The Covid-19 pandemic has opened up a problem little discussed by the Portuguese authorities until now: the precarious situation of thousands of elderly people living in clandestine houses.
The new coronavirus has revealed that, quite possibly, there are more irregular than legalized nursing homes in the country.
While there are 2,527 institutions operating with the proper authorization, it is estimated that there are around 3,500 irregular asylums.
Problems such as overcrowding and lack of specialist care tend to be even more intense in illegal settings.
About a third of Covid-19 deaths in Portugal have occurred in nursing homes, including regularized and illegal spaces.
The fifth oldest country in the world, Portugal does not have a centralized public asylum system (called “shelters”).
Besides private institutions, there are two models of non-profit administration: IPSS (Private Social Solidarity Institutions) and mercies, which are intended for religious management.
Although it is possible to benefit from a co-participation of the Portuguese State in the event of hospitalization, the monthly cost easily exceeds 600 euros (approximately R $ 3,936) per patient: a value considered high for many families.
It is also common to have a long queue for vacancies, especially in non-profit institutions.
In a way, underground houses fill this gap. With tuition fees significantly lower than regular nursing homes, they often do not have a waiting list.
Without financial resources or conditions to house the elderly in houses, many families end up using these irregular services.
Since illegal establishments do not formally exist on the regulators’ radar, they are neither subject to inspection nor to the operating rules of the sector. With the pandemic, several cases of abuse and lack of basic care have been exposed – and not just in irregular asylums, but also in officially regularized ones.
An audit carried out by the Portuguese Medical Association into the deaths in an ordinary asylum in Reguengos de Monsaraz, Alentejo, found that many victims had not died as a result of Covid-19, but due to a neglect of basic care, such as hydration and administration. medication.
The president of the Association of Homes and Retirement Homes for the Elderly, João Ferreira de Almeida, stressed in an interview with Saturday magazine that the scenario is complex and nuanced.
According to him, there are establishments in the country with terrible conditions to those who meet the standards and pay taxes, but do not obtain the proper operating license.
“There are people who have been waiting for 12, 15 years [pela licença]”, He says.
To be allowed to operate, nursing homes in Portugal must comply with a series of rules, ranging from garbage storage to minimum space for each patient. In addition, positive opinions from the city council, health authorities, social security and civil protection are needed.
The state, however, allows owners to formally establish companies before permits are granted. In practice, since the process usually takes time, it is common for establishments to open their doors before they have all the documentation up to date.
In these cases, in addition to paying taxes, asylums are subject to a certain degree of inspection by the authorities and particular attention to meeting basic standards.
However, there are nursing homes that are completely “invisible” and at the edge of the system.
With the Covid-19 pandemic, the problem has become more evident and authorities have made efforts to identify and resolve these cases. Social Security said it had already identified more than 780 irregular asylums in the country.
More than 100 have been ordered to close, at least 23 urgently due to poor conditions.
People hospitalized in nursing homes are considered a priority group and begin to be vaccinated against Covid-19 as of this week.
The situation of patients in irregular establishments is however more delicate.
Critics have drawn attention to the risk that a significant proportion of older people – who are mostly poor and live in the interior of the country – end up being invisible to the statistics and not having early access to immunizations .
The health ministry said, however, that all elderly people in nursing homes, whether regular or not, will be vaccinated.
On Tuesday (5), deputies from the largest opposition party, the PSD (Social Democratic Party, center-right), requested a special hearing in Parliament on the issue, in addition to the disclosure of a detailed list of illegal establishments identified. and their vaccination plans.
This Monday (11), Portugal recorded a new record of deaths in a single day: 122. In total, the country has 489,293 cases and 7,925 deaths from Covid-19.