Evaluation of Long-Term Institutions for Older People in Brazil: an overview of regional inequalities

Guimarães, Mirna Rodrigues Costa; Giacomin, Karla Cristina; Ferreira, Raquel Conceição; Vargas, Andrea Maria Duarte

doi:10.1590/1413-81232023287.15792022EN

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

FREE THEMES • Ciênc. saúde coletiva 28 (7) • July 2023 • https://doi.org/10.1590/1413-81232023287.15792022EN copy

Evaluation of Long-Term Institutions for Older People in Brazil: an overview of regional inequalities

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aims to evaluate the Brazilian Long-Term Institutions for Older People (LTIE), according to the Integrated Multidimensional Theoretical Model of Quality and Service (MIQA), and compare the performance achieved between the regions of the country. Descriptive ecological study carried out with public secondary data from the LTIE participating in the 2018 Census of the Unified Social Assistance System. An Evaluation Matrix was constructed from the Census variables and the MIQA Theoretical Model. Quality parameters were used to classify the institutions’ performance for each indicator as “incipient”, “developing” or “desirable”. The disparity index was obtained for each indicator. 1,665 institutions were analyzed. Differences were observed in the percentages of LTIE with “desirable” performance between Brazilian regions, and the need for improvement in most LTIE in relation to the proportion of caregivers of older people, the composition of the multidisciplinary team, accessibility and supply of health promotion actions. There was a need for government support for the suppression of exclusionary differentiation criteria and for the expansion of services to overcome overcrowding.

Key words:
Aged; Nursing homes; Long-Term Institutions for Older People; Old age assistance; Home Nursing

Indicators	SUAS Census Variables	Calculation Formula and Performance Parameters (I; ID and D)
Dimension 1 - Central focus on residents, family members, employees and community
1. Access without exclusive differentiations	a) The unit accepts older people with mental disorders;	{(Number of variables with affirmative answers/6)*100} - I: 0 to 33% - ID: 50 to 68% - D: 80 to 100%
	b) The unit accepts older refugees/immigrants;
	c) The unit accepts older people with a history of homelessness;
	d) The unit accepts older people from indigenous or traditional communities (example: quilombola, gypsies, riverside people);
	e) The unit accepts older people with physical, sensory or intellectual disabilities;
	f) The unit accepts older transvestites, transsexuals, transgenders.
2. Presence of Coordinator at the institution	a) The LTIE has a coordinator/technical manager with a higher level, with a minimum workload of 20 hours, with a formal link to coordinate the unit, according to legislation;	{(Number of variables with affirmative answers/2)*100} - I: 0% (Non-coord.) - ID: 50% (Coord., but it does not comply with the law) - D: 100% (Coord. according to law)
2. Presence of Coordinator at the institution	b) The LTIE has a coordinator/technician in charge at the unit.
3. Valuing the professional team	a) Number of professionals with an employment relationship with the institution [private sector employee, outsourced, press worker/cooperative/service provider, statutory employee or public employee;	{(a/b)*100} - I: 0 to 33% - ID: 33.01 to 66% - D: 66 to 100%.
3. Valuing the professional team	b) Number of professionals working in the institution.
4. Care for the older person’s family	a) Provides psychosocial assistance to the families of the people sheltered (family orientation);	{(Number of variables with affirmative answers/3)*100} - I: 0 to 33% - ID: 33.01 to 66% - D: 66 to 100%
	b) Promotes meetings with groups of families of the older people;
	c) Promotes contact and participation of the family in the life of the older person.
Dimension 2 - Human Resources
5. Ratio of caregivers per older person	a) Number of caregivers with a workload of 40 hours a week or more than 40 hours a week.	{(a/b*100} - I: <0.025 - ID: between 0.025 and 0.049% - D: ≥0.05%
5. Ratio of caregivers per older person	b) Number of older residents.
6. Low turnover of professionals	a) Number of professionals working at the institution for 1 (one) year or more;	{(a/b)*100} - I: <50% - ID: between 50% and 86% - D: >86%
6. Low turnover of professionals	b) Total number of professionals working at the institution.	{(a/b)*100} - I: <50% - ID: between 50% and 86% - D: >86%
7. Permanent Training	a) Existence of lectures, workshops, training and qualification of workers in the unit;	{(Number of affirmative variables/2)*100} - I: 0% - ID: 50% - D: 100%
7. Permanent Training	b) Existence of training in the area of geriatrics (Aging or Rights and care for older people).
Dimension 3 - Family Involvement
8. Favoring Family Bond	a) The unit promotes coexistence and bonding services for the older people and their families (0: no; 1 yes);	{(Sum of the variables codes a, b, c/5)*100} - I: 20 to 30% - ID: 40 to 60% - D: 80 to 100%
	b) The unit welcomes users with family ties (0: no; 1 yes)
	c) Visits are allowed in the LTIE (0: no; 1: only on some specific dates; 2: monthly and 1 to 2 days a week; 3: daily)
Dimension 4 - Individualized Care
9. Socialization	a) The LTIE promotes activities with community participation;	{(Number of variables with affirmative answers/4)*100} - I: 0 to 25% - ID: 50 to 75% - D: 100%
	b) Accompanies the older person to collect documents;
	c) Conducts tours with users;
	d) Promotes the participation of people welcomed in existing services, projects or activities in the community.
10. Health care management	a) Use of Individual Care Plan;	{(Number of variables with affirmative answers/4)*100} - I: 0 to 25% - ID: 50 to 75% - D: 100%
	b) Use of medical records in the unit;
	c) Produces technical reports of cases under follow-up;
	d) Discusses cases with other professionals in the network.
11. Multiprofessional team in the health area	a) Presence of a psychologist for psychosocial care (individual or in groups at the unit);	{(Number of variables with affirmative answers/5)*100} - I: 0 to 20% - ID: 40 to 60% - D: 80 to 100%
	b) Presence of a nurse in the unit;
	c) Presence of a nutritionist in the unit; d) Presence of a physiotherapist in the unit; e) Presence of a doctor in the unit.
12. Professionals for leisure activities	a) Number of higher-level professionals for leisure activities (occupational educator/therapist);	{(Number of professionals for leisure activities 12 hours a week/number of older residents)} - I: 0 - ED: <0.025≠0 - D: ≥0.025
12. Professionals for leisure activities	b) Number of older residents.
Dimension 5 - Environment
13. Adequate physical structure	a) Existence of dormitories for a maximum of 3 older people;	{(Number of variables with affirmative answers/9)*100} - I: 0 to 33% - ID: 44 to 67% - D: 78 to 100%
	b) Existence of bathrooms in the same number as bedrooms;
	c) Existence of an external recreation area;
	d) Existence of kitchen, with or without pantry;
	e) Existence of laundry;
	f) Existence of a cafeteria/dining room;
	g) Existence of living room, for coexistence;
	h) Existence of an administration room or meeting rooms
	i) Existence of room for collective activities.
14. Accessibility	a) Main access adapted with ramps and the existence of an accessible route from the sidewalk to the interior of the unit;	{(Number of variables with affirmative answers/9)*100} - I: 0 to 33% - ID: 44 to 67% - D: 78 to 100%
	b) Bathrooms adapted for people with reduced mobility;
	c) Route accessible to the bathroom;
	d) Route accessible to dormitories and spaces for collective use;
	e) Equipment Furniture/materials suitable for PwD or dependency (Assistive Technologies);
	f) Main access adapted with ramps and the existence of an accessible route from the sidewalk to the interior of the unit, as per regulation;
	g) Bathrooms adapted for PwD, according to regulation;
	h) Route accessible to the bathroom, according to regulation;
	i) Route accessible to dormitories and spaces for collective use, according to specific regulation.
Dimension 6 - Housing
15. Existence of materials for culture and leisure	a) Presence of a bibliographic collection;	{(Number of variables with affirmative answers/5)*100} - I: 0 to 20% - ID: 40 to 60% - D: 80 to 100%
	b) Presence of educational and cultural materials;
	c) Presence of sports equipment;
	d) Presence of educational and pastime games;
	e) Presence of television;
16. Institution’s social profile	a) Presence of an agreement or partnership with the public authorities;	{(Number of variables with affirmative answers/4)*100} - I: 0 to 25% - ID: 50 to 75% - D: 100%
	b) The institution is of a governmental nature;
	c) The institution is registered with the council for the rights of the older people;
	d) Presence of older people with the Benefit of Continued Benefit in the institution (disabled or not).
17. Occupancy rate	a) Number of people accommodated in the unit;	{(Number of older residents in the LTIE/maximum capacity of the LTIE)*100} - I: >100% - ID: <85% - D: 85 to 100%
17. Occupancy rate	b) Maximum service capacity.
Dimension 7 - Communication
18. Openness to dialogue	a) The unit organizes or promotes discussions with the older people about the routines of the unit; b) The unit holds meetings with Family members of the older people.	{(Number of variables with affirmative answers/2)*100} - I: 0% - ID: 50% - D: 100%

Indicators according to Quality Dimensions	Percentage of LTIE according to the performance achieved						Disparity Indexes
	Performance^a	Brazilian Regions (%)					Brazil (%)
	Performance^a	North	Northeast	Midwest	South	Southeast
Central focus on residents, family members, employees and community Dimension
1 Access without exclusive differentiations^c	I	5.7	19	21.8	12.3	20	18.6	7.2
	ID	22.9	19.6	15.8	17.7	14	15.6
	D	71.4	61.4	62.4	70	66	65.8
2 Presence of coordinator in the institution	I	17.1	7.4	7.9	8.9	11.7	10.5	22.2
	ID	51.4	57.1	49.1	37.7	31.8	37.7
	D	31.5	35.5	43	53.4	56.5	51.8
3 Valuing the professional team	I	42.9	38.6	24.2	7.3	6.7	12.9	29.2
	ID	31.4	14.8	17.6	8.9	8.9	10.9
	D	25.7	46.6	58.2	83.8	84.4	76.2
4 Care for the older person’s family	I	55.9	46.3	58.7	47.9	35.1	41.1	31.8
	ID	25.5	27.1	21.6	28.4	28.7	27.7
	D	17.6	26.6	19.7	23.7	36.2	31.2
% LTIE with at least one indicator with desirable performance		79.4	87.8	86.4	97.8	93.1	-	8.4
Human Resources Dimension
5. Ratio of older person caregivers	I	71.4	61.2	56.7	39.6	36.2	42.3	33.7
	ID	14.3	34	34.8	52.7	51.7	47.4
	D	14.3	4.8	8.5	7.7	12.1	10.3
6. Low turnover of professionals	I	20	4.2	5.5	2.3	3	3.6	21.3
	ID	34.3	21.7	26.7	54.2	36.6	36.6
	D	45.7	74.1	67.8	43.5	60.4	59.8
7. Permanent Training	I	4	8.7	7.8	9.4	6.2	7.1	13.7
	ID	24	28.2	37.3	35.1	28.7	30.3
	D	72	63.1	54.9	55.5	65.1	62.6
% LTIE with at least one indicator with desirable performance		88	91.2	87.3	88.5	80.1		4.6
Family Involvement Dimension
8. Favoring Family Bond	I	2.9	0.5	0	0.4	0.1	0.2	6.2
	ID	17.7	8	8.6	5.8	4.2	5.7
	D	79.4	91.5	91.4	93.8	95.7	94.1
% LTIE with at least one indicator with desirable performance ^d		79.4	91.5	91.4	93.8	95.7	-	5.6
Individualized Care Dimension
9. Socialization	I	5.9	9.6	12.3	9.3	4.9	6.9	14.2
	ID	52.9	48.9	50.9	47.1	46	47.3
	D	41.2	41.5	35.8	43.6	48.9	45.8
10. Health care management	I	5.9	11.7	14.2	11.3	4.9	7.6	15.7
	ID	47.1	47.9	50	44.8	43.5	44.9
	D	47.1	40.4	35.8	43.9	51.6	47.5
11. Multidisciplinary team in the Health area	I	80	70.4	71.5	53.1	39	48.8	48.5
	ID	17.1	23.3	23	31.5	41.9	35.8
	D	2.9	6.3	5.5	15.4	19.1	15.4
12. Professionals for leisure activities	I	85.7	86.2	86.5	88.1	81.8	83.8	22.1
	ID	2.9	5.3	5.5	6.2	6.8	6.3
	D	11.4	8.5	8	5.7	11.4	9.9
% LTIE with at least one indicator with desirable performance		64.7	60.4	56.2	75.2	66.2	-	14.2
Environment Dimension
13. Adequate physical structure	I	0	0.5	0.6	0	0.3	0.3	6.7
	ID	28.6	17.5	14.5	11.2	10.5	12.2
	D	71.4	82	84.9	88.8	89.2	87.5
14. Accessibility	I	8.6	6.9	6.1	3.5	4.4	4.8	20.4
	ID	77.1	69.3	72.7	77.3	79.3	77.2
	D	14.3	23.8	21.2	19.2	16.3	18
% LTIE with at least one indicator with desirable performance		71.4	87.3	88.5	91.5	93.1	-	7.2
Housing Dimension
15. Existence of materials for culture and leisure	I	42.9	33.9	48.5	31.9	35.5	36.2	26
	ID	42.8	45.5	34.5	40.4	41.6	41.2
	D	14.3	20.6	17	27.7	22.9	22.6
16. Institution’s social profile^e	I	0	0.1	0.1	0.1	0.1	0.1	It does not apply^e
	ID	100	99.9	99.9	99.9	99.9	99.9
	D	0	0	0	0	0	0
17. Occupancy rate	I	5.7	6.9	8.4	7.3	4.7	5.8	12.9
	ID	51.4	47.1	45.5	35.4	38	39.6
	D	42.9	46	46.1	57.3	57.3	54.6
% LTIE with at least one indicator with desirable performance		71.4	62.4	60.3	69.2	71.2	-	7
Communication Dimension
18. Openness to dialogue	I	44.1	27.7	37	38.9	28	30.8	16.8
	ID	26.5	38.3	38.3	35	36.1	35
	D	29.4	34	24.7	26.1	35.9	32.2
% LTIE with at least one indicator with desirable performance ^d		29.4	34	24.7	26.1	35.9	32.2	16.4

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva