The Impact of Crisis and Austerity on Long Term Care for Older People in Portugal – An Analysis Based on the Experiences of Social Workers in Private Institutions for Social Solidarity

Abstract

In Portugal, long-term care (LTC) for older people rests mainly upon Private Institutions for Social Solidarity (IPSS). The debt crisis of 2008-2013 and the austerity policies that followed had a considerable impact on all sectors of the country’s economy and social services. How did this crisis and austerity impact long-term care for older people? We approach this question with a qualitative research using content analyzis, based on individual interviews of a geographically convenient sample (N = 20) with social work staff of IPSS providing social responses of LTC for older people (1 full-time social work staff per each institution), located at the Center Region of Portugal. The main themes revealed by the analyzis were: financing, human resources, partnerships and quality. The results show a strong impact at the level of financing, yet, a correspondent lower impact on the quality of the services. Also, some dynamics of innovation appear in issues of partnerships and human resources. Although the results and discussion are limited to a specific historical and geographical context, upon further research, they can be considered as implications of crisis and austerity on older people’s social services more broadly, and a reference point to compare with future social policies.

Keywords:

• IPSS
• austerity
• long-term care
• older people
• social workers

Acknowledgements

We want to express our thanks to the students who participated in collecting data for this study, under the supervision of the Professor of the curricular unit of Social Economy, of the graduation on Social Work, from the Miguel Torga Institute of Higher Education, as well as to the social workers who took their time to answer the interviews.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 We take a consensual translation of the Portuguese designation: “private institutions for social solidarity” for “instituições particulares de solidariedade social”.

2 Namely, the National Confederation of Social Solidarity Institutions (CNIS), the Union of Mutualities (UM), and the Union of Portuguese Misericórdias (UMP). These last type of institutions (“Santas Casas da Misericórdia”, literally “Holly Houses of Mercy”) are more than five centuries old institutions dedicated to humanitarian solidarity based on the Christian value of mercy and have a crucial role in the provision of social security services in Portugal (Franco et al., 2005).

3 Verbatim “Houses of the People”, used to be an element of the corporative integration of rural workers in the Estado Novo and are now local associations with social and cultural aims.

4 The first Santa Casa created in Portugal (1498), contrary to the others, is considered a public sector institution (cf. Franco, 2005).

5 See Acknowledgments.

6 Monthly per capita income (MCY) is calculated using the following formula: MCY = HY / (12-E) / n, with HY being the household income, E the fixed monthly expenses (rents, taxes, health and transport costs) and n the number of household members.

7 For example, the value of the monthly contribution to the social response ‘Residential Structure for Older People’ is determined by a percentage of per capita income ranging from 75% to 90%. The respective percentages in the social response ‘Day Care Center’ can range between 45% and 60%.

8 The CSI is “a cash support paid monthly to older people with low resources, aged equal to or above the normal age of access to the old-age pension of the general Social Security regime, that is, 66 years and 5 months, and residing in Portugal” (Segurança Social, 2021).

9 The First-Degree Dependency Supplement is granted to people who cannot independently perform the acts essential to meeting basic needs of daily life, such as food, locomotion and personal hygiene (Decreto-Lei n.º 265/99).

10 See above note 9.

11 According to a recent economic study (CNIS, 2017), contributions from local authorities account for only 0.8% of total IPSS revenues.

12 The audits carried out regularly on IPSS by Social Security technicians have, among other objectives, to ensure that human resources are adequate to the legal provisions.

13 District of Coimbra Social Security Center.

14 Municipality of Coimbra.

15 Coimbra Local Council of Social Action.

16 Resolução do Conselho de Ministros, 1997.

17 A professional theater group.

18 Polytechnic higher education school in Coimbra with courses on education, social activities, communication and culture.

19 The Nursing School of Coimbra, also a polytechnic higher education school.

20 Concerns secondary education.

21 Directorate-General for Reintegration and Prison Services.