Mapping Long-Term Care in Jamaica: Addressing an Ageing Population

Abstract

Jamaica’s ageing population, high prevalence of non-communicable diseases (NCDs), and associated functional impairments suggest the need for a sustainable long-term care (LTC) system. This paper describes the current LTC system in Jamaica. A review of empirical and grey literature on LTC was supplemented with consultations and interviews and group discussions for knowledge exchange, impact and engagement events with stakeholders being conducted as part of a project on dementia care improvement. Four key findings emerged: (1) Jamaica’s LTC system depends substantially on informal care (both unpaid and paid); (2) there is a need for strategic coordination for LTC across the state, cross-ministerial, private, and volunteer sectors; (3) compulsory insurance and social protection schemes appear to exacerbate rather than narrow socioeconomic inequalities in LTC; and (4) there is a lack of systematic LTC data gathering and related information systems in both the private and public sector—for both institutional and community-based care. For LTC in Jamaica and the broader Caribbean region to be sustainable, more evidence-informed policies and practices that address inequalities in access to services, ability to pay for care, direct support from government, and the risk of needing LTC are needed.

The Experiences of Caregivers of Persons Living with Dementia in Jamaica during COVID-19

“…Responses to limited services. Formal dementia carer support services are minimal in Jamaica, but participants noted that before the pandemic more general psycho-social supports were available, provided by church groups and non-governmental organizations, geared towards stress management (Govia et al, 2021). Following the shift to remote service provision, eight participants from the middle to upper SES classification, noted that they were able to continue to access social supports virtually or, more importantly, access new supports they could not access pre-pandemic due to the in-person time commitments or their immobility.…”

“…Before the onset of the COVID-19 pandemic, unpaid carers constructed tailored, informal care systems with the resources available to them. In the context of Jamaica, these care systems existed despite a lack of dementia-specific social safety nets (Govia et al, 2021). While the construction of these informal care systems is commendable, the pandemic has emphasized their fragility.…”

“…In Jamaica, dementia care is typically provided informally in private households. This is constituted of unpaid –mostly female– family members, with or without assistance from others in the informal care sector, specifically those who are paid in cash and/or lack formal employment contracts (CaPRI, 2018; Govia et al, 2021). This results in excessive costs to family carersdirect and indirect financial costs, relationship costs, and negative health outcomes (Ferri & Jacob, 2017; Prince et al, 2009; Wimo et al, 2017).…”

Vulnerable group members coping with COVID-19 in Jamaica: A qualitative study.

“…In Jamaica, social care services and social protection mechanisms are not integrated with health care and so there is a lesser likelihood of vulnerable group members being “visible” in the health and social care system in a coordinated manner and with continuity of care. In the context of some families being reliant on agencies and organizations that offer residential or boarding arrangements for vulnerable persons, COVID-19 closures and social contact restrictions have significantly increased demands on family members with already limited capacity to offer the needed care (Govia et al, 2021; Vigo et al, 2020). In this context, coordination of efforts with the limited resources is key, and especially coordinated efforts that facilitate changes in the systems of care and services available for these vulnerable group members (Vieira et al, 2020).…”

“…Research has shown that some effects of vulnerable status may emerge over time; that vulnerability is not a static but a dynamic and multifaceted state (Govia et al, 2021;Smith & Judd, 2020). The pandemic has been of an extended duration and its effects will be long term.…”