Solidarity - Law on Social Security 2007 level Social Security and Labour) Pensions and other Central accessories Institute of Social Security IP Social benefits and supplements Funding for Social Action National Local services Social services Inclusion Plan Local Services of the Institute of National Action Social Security IP Plan for Inclusion 2 - Local Local authorities Social network Municipalities level Platform above district Municipalities Municipal Assembly council Parish Councils Parish Assembly Parish Social Committee Civil Society non-profit organizations 3- Civil Society - Law 1983 PSS - relationship with the state, Social facilities and other financing and protection: Nursing homes, Home care day centers Community SCM, Associations, Community and night, living, home support services, Centers, Social Solidarity integrated responses. Cooperatives Projects to combat poverty. University level senior, senior tourism. Call center, food bank, senior citizen Ongs online, social emergency, other Foundations, other
  • 9. 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;
  • 10. 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.
  • 11. 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.
  • 12. 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
  • 13. 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;
  • 14. 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.
  • 15. 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.
  • 16. 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