The meanings of care and quality of care in Portugal - national report

Abstract

The expression "Long-Term Care" (LTC) is still today an expression that has no straightforward translation into Portuguese apart from the strict language translation - Cuidados de Longa Duração. Traditionally LTC in Portugal has developed from social assistance and therefore the concept in use more commonly is "social care". But even this, that would translate as 'Cuidados sociais', is used mostly in the scientific literature. In legal and policy documents the term in use is 'Respostas Sociais', that translates as Social Responses. In 2006, it was created a new system, the National Network of Integrated Continuous Care (RNCCI - Rede Nacional de Cuidados Continuados Integrados), bringing together the Ministry of Health and the Ministry of Labour, Solidarity and Social Security, to create a new type of service under the National Health System (SNS - Serviço Nacional de Saúde) that would focus on securing continuous, long-duration and focused on rehabilitation and reablement care, as well as on palliative care. Care is primarily understood as the other side of the coin against needs. The two notions end up being rather circular as they imply each other. In that sense, understandings of care are tied to how the system is organised in terms of programmes and services that provide care. Despite the references to the term quality to discuss care services, interviewed stakeholders struggle with offering a clearly outlined definition of what quality of care means. Even if probed to be more explicit about the meaning of quality of care, it was not possible to get such a definition. Explanations remain fuzzy and at a very abstract level. In Portugal, the data and regulatory infrastructures related to LTC provisions reflect the system fragmentation that separates social care from the RNCCI. Regarding the most pressing problems in provision of care, views collected in interviews and the literature offer a high level of consensus around some main ideas: low coverage rates and long waiting lists signal a need for fast expansion of the system; underfunding of the care system is preventing good quality of care; shortages of workers and of qualifications have a strong impact in quantity and quality of care. The system draws on a one-size-fits-all approach, with national regulations applying to the entire country in the same manner. This includes issues of funding, types of services and regulations on licensing and operations. The ongoing political debate is vague, mostly reacting to the occasional news in the media but showing no signals of any systematic holistic discussion taking place soon about LTC. Negotiations between the state and care providers is almost exclusively focused on funding issues.