LTCcovid Country Profile – Printable Version

COVID-19 and the Long-Term Care system in Brazil

Structural characteristics of the LTC system, impact of the pandemic, measures adopted and new reforms

This is a section of the LTCcovid International Living Report on COVID-19 Long-Term Care that brings together information on the experience of the long-term care sector (focussing on people who use and provide care) during the COVID-19 pandemic in France, as well as description of the system and of new reforms. This report is updated and expanded over time, as experts on long-term care add new contributions.


Patrick Alexander Wachholz

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Wachholz P.A. COVID-19 and the Long-Term Care system in Brazil. In: Comas-Herrera A., Marczak J., Byrd W., Lorenz-Dant K., Pharoah D. (editors) LTCcovid International Living report on COVID-19 and Long-Term Care. LTCcovid, Care Policy and Evaluation Centre, London School of Economics and Political Science.

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Acknowledgement and disclaimer

This report has built on previous LTCcovid country reports and is supported by the Social Care COVID-19 Resilience and Recovery project, which is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333) and by the International Long-Term Care Policy Network and the Care Policy and Evaluation Centre at the London School of Economics and Political Science. The views expressed in this publication are those of the author(s) and not necessarily those of the funders.

Copyright: LTCCovid and Care Policy and Evaluation Centre, LSE

Update for: Brazil   Last updated: December 21st, 2021

1.03. Long-term care financing arrangements and coverage

Some public LTC services are provided through the Unified Social Assistance System, this is means-tested and targeted to people without family support, and increasing availability of private care options (source:

Update for: Brazil   Last updated: November 23rd, 2021

1.08. Care home infrastructure

Researchers from the ‘Frente Nacional de Fortalecimento à ILPI’ have published a study estimating the number of Long-Term Care Facilities (LTCFs) in the country in 7,029 facilities, noting that 64% of the 5 570 Brazilian municipalities do not have any LTCFs for older adults. (Lacerda TTB et al., 2021

Update for: Brazil   Last updated: January 6th, 2022   Contributors: Patrick Alexander Wachholz  |  

2.02. Deaths attributed to COVID-19 among people using long-term care

There is no official data on the number of cases and mortality related to COVID-19 across Brazilian care homes. A report published in September 2020, found that there had been over 4,015 confirmed cases and 937 deaths in Brazilian care homes, which represents a case fatality rate of 23.33%. This was based on data collated informally by the researchers.

An article published in December 2021 describing morbidity and mortality in long term care facilities in the state of Bahia, Brazil, found COVID-19 incidence of 30.71% in residents of a 175 facility sample from April 2020 to June 2021. According to this data 19.97% cases in older residents required hospitalisation and there was an 11.63% case fatality rate, which the authors noted to be lower than expected. (Source: COVID-19 morbimortality in long-term care facilities in the state of Bahia, Brazil)

Update for: Brazil   Last updated: January 2nd, 2022   Contributors: Disha Patel  |  William Byrd  |  

2.05. Impacts of the pandemic on the health and wellbeing of people who use Long-Term Care

A published article discusses the adoption of restrictive and protective measures to prevent the spread of the virus, aiming to keep older people healthy and mitigate the effects of the pandemic. The conclusion is that the pandemic has increased the many vulnerabilities to which institutionalised older people were already exposed, adding vulnerability to a new disease, such as COVID-19, due to its high lethality and comorbidity, aggravated by the precariousness of long-term Brazilian institutions due to the negligence of public authorities, civil society, the management of the institutions, and the families of the patients.


de Araújo, P. O., Freitas, M. Y. G. S., de Santana Carvalho, E. S., Peixoto, T. M., Servo, M. L. S., da Silva Santana, L., … Moura, J. C. V. (2021). Institutionalized elderly: vulnerabilities and strategies to cope with Covid-19 in Brazil. Investigacion y Educacion En Enfermeria39(1), 1–11.

Update for: Brazil   Last updated: January 2nd, 2022   Contributors: William Byrd  |  

3.07.03. Visiting and unpaid carer policies in care homes

The technical note No. 25/2020 (January 2021), issued by the Ministry of Health, recommended that family members only visit older residents when essential, maintaining the suspension of visits for the duration of the national public health emergency, a recommendation that was already issued by the Brazilian Society of Geriatrics and Gerontology and the ‘Frente Nacional de Fortalecimento à ILPI’ since March 2020. In April 2021, this was updated, allowing short visits to occur in ventilated common areas, using face masks, maintaining a safe distance, and other protective measures.

After significant reductions in the rates of new cases, hospitalizations, and deaths among residents of LTCF, some regions issued local policies regarding visiting and outings (e.g., the State of Ceará, cities of State of São Paulo and Belo Horizonte). Most of these recommendations suggest the adoption of plans to ease the visits and outings of residents progressively. They take into account the epidemiology of the infection in the community, the local hospital capacity, the level of vaccination of residents and workers, the physical infrastructure of the facilities, and the supplies of personal protective equipment and access to laboratory testing. During outbreaks and up to 14 days after a positive test of at least one resident, outings and visits are suspended, except for compassionate visits. In the phases of greater flexibility, exits considered essential (such as medical appointments) with return on the same day may dismiss laboratory testing or isolation. For outings lasting longer than 72 hours, most recommendations suggest the need for isolation for ten days and/or laboratory testing with Qt-PCR/antigen assays. Some guidance provided authorization for people’s entry to carry out academic and research activities and volunteer work, under local prerequisites. There is no national standardisation of protocols for outings for residents yet. The National Front suggests a plan with colours (red, orange, yellow and green) to guide an opening and progressive visit of the LTC facilities.


Update for: Brazil   Last updated: September 8th, 2021

3.11. Vaccination policies for people using and providing Long-Term Care

From 3 January 2020 to 20 December 2021, there have been 22.204.941 confirmed cases of COVID-19 with 617.395 deaths, as reported to WHO. The first vaccination date was 17 January 2021. Once supplies become available, despite the political crisis, vaccination coverage skyrocketed in the second semester of 2021. So far, Brazil has administered at least 325.593.485 doses of COVID-19 vaccines (approximately 151.80 doses/100 people). Assuming every person needs 2 doses (the number of people who received single-dose vaccines was low in the country), that’s enough to have vaccinated about 77.1% of the country’s population, at least 66% of them fully vaccinated. About 23.33 million booster doses were administered (10.90/100 people).

However, the inequity of these doses distribution in a continental country means that while some states have more than 76.7% of their population fully immunized (12.8% of these having already received the booster dose), others have only 38.8% fully vaccinated.

As the decision to prioritize population groups is currently under the responsibility of municipal and state administrations, there are not enough national data to estimate the coverage of the booster dose in the resident population and workers of LTCFs.

Higher vaccination coverage among Brazilian older adults was associated with substantial declines in relative mortality (when compared to younger individuals, with the two vaccines primarily distributed in the country until then, namely, CoronaVac and AstraZeneca, in a setting where the gamma variant predominates) (Victora CG et al., 2021).

Unfortunately, again, there are no national data to assess the effectiveness of immunization only in the population that depends on long-term care.

The country has not adopted mandatory vaccination policies for LTC staff, nor did it require visitors to present proof of their vaccination status when visits to the facilities were allowed. The current vaccination rates of staff (and the booster rollout in older residents) remain largely unknown.

Recently, researchers from the ‘Frente Nacional de Fortalecimento à ILPI’ published a study estimating the number of LTCF in the country in 7029 facilities, noting that 64% of the 5 570 Brazilian municipalities do not have LTCF for older adults. (Lacerda TTB et al., 2021)

Update for: Brazil   Last updated: December 21st, 2021   Contributors: Patrick Alexander Wachholz  |  

3.12. Measures to support unpaid carers

In Brazil a number of organisations have developed technical and educational guidelines. The Ministry of Women, Family and Human Rights established a website to provide family carers and people with long-term care needs with information around the COVID-19 pandemic. Some organisations have also established psychosocial activities (

Update for: Brazil   Last updated: September 7th, 2021