Abstract

The ageing of the Brazilian population has been accompanied by the ageing of the old population and changes in the epidemiologic profile. These changes mean an increasing proportion of persons experiencing a set of non-lethal chronic illnesses that cause a slow and gradual decline in their autonomy. The Brazilian legislation establishes that the family is the main caregiver for the old population. As a result, elder care policy does not receive due importance in the set of public policies.

But changes in family composition, in nuptiality, in the social role of women and a dramatic fertility decline have also been taking place in Brazil and have being resulting in a reduction of the offer of family caregivers. This raises the question of whether Brazilian government should take over the responsibility of caring for their fragile elders. The paper presents four scenarios for demanders of formal LTC in 2020. Besides considering the increase in the numbers of the old population that will demand LTC, it considers changes in the family capacity to take care of them.

Two scenarios are built for functionality and care arrangements. Elders who demand LTC are considered those aged 60 and plus who experience some kind of difficulty to perform by themselves the Activities of Daily Life (ADL). Data are from the General Household Survey of 1998, 2003 and 2008. In 2008, about 3.2 million persons were considered demanders of LTC, 1.0 million more than 1998. Functionality conditions improved among 1998 and 2003 and got worse between 2003 and 2008. About 500 thousand persons were not taken care of by a family caregiver. The proportion of family caregivers decreased between 1998 and 2008. The first scenario assumes that the proportions of elders with difficulties to perform the ADL will remain constant at the same level as the observed in 2008. As a result, one may expect approximately 1.5 million more frail elders in 2020 than in 2010.The second assumes that these proportions will decline and will result in about 800 thousands more elders who will need LTC in 2020 compared to 2010. The first scenario for the offer of family caregivers keeps the proportion of caregivers constant at the same level as the observed in 2008. The second one assumes a decrease in this proportion. An increase of 4.1 million of potential caregivers is expected by the first scenario and a reduction of 5.1 million by the second. The combination of the two scenarios results in four scenarios for the demand for LTC. Three of them point to an increase in the demand for non-family care. This increase may range from 491 thousands to 2,798 thousands old persons.

These results seem to be pointing to the emergence of a new social risk: LTC for the frail elder. For the Brazilian Government to take over this responsibility, what is required is a complex array of actions (income, health, housing and care). This may be done extending the system of social security adding a new pillar, the fourth one.