This blog is written by Peter Lloyd-Sherlock. It draws on and develops content from the presentation made by Nélida Redondo for the Global Platform’s 7th weekly webinar, available in Spanish here.
It has become a truism that, in all countries, responding to the pandemic requires the combined efforts of government, the general public, the business sector, and the civil society. And we all know that working across these different worlds is much easier said than done.
Nélida’s webinar presentation provided instructive examples of innovative collaborations which may offer useful lessons to other countries.
Working together to support old-age care homes
In many middle-income countries, managing the pandemic in care homes will be especially difficult. Nélida co-authored a short piece about this published in the British Medical Journal a few weeks ago. There has been a rapid increase in the number of care homes over the past decade and many are not registered with official agencies and so are effectively invisible to public scrutiny.
It is difficult to know what goes on inside these “invisible care homes”. Nélida co-led a study which used older women as under-cover “secret shoppers” in the Argentine city of La Plata. They found the quality of care was often very poor and that many institutions exposed their residents to daily abuse of fundamental human rights.
Following these revelations, a local older person’s NGO, Red Mayor, worked with the city’s of Association of Care Home Directors, government agencies and academics to set up an online platform for sharing information about care homes in La Plata. By the end of 2019, it was receiving over 12,000 hits a month and had succeeded in bringing cases of elder abuse to the attention of the local authorities.
When the threat of coronavirus became evident, Red Mayor partnered with the Association of Care Home Directors in a rapid online survey of care homes in La Plata. This revealed that most lacked any protective equipment or capacity to meet new official pandemic care home legislation. They shared their findings with local government agencies who promised to prioritise this issue.
Results of the La Plata care home survey question “Do you feel that the official guidance for care homes in the pandemic is realistic and feasible”? 55% say no.
The unique collaboration in La Plata is now influencing emergency strategies elsewhere in Argentina and also in some other countries. There is growing recognition that many care homes which fall short of idealistic official standards should be granted a degree of immunity from prosecution in exchange for their cooperation. Of course, any amnesty should not extend to cases of abuse of residents’ human rights, but there could be some temporary wiggle-room when it comes to smoke alarms or the height of tables in dining rooms. The recent case of a Buenos Aires care home shows why a more realistic approach is needed.
Following the deaths of five residents, the Director (who had notified the authorities of the first case several weeks previously but had received almost no external assistance) was put under investigation for failing to comply with official care standards. An Argentine friend commented to me that this would only serve to drive other care homes further underground and discourage cooperation.
Partly in response to lobbying from Red Mayor, as well as associations of care home directors and academics like Nélida, local governments are starting to change tack. A few days ago the Province of Buenos Aires published new legislation that, in exchange for their cooperation, care homes would be partly exempt from prosecution for failing to meet official standards. Other parts of Argentina are looking to do the same. Following her presentation, Nélida was invited to discuss the La Plata experience with leading experts in Mexico. And other countries, including Brazil and South Africa, are looking to draw on these experiences.
Finding and supporting the most vulnerable older people in the community
Even though there are many care homes in Latin America, more than 95 per cent of the region’s older people still live in the community, many in slum neighbourhoods. On 24 April, Spanish newspaper El País published an item on Covid-19 and older people in the shantytowns of Buenos Aires.
One shantytown resident quoted in the article observed: “I share a space that’s just three square metres with my father who’s 85 and my mother aged 84 and diabetic. But that’s not all. There are three other families here and we are obliged to share a bathroom between the 13 of us. So someone please tell me how we’re meant to practice prevention here”.
Local NGO delivers food to older man left to go hungry by the lockdown. El País (24.4.20).
Other webinar contributions included examples of initiatives in Costa Rica and Brazil to “risk-rate” older people in the community in order to reach those most in need. For her part, Nélida talked about a new collaboration between local government and non-profit organisations (Fundación SIDOM and Fundación Navarro Viola). They are working together to apply a simple set of criteria to identify the most at-risk:
Older people living alone or only living with other older people.
Older people with multiple chronic conditions and limited remaining life expectancy.
The scheme places particular emphasis on finding and supporting those people in these risk categories who are most economically deprived including those living in shantytown neighbourhoods. Given the restrictions of lockdown, the survey is mainly done by telephone, which might restrict its scope to reach the very poorest households. This is where collaboration with community groups comes in –to help identify and reach neighbouring older people at high-risk, either by phone or more direct means (as in the picture above).
This new collaboration has only just begun. Whether or not it succeeds in finding and helping older people who need most support remains to be seen. We will provide updates in future blogs.
Despite these promising collaborations, nobody in Argentina is in any doubt that the pandemic is here to stay and set to spread. Argentines of all ages face a very challenging future.