According to Eurostat, Portugal has the third-oldest population in Europe, ahead of only Italy and Germany (and projected to be the first by 2050). Portugal is also the EU country that is aging fastest. Portugal has the 7th highest number of elderly people in the world. In 2023, half of Portugal's population will be over 46.8 years old. The unbalanced demographic level indicates that for every 100 young Portuguese, there are now 182 elderly people. But even though the number of nursing homes has doubled in the past 20 years, there is still an acute shortage of places to meet demand.
While Portugal is one of the countries with the highest average life expectancy in Europe, it also has the lowest average number of healthy seniors. In less than 30 years, more than a third of Portugal's permanent population will be elderly, the equivalent of 3.3 million people (1 million more than the current 2.3). According to studies, 55,000 additional beds in nursing homes will be needed to respond to this demographic evolution, highlighting the attractiveness of these assets to private investors, among others. Given that Portugal has lost more than 200,000 able-bodied residents in the last decade and that the European Commission predicts the country will lose another million by 2050, strong public, private and social support measures for the age group are needed.
In recent sociological surveys, economic problems and loneliness are named as the main problems currently affecting older people in Portugal. For 35.8% of respondents, economic issues are the most pressing, while 26.4% mention loneliness. The lack of means of support (such as home help, nursing homes, etc...) is indicated by 12.7% of respondents, while 14.4% highlight health-related aspects as the most worrying. When suggesting measures to be taken to solve the problems of the elderly in Portugal, 39.6% of respondents most often cited the increase in pensions. A quarter of respondents cited the need for more support for families to keep older people in their homes, and 24.4% cited the creation of more nursing homes. Increased staffing of home care services and daycare centers were cited by 19.4% and 17.4% of respondents, respectively, and 11.1% indicated that medications for seniors should be free.
Incidentally, Prime Minister António Costa recently announced during the inauguration of a new nursing home that Portugal will increase the supply of housing for the elderly by 30% at the end of the Plano de Recuperação e Resiliência (PRR), which runs until 2026 (Plano de Recuperação e Resiliência) and the Social Equipment Network Expansion Program (Programa de Alargamento da Rede de Equipamento). He also noted that about two-thirds of the total PRR funds have already been distributed to 93,000 projects across the country, and the European Commission has approved the transfer of one-third of this amount to Portugal.
Old age is, of course, a relative concept. It can be characterized as a certain age that varies according to the culture and development of the society in which one lives. The World Health Organization chronologically classifies people over the age of 65 in developed countries as old. They have limited recuperative abilities, undergo physical and emotional changes that condition their quality of life and can lead to frailty syndrome (a set of physical and psychological manifestations of the elderly in which they can develop many diseases). According to recent data, 40% of Portuguese people over 65 spend eight or more hours a day alone. According to the National Institute of Statistics, there are 321,000 elderly people who spend many hours completely alone, and a greater percentage of them are women. Economic problems and loneliness are cited as the main problems currently plaguing the elderly. Many do not have the financial means to buy food, which is one of the reasons for the lack of a healthy diet because, unfortunately, not all people reach retirement age with enough income to guarantee all their basic needs. Therefore, in Portugal, there are several types of social support for the elderly that help to cover some of these needs.
Let's move from statistics to practice. So, elderly people are called pessoas da terceira idade or pessoas idosas or just idosos in Portugal.
There are three main types of social state support, which guarantee care at home, in a residential home, or in a foster home.
- Home support (Apoio Domiciliário): involves the provision of care and services to addicts on a physical and/or psychological level. The service can be temporary or permanent (as long as the person is unable to perform daily activities and meet basic needs and does not have a family member to help him/her). Assistance can be provided every weekday, and assistance will be provided on weekends and holidays if needed. This support includes hygiene, personal and household care, help with meals, clothing care, socialization and animation activities, and telephone support services. Family or caregiver education services, psychosocial support, transportation, and minor home repairs may also be provided.
- Residential homes (Estrutura residencial (lar): they are designed to provide collective housing for elderly people who require this service on a temporary or permanent basis. In addition to providing care and meeting basic needs, they are intended to stimulate "active" old age and the social integration of the elderly. The institution is intended for people aged 65 and older. Access for people under 65 years of age is considered by institutions on a case-by-case basis, depending on the availability of beds. Nursing and basic medical care is, of course, provided. You can find a complete map of state nursing homes nationwide at Carta Social.
- Foster family (Acolhimento familiar): under this support, elderly people are temporarily or permanently integrated in specially selected families able to offer a stable and safe environment. This measure is intended for dependent people or people with a loss of autonomy, who live isolated and without social or family support in a situation of insecurity. This support measure guarantees basic needs and privacy, basic care and a social environment. The foster family is suitable for people aged 60 and over.
Surely, you have also heard of such a phenomenon as social centers for the elderly. It is a simplified version, carrying more social burden — something like hobby clubs for the elderly, an opportunity to organize your leisure time, but in some cases with the necessary care. Social centers offer different types of services and care, depending on the particular center and your situation. They, in turn, are divided into four types:
- Cultural communication center (Centro de convívio): its purpose is to promote social, recreational and cultural activities of the elderly. This type of center prevents isolation by encouraging older people to be active in social life and communication.
- Daycare centers (Centro de dia): they are designed for people over the age of 65 and provide a range of services to maintain independence and autonomy. A day center provides various forms of care and services according to each person's needs. It allows older people to stay in their homes at night, and, at the same time, socialize with other people of different generations and be in society — during the day.
- Night centers (Centro de noite): this type of center, on the contrary, is aimed at having the elderly stay in their homes during the day and be looked after at night. Care is provided for people in situations of loneliness, isolation, or insecurity.
- Recreation and leisure centers (Centro de férias e lazer): These centers are a social answer for all age groups and their families. They aim to meet recreational needs, through being out of the familiar environment and in contact with different communities and spaces. Group experiences, a spirit of mutual assistance, creativity, and initiative are encouraged in these centers.
As with any issue related to social support, a brochure guide has been published. There is a guide Social Support for the Elderly. It's in Portuguese, but I think an online translator will help you get the gist of it. For information on the availability of the above support, you should contact your branch of Social Security (Segurança Social), They will be able to help you apply for a placement in a public institution or in one of the non-profit institutions of social solidarity (Instituição Particular de Solidariedade Social (IPSS). The latter are privately initiated, for non-profit purposes, are not run by the state or local government, but cooperate with the social security system. You can also contact a particular residential home directly for availability and details — contact details are publicly available on the already mentioned resource - Carta Social. All non-profit institutions cooperate with each other through the following organizations: Confederação Nacional das Instituições de Solidariedade, União das Mutualidades Portuguesas, and União das Misericórdias Portuguesas. If you have doubts or insufficient information, you can ask them for clarification. Once you have gone through the registration process at the public institution you are interested in, you may (and probably will) have to wait in line until the institution itself contacts you and lets you know when a place is available.
We all know how difficult it is to realize that our elderly relative needs constant care and supervision, and how difficult it is to decide to place him or her in a nursing home. The supply of nursing homes available is very diverse, and it is important to understand which services are best for the physical and psychological well-being of the elderly, as well as for your wallet. Let's consider that you have made up your mind, but how do you choose the right facility, and most importantly, how do you get into it? Firstly, it is necessary to consider the fact that the availability and pricing policy for nursing homes in Portugal is firmly linked to the region of your location because the country is conditionally divided into coastal and hinterland areas, where the proportion of elderly people is higher. The metropolitan areas of Greater Lisbon and Greater Porto (especially the latter) are dominated by a younger population. While Idanha-a-Nova (which is in the Castelo Branco district), for example, despite its name, is the oldest municipality in the country, where older people have the highest percentage (42.0% of residents of this municipality are over 64 years old). Penamacor (Castelo Branco) and Alcoutim (Algarve) are another two of the oldest municipalities, where the elderly make up about 40% of residents. So, it might be worth considering placing your relative in another municipality, if you happen to be a resident of an "old" area, where the demand for this kind of help, definitely, exceeds the supply many times over.
Nursing homes, in addition to public institutions and non-profit organizations, are also divided into private ones. There are no completely free residential homes in Portugal — in any case, you will have to pay something (of course, in a public institution the amount will be many times less than in a private one). The sum for services provided in the state institution (family fee), is calculated based on the family income (IRS). The lower the family income and the greater the number of dependents, the more modest the fee will be.
According to average estimates, a stay in a nursing home costs an average of 770 euros per month. This figure, of course, is inflated by considering the cost of accommodation in private institutions, which on average is about 925 euros; in public institutions it is 550 euros. As the relentless statistics show, two out of three elderly people in Portugal do not have enough income to pay for such housing.
It is important to understand that the final price to be paid for a stay in a nursing home consists not only of a fixed monthly fee, but also of a set of additional services (this applies to both private and public nursing homes). For example, in most nursing homes, the fixed monthly fee includes accommodation, meals, assistance with daily activities, personal hygiene care, linen handling, 24-hour supervision, medical and nursing services, entertainment and leisure activities, and sometimes group physical therapy. But, for example, it does not include any medications, hygiene products or necessary medical procedures. What will distinguish nursing homes is the way in which they provide the listed services, in other words, what is the infrastructure and degree of hygiene, whether meals are prepared independently, whether meal times are limited or whether they can be adapted to each elderly person's daily routine, for example. This also includes the frequency and quality of medical and nursing services, the availability of a sociocultural animator and the activities he or she develops. In the case of a placement in a private home, in addition to the aforementioned costs (monthly fee and the cost of additional services), you may be required to pay a deposit upon signing the contract, which will serve as a guarantee to pay the fees or possible damage to the furniture or equipment, this amount is returned at the end of the contract period if no "insured event" has occurred. There is also a registration fee (membership fee) in private residential homes, which, unlike a deposit, is a sum that is never refundable. It is convenient to search for private institutions using the search query "lares residenciais para idosos em Portugal/Lisboa, etc". A list of many aggregators and recruitment agencies, as well as individual organizations, will pop up. The choice is huge, it all depends on your financial possibilities.
Of course, the quality of life in a private institution will be different for the better, compared to the public one. But not everyone can afford the luxury of paying for a relative's stay in such a sanatorium because the cost can reach several thousand euros per month. Now there are luxury versions, which, of course, no one would dare to call nursing homes — these are living quarters for the elderly (residências seniores), which are managed by special companies. There are more and more of them, especially in expensive areas such as Lisbon and Porto. An example of this is the residence Domus Vi, which has six floors and an area of 6,915 m2 for 112 residents in 96 single rooms and 8 double rooms. An article about this residence, as well as market trends in investment in this area, wrote Idealista.
If you are not one of those who are going to use the services of private institutions, but are limited in means, and on the contrary, want to reduce the costs of this item, check out what you can try to claim in terms of social benefits from the state. In Portugal, one type of social support for the elderly that can be useful for people with low incomes is the Solidarity Allowance for the Elderly (Complemento Solidário para idosos). All recipients of this supplement have access to additional health benefits (Benefícios Adicionais de Saúde), as well as to extraordinary social support for energy consumers (Apoio Social Extraordinário ao Consumidor de Energia).
Complemento Solidário para idos - is a monthly cash payment for seniors who have reached retirement age. This support is intended for elderly people with low financial resources, whose income does not exceed €5,258.63 per year. If the elderly person is married, the financial resources of the couple must not exceed €9,202.60 per year. All seniors who receive this supplement are entitled to additional medical benefits and to extraordinary social support for energy consumers.
Benefícios Adicionais de Saúde - are given to CSI beneficiaries to help reduce healthcare costs, through two special programs: the Supplemental Health Benefits (Benefícios Adicionais de Saúde) and the National Oral Health Promotion Program (Programa Nacional de Promoção da Saúde Oral). In the case of the Supplemental Health Benefits program, you can take advantage of co-payments for medications, lenses, glasses, and dentures. For example, in the case of medications, you get 50% of the amount you paid for reimbursable medications. In the case of glasses and lenses, the state reimburses 75% of the amount paid, up to a maximum of 100 euros for 2 years. Finally, in the case of dentures, they must be removable, and the reimbursement corresponds to 75% of the amount paid, which can correspond to the purchase or repair. The maximum limit is 250 euros every three years. The National Oral Health Promotion Program operates on the recommendation of the family physician and is provided in the form of an individual dental bill. This check allows free dental appointments by doctors who adhere to the National Oral Health Promotion Plan. Depending on the needs of the senior, no more than two dental checks may be issued per year. However, the annual amount cannot exceed 80 euros. To take advantage of the scheme, simply choose a dentist from the list of attached specialists and schedule an appointment. The bill must be handed in when making the appointment. To qualify for a reduction in health care costs, you must submit a certificate from the Social Security Office to your Centro de Saude confirming your eligibility for the Solidarity Allowance for the Elderly.
Apoio Social Extraordinário ao Consumidor de Energia - is a support that corresponds to a discount on the price of electricity and natural gas. It is provided by Law 102/2011 of September 30, and is intended for economically vulnerable end users. ASECE beneficiaries are entitled to this support, regardless of whether they already benefit from any social tariff. This support can be accumulated together with the social tariff for electricity and natural gas. The discount is applied as a percentage to bills and applies to the gross supply price, excluding the cost of applicable taxes and fees. The amount of the discount is set annually by the government. To take advantage of the extraordinary social support for energy consumers, an elderly person must apply to an electricity or natural gas supplier. Once the supplier has verified that the necessary conditions for granting it have been met, the amount will be discounted and shown on the electricity and gas bills.
The topic of the article was very broad, and I hope I was able to do a useful digest for you with a guide to the links to get an idea of how the system works, since the set of documents for everyone will be different, depending on the region, the status of being in the country, and other factors.
Translated from Ukrainian by Rodion Shkurko