Skip to content
Globe Icon

Long-term care for vulnerable socio-economic groups in Brazil during the COVID-19 pandemic

2022 Conference Presentation

8 September 2022

Long-term care for vulnerable socio-economic groups in Brazil during the COVID-19 pandemic

Adriano Maluf, Keele University, United Kingdom
Karla Giacomin, Frente Cuidadosa, Brazil
Lucas Sempé, Queen’s Margaret’s University, Scotland
Peter Lloyd-Sherlock, University of East Anglia, United Kingdom


The session will explore how the needs of care dependent older people in Brazil were met during the COVID-19 pandemic. It will include papers on three separate aspects of this issue. They will include a study of how community health workers sought to maintain services for older people in poor neighbourhoods of Fortaleza city during the pandemic. They will also include a study of an innovative community-based intervention in the city of Belo Horizonte, which has been identified as a model of good practice by the Brazilian federal government and by World Health Organisation. A third paper will examine the emergence of a new social movement to support long-term care facilities during the pandemic. In combination, the papers will provide wider insights about opportunities to improve long-term care for older people in Brazil and other countries in the years following the COVID-19 pandemic.

Presentation 1: The role of community care workers in supporting care for dependent older people in deprived neighbourhoods in Fortaleza

Adriano Maluf, Keele University

Community health workers (CHW) play an important role in providing essential care to the population living on low incomes in Fortaleza, Brazil. Fortaleza is located in a poorer region in Brazil, with 36% of the 2.4 million residents living on less than $120 a month. The partial and preliminary results discussed in this presentation were based on 14 qualitative interviews involving older patients who required care, their next of kin, and the CHW. Interviews were produced remotely via video conference and the CHW facilitated the interviews by screening, inviting and supporting the participants.
ACSs are based in the ‘postos de saude’ or local health centres.

Despite having no formal medical or nursing training, CHWs are the first point of contact for individuals when accessing primary public health care. They are responsible for collecting health and social information of household members; regularly visiting patients at their home to observe the health and wellbeing of patients; and organising health team visits (the team consists of a medical doctor, a nurse and the CHW). CHWs act as enablers for families on low incomes that may otherwise struggle to access and receive continuity of care and often they formed close relationships with patients.

Presentation 2: A spontaneous social movement to support and share information about long-term care facilities during the COVID-19 pandemic: Brazil’s National Front for Long-Term Care

Karla Giacomin, Frente Cuidadosa

Brazil has a large and fast-growing number of long-term care facilities (LTCFs). Before the pandemic, government regulation and oversight of LTCFs was extremely limited and reliable registers of providers were largely- absent. This greatly increased LTCFs’ potential vulnerability to the pandemic and reduced the capacity of government agencies to intervene. Consequently, a network of academics, providers and other experts quickly developed an online network to provide support to these LTCFs: the National Front for Long-Term Care (NF-LTC). By the end of 2021, over 8,000 LTCFs were registered and participating in NF-LTC, and there is evidence that the network has contributed significantly to mitigating the effects of the pandemic. NF-LTC represents the only national network and register of LTCFs anywhere in Latin America. This paper examines how it was possible to create this large-scale, innovative initiative and what lessons it offers countries like Brazil in the post-pandemic period.

Presentation 3: Evaluating the effects of an integrated community-based project to support dependent older people in poor neighbourhoods of Belo Horizonte

Lucas Sempé, Queen’s Margaret’s University

Since 2011, the city of Belo Horizonte has run an innovative project supporting care for dependent older people living in highly vulnerable households: Programa Maior Cuidado. Since 2018 there has been an ongoing evaluation, applying a range of opportunistic qualitative and quantitative methods. This paper will explore both the process of conducting the evaluation and the related results. These include data on how the project affects the use of health services by older people, as well as effects on the health and wellbeing of older people and their families. The paper will discuss the design of a new evaluation strategy for a similar intervention which is now under development in the city of Salvador.

Presentation 4: An emergency strategy to support long-term care facilities during the COVID-19 pandemic: Salvador’s Inter-Sectoral Commission

Peter Lloyd-Sherlock, University of East Anglia

This presentation examines the creation of a unique alliance between local government agencies in the city of Salvador during the COVID-19 pandemic. Recognising a lack of previous coordination between local government agencies responsible for long-term care facilities (LTCFs), weak regulation and a lack of reliable registers of LTCFs, the alliance developed ad hoc strategies to locate facilities and offer them support and information. The paper discusses how this was possible and presents evidence of its impacts on COVID-19 mortality and prevention in the city’s LTCFs.