Evaluation of Long-Term Institutions for Older People in Brazil: an overview of regional inequalities

Abstract This article aims to evaluate the Brazilian Long-Term Institutions for Older People (LTIE), according to the Integrated Multidimensional Theoretical Model of Quality and Service (MIQA), and compare the performance achieved between the regions of the country. Descriptive ecological study carried out with public secondary data from the LTIE participating in the 2018 Census of the Unified Social Assistance System. An Evaluation Matrix was constructed from the Census variables and the MIQA Theoretical Model. Quality parameters were used to classify the institutions’ performance for each indicator as “incipient”, “developing” or “desirable”. The disparity index was obtained for each indicator. 1,665 institutions were analyzed. Differences were observed in the percentages of LTIE with “desirable” performance between Brazilian regions, and the need for improvement in most LTIE in relation to the proportion of caregivers of older people, the composition of the multidisciplinary team, accessibility and supply of health promotion actions. There was a need for government support for the suppression of exclusionary differentiation criteria and for the expansion of services to overcome overcrowding.

摘要 本研究旨在依据服务质量整合多维理论模型（Integrated Multidimensional Theoretical Model of Quality and Service，MIQA），对巴西老年人长期照护机构（Long-Term Institutions for Older People，LTIE）开展评估，并对比该国各区域间的机构表现水平。本研究以参与2018年统一社会援助系统（Unified Social Assistance System）普查的LTIE公共二手数据为基础，开展描述性生态学研究。本研究基于普查变量与MIQA理论模型构建评估矩阵，通过质量参数将各指标对应的机构表现划分为“起步型”、“发展型”与“理想型”三个等级，并为各指标计算得到差异指数。本研究共分析1665家机构，结果显示巴西各区域间达到“理想型”表现的LTIE所占比例存在显著差异；多数LTIE在老年人照护人员配比、多学科团队（Multidisciplinary Team）构成、服务可及性以及健康促进行动供给等方面均存在改进空间。研究同时提出，需获得政府支持以废止排他性差异化准入标准，并通过扩大服务供给缓解机构拥挤问题。