Evaluating the quality of long-term care services in the city of La Plata, Argentina

Abstract

This paper reports on an innovative survey of long-term care facilities for older people in the Argentine city of La Plata. It applies a range of qualitative methodologies, including a clandestine audit conducted by older people living in the community. The paper pays particular attention to the types and availability of services, perceived quality and the rigour of regulatory processes. It finds that there has been a rapid growth in the availability of formal services, but that there are many gaps in provision, especially for older people with complex care needs. There are strong indications that service quality is uneven and, in some cases, this amounts to the contravention of basic human rights. State regulation is hampered by institutional fragmentation and weak governance. A wider set of expert interviews and the limited available published information indicate that these findings are unlikely to be exceptional, and that similar issues affect rapidly emerging long-term care systems in many low- and middle-income countries.

An Emergency Strategy for Intersectoral Local Government Responses to COVID-19 in Long-term Care Facilities in Western Cape Province, South Africa

“…This brings us to the questions: to what extent was the South African experience substantially different to that of other countries and, by extension, to what extent would the CIAT Framework have offered them useful guidance? Poor coordination between government agencies responsible for LTCFs had been reported in many other countries prior to the pandemic (The Kings Fund, 2016;Lloyd-Sherlock, Penhale & Redondo, 2019;Feng et al, 2020;Lloyd-Sherlock et al, 2021b). Studies from Canada, Chile, and the USA report that these weaknesses in coordination obstructed responses during the pandemic, including surveillance, ensuring PPE and vaccination priority status to LTC staff, and avoiding the discharge of hospital patients into LTCFs without testing or suitable precaution (Dawson et al, 2021;Béland & Marier, 2020;Browne et al, 2020).…”

“…Studies in the USA report higher COVID-19 mortality in facilities with poor quality ratings, more crowding, and higher shares of residents who were not white (Li et al, 2020;Weech-Maldonado et al, 2021). The limited evidence about LTCFs in LMICs indicates that the quality of facilities is often poor due to limited resources and weak government oversight (Lloyd-Sherlock, Penhale & Redondo, 2019;Feng et al, 2020;WHO, 2015). In 2021, it was estimated that South Africa contained 1,150 LTCFs for older persons (Mahomedy, 2021).…”

Integrated long‐term care partnerships between government social care and health agencies in Brazil: The Belo Horizonte model

“…These experiences have prompted calls for a deep or "structural" integration of health and care services for older people, so that they become parts of a single system (Harvey et al, 2018;Lloyd-Sherlock et al, 2019). In recognition, most high-income countries have embraced integration of some sort, albeit with mixed results (The Kings Fund, 2018).…”

“…A similar division occurs between the Departments of Health and Social Development in South Africa. A study of local LTCF regulation in Argentina asked different agencies if they ever met with their counterparts in other agencies in the same city (Lloyd‐Sherlock, Penhale and Redondo, 2019). All responded that this had not even been considered, despite the proximity of their offices and strong informal networks (for example, several informants had been trained in the same department of the local university).…”