1
Enferm eira, Dout or em Geront ologia Biom édica , Professor Adj unt o, Vice–Diret or da Faculdade de Enferm agem , Nut rição e Fisiot erapia, da Pont ifícia Universidade Cat ólica do Rio Grande do Sul, Brasil, e- m ail: m arionc@pucrs.br; 2 Enferm eira, Dout or em Enferm agem , Professor Tit ular do Depart am ent o de Enferm agem , da Universidade Federal de Sant a Cat arina, Brasil, e- m ail: lt akase@brt urbo.com .br; 3 Sociólogo, Dout or em Sociologia, Professor Adj unt o da Faculdade de Filosofia e Ciências Hum anas, da Pont ifícia Universidade Cat ólica do Rio Grande do Sul, Brasil, e- m ail: sobot t ka@pucrs.br
Disponible en castellano/ Disponível em língua portuguesa SciELO Brasil w w w .scielo.br/ rlae
THE ECONOMI C SURVI VAL OF LONG STAY I NSTI TUTI ONS FOR I MPOVERI SHED AGED PEOPLE
Mar ion Cr eut zber g1 Lúcia Hisak o Tak ase Gonçalv es2 Em il Alber t Sobot t ka3
Cr eut zber g M, Gonçalv es LHT, Sobot t k a EA. The econom ic sur v ival of long st ay inst it ut ions for im pov er ished aged people. Rev Lat ino- am Enfer m agem 2 0 0 7 set em br o- out ubr o; 1 5 ( núm er o especial) : 7 4 8 - 5 4 .
Obj ect ive: I dent ify st ruct ural couplings of Ret irem ent I nst it ut ions for t he Aged ( RI A) wit h t he econom ic sy st em , in or der t o m aint ain t hose inst it ut ions t hat shelt er t he poor aged in t he Br azilian cont ex t . Met hod: Qualit at iv e, ex plor at or y - descr ipt iv e st udy . The dat a collect ion w as car r ied out t hr ough int er v iew s w it h sev en leading people and eight aged people, analy sis of com m unicat ion of 52 non- pr ofit Br azilian RI As, bot h public and pr ivat e. The cont ent analysis w as per for m ed based on t he Niklas Luhm ann’s Syst em s Theor y. Result s: I t w as v er ified t h at in face of t h e aged scar ce r esou r ces, a con sider able sh ar e of t h e m ain t en an ce cost s ar e suppor t ed by t he inst it ut ions t hem selves, w hose sear ch for r esour ces is done by leader s, t eam , t he aged and com m unit ies. Conclusions: The ex cessiv e inv olv em ent of t hese inst it ut ions in t he elabor at ion of pr ogr am s for searching funds can harm t he perform ance of t heir essent ial funct ion w hich is t o care for t he poor aged.
DESCRI PTORS: hom es for t he aged; aged; ger iat r ics aging; sy st em s t heor y ; pov er t y
LA SUPERVI VENCI A ECONÓMI CA DE HOGARES PARA ANCI ANOS EMPOBRECI DOS
Objetivo: Identificar acoplamientos estructurales de Hogares para Ancianos (HA) con el sistema económico, para la manutención de las instituciones que abrigan ancianos pobres, en el contexto brasileño. Método: estudio de aproximación cualitativa de tipo exploratorio descriptivo. La recolecta de datos fue realizada mediante entrevistas con 7 dirigentes y 8 ancianos y análisis de comunicaciones de 52 HAs sin fines lucrativos, de carácter público o privado. El análisis del contenido fue procesado con base en los referenciales de la Teoría de Sistemas de Niklas Luhmann. Resultados: Se verificó que, ante la falta de recursos económicos de los ancianos, una parte importante de los gastos para la manutención de las Has es asumida por las propias instituciones y la búsqueda de esos recursos involucra a dirigentes, equipo, ancianos y comunidades. Conclusiones: El excesivo comprometimiento de las instituciones en la elaboración de programas en búsqueda de fuentes de recursos puede perjudicar el desempeño de la función esencial de cuidado al anciano pobre.
DESCRI PTORES: hogar es par a ancianos; anciano; ger iat r ía; env ej ecim ient o; t eor ía de sist em as; pobr eza
A SOBREVI VÊNCI A ECONÔMI CA DE I NSTI TUI ÇÕES DE LONGA PERMANÊNCI A PARA
I DOSOS EMPOBRECI DOS
Obj etivo: I dentificar acoplam entos estruturais da instituição de longa perm anência para idosos ( I LPI s) com o sistem a econôm ico, para a m anutenção das instituições que abrigam idosos pobres, no contexto brasileiro. Método: Est udo explorat ório- descrit ivo, de abordagem qualit at iva. A colet a de dados foi realizada por m eio de ent revist as com set e dirigent es e oit o idosos, análise de com unicações de 52 I LPI s sem fins lucrat ivos, de carát er público ou privado. A análise de conteúdo foi processada com base nos referenciais da teoria de sistem as de Niklas Luhm ann. Resultados: Foi verificado que, diante da escassez de recursos econôm icos dos idosos, parte im portante das despesas para a m anut enção das I LPI s é assum ida pelas próprias I nst it uições e a busca desses recursos dirigent es, equipe, idosos e com unidades. Conclusões: O excessivo envolvim ent o das inst it uições na elaboração de program as em busca de fontes de recursos pode prej udicar o desem penho da função essencial de cuidado ao idoso pobre.
I NTRODUCTI ON
I
n Brazil, im poverished elderly who face t he need t o t urn t o a Long St ay I nst it ut ion for Aged People( LSI AP) , have privat e and public nonprofit inst it ut ions
a s a l t e r n a t i v e s. Fa ct o r s l i k e t h e i n e x i st e n ce a n d
im p ossib ilit y of af f or d in g t h e cost s of alt er n at iv es
before inst it ut ionalizat ion, as well as t he few vacancies
in nonpr ofit inst it ut ions cr eat e a m ar ket of ( lack of )
car e t o im pov er ished elder ly, and t he appearance of
oft en irregular facilit ies wit h iat rogenic charact erist ics,
a shock ing r ealit y of t ot al abandonm ent , negligence,
v iolence and abuse( 1- 3). Fr om t he per spect iv e of t he n ecessar y qu alif icat ion of elder ly car e f acilit ies, t h e
obj ect of t his st udy was det erm ined: t he m aint enance
and survival of LSI AP for im pov erished elderly, in t he
Br azilian con t ex t .
Am ong ot her funct ions, LSI APs should at t end
elderly “ without fam ily ties or conditions to provide their
own subsist ence, so as t o fulfill t heir needs regarding
housing, nut rit ion, healt h and social living” or shelt er
“ dependent and/ or independent elderly in a condit ion
of social v u ln er abilit y ”( 4 ). I n or der t o car r y ou t t h is function, LSI APs should be organized from an econom ic
v iew point , becom ing inv olv ed w it h econom ic sy st em
op er at ion s. Th is sy st em is f ocu sed on t h e lack of
resources, as well as their distribution and the guarantee
of fulfilling social syst em needs. Meet ing t he needs of
aged people liv in g in n on pr of it LSI APs is, f or t h ese
inst it ut ions, a r eal and const ant pr oblem , since t hey
attend low- incom e people. Thus, LSI APs are responsible
for t he large m aj orit y of resources needed t o m aint ain
the elderly. Hence, institutions have to constantly assure
them selves with certain elem ents to elim inate scarcity( 5) and guarant ee t he care t hey propose.
OBJECTI VE
To identify the structural connections of a Long
St ay I n st it u t ion f or Aged People w it h t h e econ om ic
sy st em in or der t o m aint ain inst it ut ions t hat shelt er
im poverished elderly, in the Brazilian context, observing
com m unicat ions and resonances at t he LSI AP.
METHOD
This is a qualit at iv e, ex plor at or y - descr ipt iv e
st udy, focused on LSI APs in t he Brazilian cont ex t , in
t h e u r ban ar ea, w it h r esiden t s w it h ou t con dit ion t o
pr ov ide t h eir ow n su bsist en ce or com in g f r om low
-i n co m e f am -i l -i es. Th e st u d y co m p r -i sed -i n st -i t u t -i o n s
regularly recognized as nonprofit LSI APs, eit her public
or pr iv at e.
Dat a collect ion w as car r ied out by m eans of
int er v iew s, follow ing a scr ipt w it h guiding quest ions,
wit h seven adm inist rat ive professionals from different
LSI AP int ernal subsyst em s and eight elderly resident s
from t hree LSI APs in t he m et ropolit an region of Port o
Alegr e. I n addit ion, com m unicat ions pr oduced by 52
LSI APs and br oadcast by t he m edia w er e obser v ed.
Th e se co m m u n i ca t i o n s e x p r e sse d t h e v i e w t h a t
o r g a n i z a t i o n s h a d o f t h e m s e l v e s a n d s o c i a l
en v ir on m en t ex pect at ion s.
Dat a analysis of t he observat ions were based
on Nik las Luhm ann’s( 5) funct ional analy sis m et hod. I t is an u pdat ed f or m u lat ion of Sy st em s Th eor y, w it h
applicat ions t o social and cult ur al phenom ena, using
an int erdisciplinary approach. For Luhm ann, organized
social sy st em s lik e LSI APs, can be analy zed by t heir
in t er n al pr ocesses an d t h eir in t er depen den ces w it h
ot her sy st em s and or ganizat ions. These sy st em s ar e
au t op oiet ic an d t h eir d ecision s h av e a p er m an en t
st r uct ur al connect ion, t hr ough com m unicat ions, w it h
t heir surroundings, and can t hus st im ulat e resonances
in t he syst em s involved. The dat a obt ained fr om t he
t r a n s c r i p t i o n s o f t h e i n t e r v i e w s a n d LS I A P
com m u n icat ion s w as su bj ect t o Con t en t An aly sis( 6 ). Mea n i n g u n i t s, i d en t i f i ed i n t h e Co n t en t An a l y si s
pr ocess, w er e coded using t he let t er E for elder ly, A
for adm inist rat ors, and LSI AP for inst it ut ions, followed
by an ident ificat ion num ber.
The st udy was approved by t he Review Board
at t he Pont ifical Cat holic Univer sit y of Rio Gr ande do
Su l ( PUCRS) . LSI AP a d m i n i st r a t o r s a n d r e si d e n t
el d er l y p r o v i d ed w r i t t en co n sen t . I n ad d i t i o n , t h e
or gan izat ion s’ iden t it ies w er e pr eser v ed, con cer n in g
t he dat a obt ained fr om LSI AP com m unicat ions.
DATA PRESENTATI ON AND ANALYSI S
The need for LSI APs t o find w ay s t o supply
t h e eco n o m i c n eed o f t h e el d er l y t h ey sh el t er i s
not iced in t he elder ly ’ st at em ent :
Here we pay half our salary, which is a m inim um salary
[ U$190] . We can’t afford paying U$380 or U$500 every m onth (E3).
Considering that retirem ent is the m ain incom e
evidences t he vulnerabilit y inst it ut ionalized elderly m ay
be facing, since t hey do not have condit ions t o supply
t h ei r o w n m a i n t en a n ce co st i n t h ese p l a ces. Th e
st r u ct u r a l co n n e ct i o n s b e t w e e n LSI APs a n d t h e
econ om ic sy st em , in t h e sear ch t o m ain t ain t h ese
organizat ions t hrough t he com pensat ion of t he scarcit y
o f el d er l y p eo p l e’s r eso u r ces, w er e i d en t i f i ed an d
organized in t hree cat egories: “ Econom ic resources for
LSI AP m aint enance”, “ Sources of econom ic resources”,
“ Resources, alt ernat ive sources and st rat egies”.
Econ om ic r esou r ces for LSI AP m ain t en an ce
LSI APs’ relat ionship wit h t he econom ic syst em
i s t h at o f a d eb t o r, an d t h er e i s n o o t h er w ay o f
b e co m i n g d e b t - f r e e t h a n b y p a y i n g t h e f i n a n ci a l
com m it m ent s. The econom ic syst em has no influence
on m aking or denying paym ent s. For t his m at t er, t here
ar e self- r egu lat in g pr ogr am s, w h ich or igin at ed fr om
t h e su p p ly an d d em an d r elat ion sh ip in t h e m ar k et
d y n a m i c s( 5 ), w h i c h c o n v e r g e t o d e t e r m i n e t h e m a i n t e n a n ce co st s o f e l d e r l y i n LSI APs, a s w e r e
r efer en ced by t h e com m u n icat ion s.
Our m ont hly cost t oday, considering t he m oney we
receive and spend, including all our donat ions, if a fixed price
w er e t o be set , it w ould have t o be bet w een U$300.00 and
U$350.00, m ont hly ( A4) .
Th e cost of an eld er ly t od ay f or u s r an g es f r om
U$275.00 t o U$300.00 ( A3) .
Today , an elder ly cost s, apar t fr om t he donat ions,
U$210.00 per m ont h ( LSI AP3) .
According t o t he facilit y’s adm inist rat ion, m aint aining
each elderly person’s cost s, on t he average, U$500.00 ( LSI AP52) .
A n e l d e r l y p e r s o n ’ s m o n t h l y c o s t i s
det er m ined by all t he r esour ces needed t o m aint ain
t he elderly in t he inst it ut ion, w hich ranges from food
supplies and hygiene m at erial t o paying t he st aff and
t ax es, as descr ibed below . I t should be em phasized
t hat t he descript ion does not aim t o be t horough, but ,
rat her, t o ident ify t he indicat ives of t he dim ension of
r esponsibilit ies w it h t he econom ic sy st em .
Ea t i n g i s a d a i l y r e s o u r c e t h a t m u s t b e
av ailab le at t h e LSI AP, in t h e q u alit y an d q u an t it y
appropriat e for t heir resident s. I n m ost organizat ions,
m eals are processed at t he inst it ut ion. Therefore, t hey
p u r c h a s e e v e r y s u p p l y i t e m , p e r i s h a b l e a n d
im p er ish ab le.
We receive m any donat ions, but not every donat ion we
receive supplies t he elderly’s needs - so t here are expenses wit h
m eat , veget able, and fruit t hat t hey need ( A2) .
Hy g ien e p r od u ct s ar e in d isp en sab le. Th ese
include soap, sham poo, t oot h past e and t oot h brushes,
in addit ion t o geriat ric diapers for people wit h urinary
a n d / o r i n t e s t i n a l i n c o n t i n e n c e , w h i c h a r e v e r y
com m on in t hese facilit ies.
We have t o buy geriat ric diapers, we have elderly in
bed ( A2) .
Just regarding geriat ric diapers, t here is a need of up
t o 80 per day ( LSI AP3) .
Mo r e o v e r, s o m e p e o p l e r e g a r d g e r i a t r i c
d iap er s as a lu x u r y it em . Nu r ses h av e f ou g h t r eal
b a t t l e s t o g u a r a n t e e t h i s i t e m , w h i c h , d e s p i t e
g en er at in g h ig h cost s, g iv es com f or t , esp ecially t o
e l d e r l y, b u t a l s o p r o v i d e s f o r t h e q u a l i t y a n d
opt im izat ion of t he st aff looking aft er t he elderly wit h
su ch a n eed . En v ir on m en t al h y g ien e p r od u ct s an d
laundry it em s also t ot al a significant m ont hly t oll, and
n e e d t o b e g u a r a n t e e d s o a s t o m a i n t a i n
env ir on m en t al saf et y.
Me d i ca t i o n s a r e a h i g h h e a l t h ca r e co st ,
e s p e c i a l l y t h o s e n o t o b t a i n e d f r o m t h e H e a l t h
S e c r e t a r i a t . Th e i n s t i t u t i o n ’ s c o m m i t m e n t i n
gu aran t eein g access t o t h erap y, ev en if t h at m ean t
hav ing t o buy t he dr ug, w as ev idenced.
Every m ont h, t he organizat ion has an expense of t welve
t housand Reais only wit h drugs ( LSI AP1) .
The st aff payroll represent s a high percent age
o f t h e LS I A Ps ’ m o n t h l y e x p e n s e s , d e s p i t e t h e
ex em pt ion fr om t he em ploy er s’ legislat ion dut y.
We have m any em ployees, t oday t here are fift y- nine
workers, j ust in nursing we have t hirt y em ployees [ …] . That is
one of t he highest expenses, our payroll. Act ually, we could use
even m ore em ployees ( D3) .
Th e w ei g h t of t h e p ay r ol l o n t h e m o n t h l y
budget is referred t o as t he explanat ion for t he sm all
num ber of em ploy ees and t heir low salar ies.
...caregivers are paid m inim um salaries ( LSI AP12) .
Regar ding w at er, elect r icit y and gas bills, as
w e l l a s t a x e s, t h e r e a r e n o su ch p o ssi b i l i t i e s o f
exem pt ion, alt hough t he LSI APs have already pursued
t h em .
Because inst it ut ions have expenses, t hey ar e fix ed
expenses wit hout exem pt ions, we pay elect ricit y and wat er bills,
we pay t axes ( A6) .
The t axes on our elect ricit y bill are sim ilar t o t hose of
an indust ry, who produces and sells som et hing for profit ( A3) .
I t is em p h asized t h at p ar t of p h ilan t h r op ic
ent it ies, as w ell as LSI APs, m ight not be included in
ev er y t y pe of ex em pt ion , sin ce t h ey ar e on ly giv en
Nacion al d o Seg u r o Social ( I NSS) [ Nat ion al Social
S e c u r i t y I n s t i t u t e ] , w h i c h i n c l u d e h a v i n g t h e
Cer t if icad o d e En t id ad e Ben ef icen t e d e Assist ên cia
Social ( CEAS) [ Cer t ificat ion of Social Car e Beneficent
Ent it y] , given by t he Conselho Nacional de Assist ência
Social ( CNAS) [ Nat ional Social Care Council] , in which
only 64% of all philant hropic ent it ies w ere regist ered
in 2004( 1).
LSI APs u se a l ot of eq u i p m en t , esp eci al l y
t hose for self- car e, w hich ar e gener ally ex pensiv e t o
buy and m aint ain.
Type of donat ions needed: beds, st ret chers, bat hing
chairs, wheel chairs and ort hopedic product s ( LSI AP9) .
One of t he inst it ut ion’s worst problem s was t he lack
and poor condit ions of t he wheel chairs ( LSI AP26) .
Cost s w it h cont inuous building m aint enance,
as w ell as t h e n eed f or r ef or m s an d ad j u st m en t s,
fou n ded on legislat ion , despit e bein g in dispen sable,
ar e not t he pr ior it y. Mor eov er, in public LSI APs, t his
asp ect r eq u i r es l o n g an d so m et i m es u n su ccessf u l
n egot iat ion s.
Part of t he m aint enance, very lit t le, is done by t he
Municipalit y ( A7) .
We are always wait ing. I n fact , our hom e, wit h all t his
t im e of exist ence, we t ry t o offer elderly everyt hing t hey need,
wit h qualit y, but we don’t have t he m at erial t o reform t he building,
t o paint t he room s, t o replace t he wood fram es, which are infest ed
wit h t erm it es, t he t iles, reform bat hroom s, since t here are old
bat hroom s. There is a need for m aint enance, changing equipm ent
because of t he high use, for exam ple, t here are fort y people using
t he sam e shower once a day ( A3) .
Due t o t hese needs and t he lack of econom ic
r esou r ces t o m eet t h em , m ost LSI APs st ill d o n ot
com p ly w it h t h e st an d ar d s. Th is w as con f ir m ed b y
au t h or s( 8 - 1 0 ) w h o st u died t h e st r u ct u r es of dif f er en t LSI APs in t erm s of t he legislat ion, especially Law 810/
89( 11). Despit e t he irregularit y st ill present in LSI APs, lit erat ure point s at a slow and gradual change in t his
r e s p e c t( 8 - 9 , 1 2 ). Co m m u n i c a t i o n s r e f e r r i n g t o const ruct ions reflect t he adapt at ion t o legal st andards,
and also t o com ply w it h t he elder ly ’s div er se needs,
as well as t he hum anizat ion in t he facilit ies.
The j unina fest ( folkloric fest ival in June) coincided
wit h t he com plet ion of t he revit alizat ion reform t hat assigned t he
cit y’s inst it ut ion t he condit ion of a m odel in t he count ry’s Sout hern
region ( LSI AP22) .
I n st al l i n g su r r o u n d so u n d i n ev er y r o o m i n t h e
inst it ut ion ( LSI AP2) .
Building a porch so it ’s easier for elderly t o get som e
sun on t he second floor ( LSI AP2) .
As som e adm inist r at or s w ell st at ed, phy sical
ar ea, fur nit ur e, equipm ent , and leisur e m at er ials ar e
n ot secon d ar y. Th ey h av e an in d ir ect in f lu en ce on
qualit y of life, and t hus det er m ine a higher or low er
r isk of fr act ur es, for ex am ple, or social isolat ion.
I n addit ion t o t rying t o also include t he st ruct ure part ,
providing elderly wit h adj ust m ent s so t hey can m ove around, so
t hey have som e space t hat m eet s t heir needs ( A2) .
Having a m ore com fort able chair t o sit on, I t hink t hat
is what ’s m issing ( A1) .
I n t his sense, st udies( 1,13) have found t hat t he lack of eq u ip m en t s in LSI APs r esu lt s in a r ed u ced
par t icipat ion of t he elder ly in sev er al act iv it ies, lik e
wat ching TV, list ening t o t he radio and t o m usic, eit her
indiv idually or collect iv ely.
Sou r ces of econ om ic r esou r ces
I n t h e o b ser v at i o n , i t w as ev i d en ced t h at
p u b l i c g r an t s an d co m m u n i t y d o n at i o n s w er e t h e
sou r ces of r esou r ces for LSI AP m an agem en t .
Generally, nonprofit LSI APs absorb part or all
of the elderly’ retirem ent pay as their form of contributing
t o t he inst it ut ion’s m aint enance. This is referred t o in
literature(10), as well as by the interviewed adm inistrators. We have a part nership wit h t he elderly who pass us
t he benefit t hey receive so we can afford t hese expenses ( D3) .
Though t his is underst ood by t he elderly, t hey
ex p r ess a sen sat ion of sp oliat ion . Wit h t h e Eld er ly
St at ut e, t he possibilit y of m aint aining part of t he elderly’
incom e in t he LSI AP w as legit im ized, as long as it is
g u ar an t eed t h at eld er ly w ill k eep a p er cen t ag e( 1 4 ). Lit erat ure em phasizes t hat inst it ut ionalized elderly who
do not m anage t heir incom e are not “ able t o give t heir
opinion about t he ser v ices”( 12) and, for inst ance, t his sit uat ion m akes it difficult t o est ablish links wit h realit y
and rem ain updat ed on m onet ary values. Som e of t he
LSI AP r esident s do not r eceiv e any r et ir em ent . They
possibly represent t he group of ext rem ely im poverished
e l d e r l y( 7 ). Fo r t h e s e c a s e s , LSI APs f o r w a r d a n applicat ion for t he Cont inuous Car e Benefit , but only
aft er t hey com plet e 65 years of age.
Public LSI APs ar e m ost ly m aint ained by t he
m u n icipalit y ’s bu dget . Ot h er LSI APs r ecogn ized an d
a ck n o w l e d g e d a s n o n p r o f i t o r g a n i za t i o n s u su a l l y
receive som e kind of public grant as a resource. The
r efer r ed com m unicat ions ex pr ess t his possibilit y :
W e h a v e a f ed er a l g r a n t t h a t i s p a ssed t o t h e
m unicipalit y, of U$20.00 per independent elderly and U$30.00
Federal and St at e part nerships are t he m ain resources
for m aint aining social work ( LSI AP2) .
LSI APs sadly express t hat , in addit ion t o being
scar ce, public r esour ces ar e fr equent ly r eceiv ed lat e.
I n som e sit uat ions, public grant s are passed t o specific
p r o j e ct s t o e x p a n d o r r e f o r m f a ci l i t i e s, p u r ch a se
equipm ent and ot her, approv ed in governm ent organs.
Toget her, t he elder ly ’s incom e passed t o LSI APs and
t h e p u b l i c g r an t s d o n ot r each t h e t ot al n eed f or
r esour ces t o m eet financial com m it m ent s:
I t is a ph ilan t h r opic or gan izat ion m ain t ain ed w it h
Feder al and Municipal gr ant s and r esident s’ benefit s, w hich
represent 50% of t he m ont hly budget ( LSI AP12) .
I n t h i s se n se , n o n p r o f i t LSI APs st r o n g l y
depend on donat ions fr om t he com m unit y.
Pr i v a t e n o n p r o f i t LSI APs f a ce m a n y m o r e
difficult ies t o m eet t heir m ont hly budget , since m ost
r esour ces com e fr om donat ions and par t ner ships, or,
as t hey say :
... it is what we have t o search for out side ( A3) .
Donat ions from t he com m unit y include t hose
m ad e b y i n d i v i d u a l s, g r o u p s a n d co m p an i es. Th e
var ious individual and gr oup donor s ar e im por t ant t o
m a i n t a i n t h e i n s t i t u t i o n s a n d a r e c o n s t a n t l y
encour aged and called t o solidar it y :
We h av e t h e com m u n it y an d w e h av e p ar t n er s,
collaborat ors, a great am ount of cont ribut ing part ners ( A3) .
Par t n er sh ips w it h com pan ies r equ ir e agilit y
i n f o r w a r d i n g p r o j e ct s t h a t , so m e t i m e s, a r e n o t
approved. Special em phasis is given t o Governm ent al
a n d No n - Go v e r n m e n t a l co m p a n i e s f r o m d i f f e r e n t
econom ic sect or s, indust r y, com m er ce and ser v ices,
as well as t hird sect or organizat ions. The adm inist rat or
com m en t s:
Today, t he search for part nerships is one of t he key
point s. The inst it ut ion’s nur se is paid by a healt h com pany .
Today we have several part nerships, som e com panies who pass
us t he m oney t o use in som e proj ect . These part ners don’t want
t o sim ply give us t he m oney, t hey want t o see where and how
t hat m oney is being used. Som e even det erm ine obj ect ives, t hey
supervise, give inst ruct ions ( A6) .
Par t n er sh ip s w it h com p an ies ar e t h e m ost
d i s p u t e d b y LS I A Ps a n d , a s a r e s u l t o f s o c i a l
r espon sibilit y pr ogr am s, possibilit ies h av e in cr eased
over t he last years. Wit h t he im plem ent at ion of social
act ions, com panies, in addit ion t o responding t o a new
cu lt u r e b ased on et h ics, u n d er st an d t h at t h ey can
i n cr ea se em p l o y ee p r o d u ct i v i t y a n d co m m i t m en t .
Mor eov er, t hey can guarant ee t hat t hey w ill r eceiv e
gr eat er r ecognit ion in t he com m unit y and m ar k et( 15).
A com p an y ch ooses a cer t ain LSI AP, d ep en d in g on
t he inst it ut ion’s st im uli and r espect iv e r esonances in
t h e en v ir on m en t , fav or in g t h e st r u ct u r al con n ect ion
wit h t his sect or of t he econom ic syst em . Besides, it is
also suggest ed t hat suppor t is est ablished based on
m ar k et and m ar k et ing int er est s, w hich ar e v er y w ell
weighed, so t hat t his part nership can becom e st ronger.
Th e r e f o r e , s e l e c t i o n i s d o n e t h r o u g h a s e n s e
det er m in ed by t h e com pan y an d, if t h e par t n er sh ip
does not respond t o t he com pany’s expect at ions, it is
abandoned. Philant hropic and care inst it ut ions are t he
lar gest r eceiv er s of r esour ces fr om com panies’ social
r e sp o n si b i l i t y. Ad m i n i st r a t o r s e x p r e sse d t h a t t h e
sect or ’s par t icipat ion is st ill lim it ed.
Alt er nat iv e sour ces and st r at egies
LSI APs creat e a wide range of ways t o gat her
f u n d i n g . On e o f t h e r eso n a n ces o f t h e st r u ct u r a l
c o n n e c t i o n w i t h t h e e c o n o m i c s y s t e m o v e r t h e
i n st i t u t i on i s t h e cr eat i on of i n t er n al p r og r am s t o
g u ar an t ee r esou r ces in or d er t o ov er com e in t er n al
a n d e x t e r n a l co n t i n g e n ci e s a s w e l l a s e co n o m i c
c o n d i t i o n i n g s . H e n c e , a l t e r n a t i v e s a r e c r e a t e d ,
st r a t e g i e s a r e i m p l e m e n t e d , a n d i n t e r n a l LSI AP
su b sy st em s ar e en co u r ag ed t o o v er co m e p o v er t y
con dit ion s.
Am ong t he m any cr eat iv e alt er nat iv es found
by LSI APs, t h ey m ak e h oliday car ds, gar age sales,
part ies, beneficent bazaar and show, as well as raffles.
Ex em p lif y in g :
So we have ot her alt ernat ives, we have our fairs, which
t ake place four t im es a year ( A3) .
They part icipat e in m ont hly part ies at t he inst it ut ion,
where t he m ain purpose is t o allocat e m oney for im provem ent s.
( LSI AP14) .
Financial inv est m ent s and r ent s ar e sour ces
st at ed by t he LSI APs, in addit ion t o part nerships wit h
service rendering com panies, w ho offer t heir services
as an alt er n at iv e r esou r ce. Less com m on r esou r ces
also m ak e a differ ence:
The group [ of indust ry em ployees] decided t o reform
t he chairs, every Sat urday m orning, t radit ionally dedicat ed t o
t he 5S. The group was also com m it t ed t o doing t he prevent ive
m aint enance of t he inst it ut ion’s chairs ( LSI AP26) .
Th e ser v ice aim s t o av oid an im al an d v eg et ab le
product s t o ent er Brazilian t errit ory. ( …) An inst it ut ion for aged
people is included in t he list of or ganizat ions benefit ed w it h
m erchandise collect ed [ apprehended] at t he inspect ion service
One of t he report ed form s was t ax collect ion
on inv oices, a pr ogr am in som e St at es, w hose m ain
p u r p ose w as t o in cr ease r ev en u e. Th e in st it u t ion s,
d e s p i t e r e c o g n i z i n g t h e b e n e f i t , s t a t e s o m e
con t r ov er sies:
I t is a good t hink but it causes som e work, we are
being supervisors for t he governm ent . We have t o t ype so m any
invoices, one by one, in t he syst em … t o receive around one or t wo
t h o u san d r eai s ev er y t h r ee m o n t h s t o su p er v i se f o r t h e
governm ent … And we also have t o account for what we do wit h
t hat m oney, we have t o send t he invoices, prove it ( D3) .
LS I A Ps s e l e c t e d t h i s s p e c i f i c o f f e r a s
com m unicat ion for t he inst it ut ion, but underst and t hat
it s r esonance w it hin t he sy st em gener at es a bur den,
w h i ch t h e y a r e su b j e ct t o d u e t o t h e e co n o m i c
con dit ion in gs.
These alt ernat ives in t he search for resources
dem onst r at e t hat LSI APs ex pect som e ot her sy st em
t o u n d e r s t a n d , p r o c e s s a n d m a k e u s e o f t h e
in f or m at ion t h ey pu t in t h e en v ir on m en t , an d t h en
provide favorable feedback t o t his resonance t hat t he
com m u n icat ion cau sed( 5 ). Adm in ist r at or s em ph asize t he fact t hat depending on donat ions is not so sim ple.
D o n o r s sh o u l d w o r k acco r d i n g t o t h e i n st i t u t i o n ’s
needs, w hich st at es t hat :
... any charit y is not enough ( A6) .
Th er ef or e, t h er e is a con cer n f or people t o
k now about w hat happens, t hat t hey t r y t o discov er
h ow t h e LSI AP w or k s an d w h at it s r eal n eeds ar e,
t h u s co l l a b o r a t i n g w i t h i t s a d e q u a t e f u n ct i o n i n
pr ov iding elder ly w it h int egr al car e. I n t his sense, in
addit ion t o being available t o offer inform at ion direct ly
at t h e in st it u t ion , LSI APs dif f u se in f or m at ion w it h in
t h e c o m m u n i t y, i n a s p e c i f i c a n d d e t a i l e d w a y,
inform ing about t heir needs t hrough fliers, inst it ut ional
w eb sit es an d j ou r n alist ic r ep or t s. Th ey also in f or m
t h e w a y s p eo p l e ca n co n t r i b u t e. Th e d i v er si t y o f
possibilit ies w as observed, in t he sense of facilit at ing
t he inv olv em ent of differ ent social gr oups:
Co n t r i b u t i o n s ca n b e m a d e m o n t h l y , q u a r t er l y ,
biannually, yearly or sporadically in t he following bank account s
( LSI AP3) .
I t w a s o b s e r v e d t h a t d o n o r s a r e n o t
p e r m a n e n t . He n ce , t h e r e i s a co n st a n t n e e d f o r
obt aining new part ners. I n addit ion, LSI AP com plexit y
and new dem ands t o respond t o societ y’s expect at ions
r equir e t he br oadening of r esour ce sour ces( 3 ). Since t he m ain m ot iv at ion for par t ner ship and cont r ibut ion
i s s o l i d a r i t y, i t s h o u l d b e p o s i t i v e l y e x p l o r e d ,
a c c o m p a n i e d b y c l a r i f i c a t i o n s a n d a n e w v i e w
r e g a r d i n g LSI APs, se e k i n g so l i d a r i t y w i t h se n i o r
c i t i z e n s . H e n c e , t h r o u g h r e p o r t s s h o w i n g t h e
i n s t i t u t i o n , t h e o r g a n i z a t i o n s g u a r a n t e e
com m unicat ion as w ell as t he r enew al of donor s. I n
f act , m an y act ion s ar e on ly p ossib le t h an k s t o t h e
s o l i d a r i t y o f t h e c o m m u n i t y, p e o p l e , g r o u p s ,
com panies and educat ion inst it ut ions.
Aw ar e t h at t h eir ow n m aint enance depends
m o st l y o n t h e i n st i t u t i o n , r esi d en t el d er l y f o l l o w ,
closely, act ions of seek ing and r eceiv ing donat ions:
They m ake donat ions, t he com m unit y com es t o visit
and brings donat ions ( E3) .
Pr of ession al t eam s sh ou ld also be in v olv ed
in t he pr ocess of obt aining r esour ces. How ev er, t he
concer n in guar ant eeing r esour ces is so lar ge t hat it
en d s u p b ei n g cr i t i ci zed ev en b y t h e i n st i t u t i o n ’ s
professionals. They underst and t hat t he priorit y given
t o ob t ain in g f u n d in g an d sav in g p u t s p lan n in g t h e
necessar y inv est m ent s for t he elder ly ’s w ellbeing in
t he second place:
I see t h at t h is in st it u t ion is t oo con cer n ed abou t
obt aining funding. Because I know it ’s im port ant , I know it ’s
im port ant for t he support ( A1) .
I see t hat elderly, t heir needs are left aside, I t hink
t hey deserve at least m ore com fort ( A1) .
I t w a s o b s e r v e d t h a t g i v i n g p r i o r i t y t o
i n v est m en t i n el d er l y ’ s w el l b ei n g d ep en d s o n t h e
m anagem ent ’s per spect iv e on elder ly needs, fr om a
geriat ric point of view( 3,12).
FI NAL CONSI DERATI ONS
I n v i ew o f t h e i m p o v er i sh m en t o f el d er l y
liv in g in n on pr of it LSI APs, pu blic or pr iv at e, it w as
ob ser v ed t h at t h er e ar e in n u m er ab le r eq u ir em en t s
for t hese inst it ut ions’ st r uct ur al connect ion w it h t he
econom ic sy st em : on t he one hand, det er m ining t he
n eed s of LSI AP in t er n al su b sy st em s, n u r sin g car e,
nut rit ion, leisure and wellbeing, am ong ot hers; on t he
ot her hand, t he needs result ing from t he part ial social
sy st em s, such as w or k legislat ion and t he St andar ds
f or Elder ly Car e Ser v ice Fu n ct ion in g. Th e econ om ic
sy st em co n d i t i o n s t h e p a y m en t p r o cesses w h i ch ,
con seq u en t ly, w h en select ed as in f or m at ion by t h e
LSI APs, det erm ine t he inst it ut ions’ involvem ent in t he
const ant sear ch for r esour ce sour ces.
El d er l y, su p p o r t ed b y t h e El d er l y St at u t e,
ex pr essed t he desir e t o r eceiv e and m anage par t of
sh ou ld be t ak en in t o con sider at ion by LSI APs w h en
m ak ing decisions about using t hese r esour ces, w hich
a l s o c o n t r i b u t e t o m a i n t a i n i n g t h e i n s t i t u t i o n s .
I m p o v e r i sh e d e l d e r l y, i n v i e w o f h o sp i t a l i za t i o n ,
b e co m e v u l n e r a b l e t o t h e sp o l i a t i o n o f t h e i r f e w
r eso u r ces.
Receiving public grant s depends on successful
com m unicat ion in t he st r uct ur al connect ions bet w een
t h e LSI AP an d t h e p o l i t i cal p ar t i al so ci al sy st em .
A m o n g t h e d o n a t i o n s f r o m t h e c o m m u n i t y,
part nerships wit h com panies are m uch welcom ed and
t h e i r e x p a n s i o n i s d e t e r m i n e d b y t h e c o n s t a n t
en co u r ag em en t o f t h e LSI AP i n t h e en v i r o n m en t .
Resour ces fr om alt er nat iv e sour ces equally r epr esent
resonances in t he surroundings, based on inform at ion
d el i v er ed b y t h e LSI AP, w h i ch sh o u l d ch an g e t h e
cu lt u r e t h at an y d on at ion is su it ab le t o ov er com e
p ov er t y.
I t is essent ial t o cont inuously out line int ernal
p r o g r am s w i t h a v i ew t o m ak i n g co m m u n i cat i o n s
u n d e r st o o d i n t h e su r r o u n d i n g s a n d r e v e r t i n t o
financial resources for t he LSI AP. However, t he effort s
t o en su r e t h ese r esu lt s sh ou ld n ot add r isk s or pu t
p r og r am s of in t eg r al car e t o eld er ly in t h e secon d
p l a c e . Th e n e e d s e v i d e n c e d b y s u b s y s t e m s
r esp on sib le f or d ir ect car e can n ot b e ig n or ed an d
d em an d n ew i n v est m en t s o r b u d g et ad j u st m en t s.
Plans r egar ding bot h t he guar ant ee of sust ainabilit y
and invest m ent in funct ion qualit y reinforce t he evident
need t o develop new m anagem ent m odels for LSI APs
t hat shelt er im poverished elderly, founded on geriat ric
p r in cip les.
REFERENCES
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