The meanings of long-term care needs in Portugal: national report

Abstract

The Portuguese Long-Term Care (LTC) system is a dual system that splits into two branches. One is the Social Care branch - Respostas Sociais (which would translate as "Social responses" but is generally labelled in the literature as Social Care) - while the other is the Healthcare branch - Rede Nacional de Cuidados Continuados Integrados (RNCCI), which translates into National Network of Integrated Continuous Care. Understandings of what is entailed in the concept of 'care needs' are deeply rooted in this dual system and definitions tend to mirror the duality of social care and healthcare. The needs for social care involve identification of limitations in functionality that limit the possibility of living independently considering the context of life of the person, namely in terms of available material resources and family support. Contrary to social care needs, healthcare needs are understood as absolute and universal and to be tackled by the national healthcare system, which is a universal system. Despite the fragmentation of the system across the healthcare and the social care institutional sectors, there is a growing consensus among stakeholders and researchers alike that borders are increasingly blurred and that higher levels of integration of the two types of needs are necessary to overcome performance problems of the LTC system, both on the healthcare and on the social care sides. Understandings of needs are mirrored in how the topic is measured, monitored and regulated. In Portugal, the data and regulatory infrastructures related to LTC needs reflect the system fragmentation that separates social care needs from healthcare needs. If for the first there is scarcity of empirical evidence and administrative data, vagueness of assessment criteria and a regulatory framework that leaves ample space for arbitrary management on the care providers side, for the second there is not only a considerable wealth of data but also routine protocols of recording of data always offering up-to-date information and stricter regulatory frameworks. The LTC system in Portugal displays traits of a highly centralised system in aspects of funding and regulation, coupled with traits of a very fragmented system at the level of service provision. This model applies, in broad terms, to both social care and healthcare LTC services. The State, through the national government and its constitutive bodies, finances the LTC system in Portugal. The social care system is funded directly by the Ministry of Labour, Solidarity and Social Security, which involves a contributions-based financing model. The RNCCI system is funded jointly by the Ministry of Labour, Solidarity and Social Security and by the Ministry of Health. The healthcare component is part of the National Health System and therefore funded by general taxation. Discussion about future trends in needs for LTC point to both quantity and quality challenges.