Chile – Resources to support community and institutional Long-Term Care responses to COVID-19

LTCcovid Country Profile – Printable Version

1.00. Brief overview of the Long-Term Care system

The majority of people with support needs receive care from their family members, mostly women.

There is some provision of subsidized institutional care. In principle all long-term care facilities should be registered with the Ministry of Health and subject to staffing requirements. However, it has been estimated that half of all care homes are not registered or unregulated.

References:

Browne J, Fasce G, Pineda I, Villalobos P (2020) Policy responses to COVID-19 in Long-Term Care facilities in Chile. LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 24 July 2020.

Browne, J., Palacios, J., Madero-Cabib, I., Dintrans, P. V., Quilodrán, R., Ceriani, A., & Meza, D. (2021). Enablers and Barriers to Implement COVID-19 Measures in Long-Term Care Facilities: A Mixed Methods Implementation Science Assessment in Chile. Journal of Long-term Care, 114–123. DOI: http://doi.org/10.31389/jltc.72

Update for: Chile Last updated: February 16th, 2022

1.01. Population size and ageing context

In 2017 there were nearly 3,500,000 people aged 60 or over in Chile, of whom 14.2% (489,000) had some degree of functional dependency (Browne et al., 2020).

References

Browne J, Fasce G, Pineda I, Villalobos P (2020) Policy responses to COVID-19 in Long-Term Care facilities in Chile. LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 24 July 2020.

Update for: Chile Last updated: December 22nd, 2021

1.08. Care home infrastructure

There an estimated 25,000 older people living in registered care homes (1.4% of the population aged 65 or older). Of the 994 registered care homes, 16 are public, 181 are not-for-profit (with public subsidies) and the rest are for-profit (operating under supervision of the Ministry of Health) (Browne et al., 2020).

There are many unregulated care homes operating in an informal manner, probably as many as there are in the regulated sector. Prior to the COVID-19 pandemic there were no regulations or mechanisms to survey the Infection Prevention and Control capabilities of care homes (Browne et al., 2021).

References

Browne J, Fasce G, Pineda I, Villalobos P (2020) Policy responses to COVID-19 in Long-Term Care facilities in Chile. LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 24 July 2020.

Browne, J., Palacios, J., Madero-Cabib, I., Dintrans, P.V., Quilodrán, R., Ceriani, A. and Meza, D., 2021. Enablers and Barriers to Implement COVID-19 Measures in Long-Term Care Facilities: A Mixed Methods Implementation Science Assessment in Chile. Journal of Long-Term Care, (2021), pp.114–123. DOI: http://doi.org/10.31389/jltc.72

Update for: Chile Last updated: January 6th, 2022

1.09. Community-based care infrastructure

There is a home-based care programme for people with severe dependency and also to provide health care to people who cannot access healthcare centres. Since 2016, the Ministry of Social Development has implemented a Local Support and Care Network, as part of a set of programmes towards a National System of Care. There are also initiatives to support family carers through cash benefits and respite care (Browne et al., 2020).

References

Browne J, Fasce G, Pineda I, Villalobos P (2020) Policy responses to COVID-19 in Long-Term Care facilities in Chile. LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 24 July 2020.

Update for: Chile Last updated: February 1st, 2022

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

There are no official publicly available estimates of the total number of people who use care who have died with COVID-19 infections. The lack of data on the impact of the pandemic is particularly problematic in the unregulated sector (Browne et al., 2020).

References:

Browne J, Fasce G, Pineda I, Villalobos P (2020) Policy responses to COVID-19 in Long-Term Care facilities in Chile. LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 24 July 2020.

Update for: Chile Last updated: December 22nd, 2021

3.02. Governance of the Long-Term Care sector's pandemic response

The Ministry of Health, the National Service for Older People (Servicio Nacional de Personas Mayores, SENAMA), and the Chilean Geriatrics and Gerontology Society (SGGCh) developed a set of prevention and management measures. Additionally, SENAMA implemented a mitigation strategy that included face to face technical support, supply of PPE, testing, and temporary transfer of residents who had tested positive to other health settings (Browne et al., 2021).

References:

Update for: Chile Last updated: December 22nd, 2021

3.02.01. National or equivalent Covid-19 Long-Term Care taskforce

The Ministry of Health (MoH), the National Service of Older People (Servicio Nacional del Adulto Mayor, SENAMA), the Chilean Geriatrics and Gerontology Society (GGS), and the main non-profit organizations started a working group to coordinate the implementation of prevention and control measures (Browne et al., 2020).

References:

Browne J, Fasce G, Pineda I, Villalobos P (2020) Policy responses to COVID-19 in Long-Term Care facilities in Chile. LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 24 July 2020.

Update for: Chile Last updated: December 22nd, 2021

3.04. Financial measures to support users and providers of Long-Term Care

In early March 2020, the National Service of Older People (Servicio Nacional del Adulto Mayor, SENAMA) led a public-private partnership that raised approximately $15 million for COVID-19 measures for publicly subsidized care homes. This funding was used to provide on-site technical support, PPE, to provide back up staff, to transfer residents with COVID-19 to isolation facilities, and for testing. In mid-June additional funding for this project made it possible to extend the support to “non-luxury” for-profit care homes (where the average fee per resident is lower than $USD 850). By mid-July 2020, this initiative was estimated to have reached 85% of the most vulnerable for-profit care homes (Browne et al., 2020).

References:

Browne J, Fasce G, Pineda I, Villalobos P (2020) Policy responses to COVID-19 in Long-Term Care facilities in Chile. LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 24 July 2020.

Update for: Chile Last updated: December 22nd, 2021

3.07. Infection Prevention and Control measures in the Long-Term Care sector: guidance, support and implementation

Guidance for care homes on use of PPE, cleaning and disinfection, implementation of isolation areas and clean areas for staff, and actions to manage and mitigate suspected and confirmed COVID-19 cases was issued by the Ministry of Health (MoH), the National Service for Older People (Servicio Nacional de Personas Mayores, SENAMA) and the Chilean Geriatrics and Gerontology Society (SGGCh). Additionally, the SENAMA supported care homes with face-to-face technical support, supplies of PPE, staff replacement, testing and transfer of residents with COVID to isolation facilities. A survey of care homes staff showed that, in July 2020, the majority of managers had a high degree of knowledge of COVID-19 prevention and control and reported high degrees of agreement and support for the measures. Around 20% of managers reported PPE shortages, but there were reports of improvement in availability PPE over time. Half of all managers reported that the infrastructure of the homes was inadequate to implement measures, and lack of trained staff, support for staff and trust were identified as other barriers to the implementation of Infection Prevention and Control measures (Browne et al., 2021).

References:

Update for: Chile Last updated: December 22nd, 2021

3.07.01. Measures in relation to transfers to and from hospital, from community to care homes and between settings

According to a report published in July 2020, at the time there was no specific protocol for hospital discharges to nursing homes and due to the high pressure on health services, people were being discharged from hospital to nursing homes without the requirement of COVID-19 testing, but discharged residents were required to remain in an isolation area for 14 days (Browne et al., 2020).

References:

Browne J, Fasce G, Pineda I, Villalobos P (2020) Policy responses to COVID-19 in Long-Term Care facilities in Chile. LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 24 July 2020.

Update for: Chile Last updated: December 22nd, 2021

3.07.03. Visiting and unpaid carer policies in care homes

Both enabling visiting in care homes and outings for residents are regulated in “plan paso a paso” (step by step). This regulates the number of personal visits and outings allowed based on the epidemiological status of each community. For “Fase 2” (step 2), the second step after lockdown, personal visits and outings are permitted. Isolation is not required following these activities (source: LTCCovid report).

Update for: Chile Last updated: December 22nd, 2021

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

Long-Term Care residents were prioritized and mass vaccination started in January 2021 using an extramural vaccination strategy. This primary scheme used Coronavac – Sinovac (96%) and Pfizer/BioNTech (4%). Later in, August 2021, a booster mass vaccination strategy was carried out reaching 83% of the residents who had been vaccinated with the primary scheme. The booster scheme used the Oxford – AstraZeneca vaccine except for those with known thromboembolic disease (eg. Myocardial Infarction, deep vein thrombosis).

Long-Term Care staff have been also identified as a prioritized group and where vaccinated using extramural strategies in their place of work. Furthermore, booster doses were given simultaneously to residents. Vaccination remains optional, no governmental compulsory policies have been implemented.

Data available: SAS Report

Update for: Chile Last updated: December 22nd, 2021 Contributors: Jorge Browne |