Turkey – 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

There is no long-term care (LTC) insurance system in Turkey. Until recently, long-term care infrastructure has been scarce; Turkey has a familialist welfare system with the majority of the elderly population being taken care of by their families (in particular, by female family members) (Oglak et al., 2017). In fact, the Turkish Civil Code involves intergenerational obligations for family members to look after dependents. However, to some extent this system is beginning to erode, and as such that has been an expansion of LTC services in the past two decades. (Akkan & Canbazer, 2020).

A fraction of older people in Turley (0.4%) live in care homes. Of these, 61% are in public nursing homes and the remainder in private ones. Private entities were only allowed to open nursing homes from 2008, but since then the sector has been rapidly expanding. In 2020, 247 of the 426 nursing homes were private, and 179 public. Apart from these care homes, the state also provides community-based care facilities, care and rehabilitation centres (which may also be run by private entities), and day-centres (Akkan & Canbazer, 2020).

References:

Akkan, B. (2017). “The politics of care in Turkey: Sacred familialism in a changing political context”, Social Politics: International Studies in Gender, State & Society, 25(1), 72–91, https://doi.org/10.1093/sp/jxx011.

Akkan B and Canbazer C (2020) The Long-Term Care response to COVID-19 in Turkey. LTCcovid, International Long-Term Care Policy Network, CPEC-LSE, 10 June 2020.

Oglak, S., Canatan, A., Tufan, I., Acar, S., & Avci, N. (2017). Long-Term Care in Turkey: Are We Ready to Meet Older People’s Care Needs? Innovation in Aging, 1(suppl_1), 566–566. https://doi.org/10.1093/GERONI/IGX004.1991

Update for: Turkey Last updated: January 26th, 2022 Contributors: Daisy Pharoah |

1.01. Population size and ageing context

The current population of Turkey is 84,339,067 (World Bank). Turkey still has a relatively young population, but the fertility rate has been steadily falling, while the percentage of the population over age 65 has been rising (Statista). The increasingly ageing population is resulting in swiftly increasing health expenditure and long-term care service needs (Oglak et al., 2017). The majority of the aging population is between ages 65 and 74 (Daily Sabah).

References:

Update for: Turkey Last updated: January 26th, 2022 Contributors: Daisy Pharoah |

1.03. Long-term care financing arrangements and coverage

Turkey has a familiarist welfare, placing intergenerational obligations to provide care on family members, but there are concerns about the sustainability of this model. There is growing support from the non-profit sector and other private providers, some of whom receive public funding from provision of services, this support is means and needs-tested (source: The-COVID-19-Long-Term-Care-situation-in-Turkey-1.pdf).

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

1.10. Workforce conditions: pay, employment conditions, qualification levels, shortages

When LTC is provided formally within care settings, women remain the primary providers. With low female labour participation rates, LTC is seen as a potentially suitable sector to enhance women’s training and employability. Recent evidence highlights the role of informally employed domestic and migrant live-in care workers to provide LTC at home when the family cannot meet such needs, funded either through cash-for care schemes or out-of-pocket by the private households (source: https://www.mdpi.com/2071-1050/13/11/6306/htm).

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

2.00. Overview impacts of the Covid-19 pandemic on people who use and provide Long-Term Care

In Turkey, older people (over 65s) and children under 20 were subject to a strict curfew between March and June 2020 (Akkan, 2020).

Case Study of a Care Home in Istanbul (Özten et al, 2021)

A recent report describes successful pandemic response measures in a nursing home in Istanbul. This nursing home (which is one of the biggest nursing homes in the country, with 679 residents) managed to avoid COVID-19 cases altogether (for both residents and employees) during the first year of the pandemic by using a working plan to successfully prevent cross-contamination.

Within the first month of the global outbreak, this nursing home had introduced the use of protective equipment and temperature checks for all employees (including face-shields and disposable clothing), the announcement of a COVID-19 protocol – including preventative measures and an algorithm for positive cases – and temporary suspension of new admissions and visitors, among other measures. In the eleven months to follow, further safety measures were implemented such as regular PCR testing for all staff, restricted access for staff to different areas of the building, and an assigned quarantine ward for residents with suspicious symptoms.

Psychosocial support was given to residents, to mitigate fears of death and abandonment: exercise activities were carried out periodically, and the message “we are with you, you are not alone and unattended” was repeatedly communicated to residents. Psychosocial support was also offered to staff, whose levels of stress increased due to the newly implemented 15-day shift patterns. Group communication therapies were offered, and various solutions were offered to mitigate feelings of anxiety from being separated from family (Özten et al, 2021).

References:

Akkan B and Canbazer C (2020) The Long-Term Care response to COVID-19 in Turkey. LTCcovid, International Long-Term Care Policy Network, CPEC-LSE, 10 June 2020.

Özten O, Aytekin Akta? T, Süer H, Do?an H, Üner A, Özp?nar S, Ayy?ld?z Y, Bekta? H, Saka B. 2021. A 15-day Working Shift Prevent the Cross-contamination of Coronavirus Disease-2019 in a Nursing Home in Turkey. Eur J Geriatr Gerontol 2021;3(3):131-133

Update for: Turkey Last updated: January 26th, 2022 Contributors: Daisy Pharoah |

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

On September 30, 2020, the Minister of Heath announced that the official figures of COVID-19 refer to the number of COVID-19 ‘patients’ (who have received treatment), whereas COVID-19 ‘cases’ (who tested positive but do not show any symptoms) have not been included in the published data since July 29, 2020. As of October 2, 2020, the total number of patients was 321,512 and 8,325 COVID-19 related deaths have been recorded (Source: https://covid19.saglik.gov.tr/?_Dil=2).

No recent official data on deaths of care home residents has been released by the Ministry. Based on public statements of government officials provided on different platforms, as of May 7, 2020, there have been 1,030 diagnosed COVID-19 cases in care institutions where the resident had been admitted to a hospital and 150 deaths of care home patients. The deaths in nursing homes accounted for 4% of all COVID-19 deaths in Turkey (Source: https://ltccovid.org/wp-content/uploads/2020/06/The-COVID-19-Long-Term-Care-situation-in-Turkey.pdf).

Update for: Turkey Last updated: August 3rd, 2021

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

In Turkey, older people (over 65s) and children under 20 were subject to a strict curfew between March and June 2020 (Akkan, 2020). A study involving 133 older adults living in nursing homes and in the community carried out in December 2020 using telephone interviews shows that, in spite of long confinements, the majority of older adults reported no or mild depression, anxiety and stress and were slightly satisfied with their lives. However, those aged over 80 and older people living in nursing homes reported worse outcomes. People living in nursing homes reported higher levels of depression and anxiety, higher anxiety about death and lower life satisfaction that people living in the community. People aged 80 or over reported higher depression, anxiety, stress and death anxiety. Older people who met their relatives less frequently were found to have lower life satisfaction and higher depression scores (Arpacioglu S et al., 2021).

References:

Akkan B and Canbazer C (2020) The Long-Term Care response to COVID-19 in Turkey. LTCcovid, International Long-Term Care Policy Network, CPEC-LSE, 10 June 2020.

Arpacioglu S, Yalçin M, Türkmenoglu F, Ünübol B, Çelebi Çakiroglu O. Mental health and factors related to life satisfaction in nursing home and community-dwelling older adults during COVID-19 pandemic in Turkey. Psychogeriatrics. 2021 Nov;21(6):881-891. doi: 10.1111/psyg.12762.

Update for: Turkey Last updated: January 26th, 2022

3.01. Brief summary of the overall pandemic response (not specific to Long-Term Care)

The government imposted a curfew on people aged 65 and older, as of 22nd March 2020. This became became a partial curfew on the 1st of June 2020, when infection rates had started to decrease. The hours that people were authorised to go out varied according by region and changed according to infection rates. As of 22nd November 2020, individuals aged 65?years and over have been allowed to go out between 10:00–13:00?hours (Arpacioglu et al., 2021).

References:

Arpacioglu S, Yalçin M, Türkmenoglu F, Ünübol B, Çelebi Çakiroglu O. Mental health and factors related to life satisfaction in nursing home and community-dwelling older adults during COVID-19 pandemic in Turkey. Psychogeriatrics. 2021 Nov;21(6):881-891. doi: 10.1111/psyg.12762.

Update for: Turkey Last updated: January 12th, 2022

3.06. Support for care sector staff and measures to ensure workforce availability

Case Study of a Care Home in Istanbul (Özten et al, 2021)

A report describes successful pandemic response measures in a nursing home in Istanbul (one of the biggest in the country). Among other strict preventative measures to protect staff and residents, were the implementation of a 15-day shift plan, regular PCT testing and temperature checks, restricted access for staff to different areas of the building, and an assigned quarantine ward for any residents with suspicious symptoms.

Psychosocial support was also offered to staff, in order to mitigate stress and anxiety that may arise from being on-site and away from family for 15 day periods: for example, group communication therapies were offered, and staff were encouraged to use video calling technology to retain contact with their families (Özten et al, 2021)

References:

Update for: Turkey Last updated: January 26th, 2022 Contributors: Daisy Pharoah |

3.07.02. Approach to isolation of people with confirmed or suspected Covid-19 infections in care homes

Case Study of a Care Home in Istanbul (Özten et al, 2021)

A report describes successful pandemic response measures in a nursing home in Istanbul. This nursing home, which is one of the biggest in the country, managed to avoid COVID-19 cases for residents and staff altogether, as a result of strictly adhered-to regulations and implementation of preventative measures. This included the use of an assigned quarantine ward for any residents with suspicious symptoms. Residents sent to this ward were isolated, evaluated clinically, and followed up on by doctors and nurses. If indicated, they were transferred to hospital (Özten et al, 2021).

References:

Update for: Turkey Last updated: January 26th, 2022 Contributors: Daisy Pharoah |