People prefer to age at home, in a familiar setting, and surrounded, when possible, by their belongings and closest relatives and friends. This is not only a matter of personal preference. The World Health Organization highlights the importance of the context in determining the effects of aging on health: aging at home increases confidence levels, independence, and autonomy.
Taking this into account, many countries have redesigned their long-term care systems to encourage the use of home care services. These are personal services that provide functionally dependent people with the necessary help to perform their daily activities and allow them to stay in their home and be as autonomous as possible, for as long as they can.
The benefits of aging at home
Besides respecting older adults’ preferences – and having positive impacts on their health status – home care services have two other advantages. First, they provide relief to family caregivers, freeing their time, allowing them to participate in the paid job market, or even engaging in leisure activities, hence improving their emotional and physical well-being. Second, compared to the alternative of institutionalization, they lead to savings for the public system (except in the case of severely dependent individuals, when the constant need of care could increase home care).
The type of activities included as part of home care services differs across countries. Personal care services – which refer to the help with basic activities of daily living, such as personal hygiene, eating, or dressing – are always included. In some cases, instrumental activities – help with domestic chores, transportation from one place to another, or assistance in social activities, such as going to the doctor or other social interactions – are also included. Services that do not involve the presence of a personal assistant, but that make it easier for individuals to stay in their homes, such as home adaptations, meal delivery, or teleassistance, can also be considered home care services.
¿How does the public sector provide these services?
Home care services can be provided in-kind (for example, a certain number of hours of a personal assistant per month) or through cash transfers that enable dependent persons to hire the services themselves. Moreover, services could be offered by public or private providers. Considering both users’ preferences and cost-containment considerations, the trend is to widen beneficiaries’ flexibility and their range of options through, for example, the use of cash transfers that allow the hiring of a personal assistant of their choice (including relatives), or through the dynamization of the market of authorized providers.
Regardless of the type of services included and the way they are provided, most countries have mechanisms to encourage home care services instead of more intensive care services, such as long-term residences. Sometimes, even copayment levels are lower for home services than for residential care.
The main challenge: ensuring quality
Despite their many advantages, home care services are not exempt from challenges. One of the main ones has to do with ensuring the quality of the services provided, which turns to be more difficult when services are provided in the home than in residential settings. As stated in the publication Age with Care, one of the main tools to achieve high-quality services is to invest in the training and formal accreditation of human resources. This is crucial: the caregiving job is not for everybody; it requires some special personal skills, such as plenty of patience, organization, and the ability to maintain good interpersonal relationships, but also technical skills, such as the ability to move a severely dependent or bed-ridden person from one place to another, strategies to care for a person with Alzheimer, and so on. Investing in the training and formalization of caregivers has the twofold aim of not only improving the quality of care but also highlighting the value of a job that has traditionally been regarded as a low-qualified one.
Countries in Latin America and the Caribbean are not an exception to these global trends. Although the issue of long-term care services has only recently started to gain attention within the regional public agenda, there is a growing interest in the development of home care services. International experiences could bring important lessons when it comes to their design and definition of their main characteristics.
If you want to learn more about home long-term care services and their characteristics in many countries in the world, you can read our recently published technical note: Servicios de apoyo personal para personas con dependencia funcional: antecedentes, características y resultados (in Spanish), available in the Panorama of Aging and Long-Term Care webpage.