Around 30% of patients have no medical problem at all
Around 30% of patients in Portugal’s National Network for Long-Term Care (RNCC) are ‘social’ cases – that is, they do not have any kind of medical problem that warrants them occupying a place.
The upshot is that families of people who desperately need the kind of care that cannot be given at home – but are medically ready to be discharged from hospital – face “obstacles” (if not heartache, even a great deal of expense) trying to get loved ones the care they need.
The situation has been highlighted by Lusa, citing “a National Health Service (SNS) official”.
“The National Association for Long-Term Care has received dozens of complaints from people facing “obstacles” in hospitals to transferring a family member to the nursing care network, prompting the association to question whether there is any internal guidance preventing such transfers”, says Lusa..
Assessments made by the SNS board is that both hospitals and primary healthcare units “are very attentive and diligent in referring users to the National Network for Continued Care,” stressing that “not all patients have criteria for the network.
“A patient who exclusively needs social support is not a patient for the network,” said nurse Filomena Cardoso, of the SNS executive directorate, stressing that it is patients who need “continuity of care, (who) need health care but not in an acute hospital” who qualify.
Criteria however also includes ‘a need for social support’ and a ‘lack of family support’, stressing that, unlike in the case of nursing homes – designated Residential Structures for the Elderly (ERPI) – the RNCC “does not provide for the patient to stay forever”. The idea is they are there while “in recovery”.
According to Cardoso, one of the RNCC’s principal problems is an “excess of patients” who really are no longer in recovery: “patients who joined the network with criteria, but in the meantime no longer need health care and have become merely social patients. These patients should leave the network”.
But they don’t – or, put it another way, they have not been leaving (for a variety of reasons) – and their numbers are now up to about 30% of all continuous care placements.
According to Cardoso, as of October 31 2022 the network had 15,790 beds, with around 4,737 occupied with ‘social cases’.
Confronted with the fact that the National Association for Long-Term Care has received dozens of complaints about hospitals allegedly blocking referral to the RNCC, Cardoso said she understands it is not easy for families to accept that a patient does not in fact need a long-term care response, but rather a social one.
“There has to be a clarification that the network does not solve merely social cases,” she said, arguing that the “main explanation” for this number of complaints is that patients “do not meet the criteria”.
But that doesn’t help their families, who also invariably are not in a position to offer what in many cases is a requirement for full-time care.
According to Lusa’s report, this deep rooted problem in the long-term care system began during the ‘adjustment programme’ as a condition of Portugal’s bailout. It “compromised the goals set”, explains Filomena Cardoso.
Hopes now centre on PRR funding (Brussels’ bazooka for post-pandemic resilience) that “foresees an extra 5,500 beds in all services across the country”.