Country Diagnostic Study on Long-Term Care in Sri Lanka

• Publisher: Asian Development Bank
• Year: 2021
• ISBN:
  9789292629175
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

This publication presents findings of a study on the availability and provision of long-term care (LTC) in Sri Lanka, including the need for and supply of LTC, regulatory and policy frameworks, service provision, quality management, human resources, and financing. Analysis, conclusions, and recommendations for the development of LTC systems in Sri Lanka are also included. It contributes to the development of an in-depth knowledge base on LTC policies, programs, and systems. It is one of six country diagnostic studies—the others on Indonesia, Mongolia, Tonga, Thailand, and Viet Nam—prepared under the Asian Development Bank technical assistance 9111: Strengthening Developing Member Countries' Capacity in Elderly Care.

IV. SERVICE PROVISION FOR LONG-TERM CARE

A. Types of Organizations

Day care and community care. NSE- and NGO-operated day-care centers are places where older persons can engage in productive and social daytime activities with their peers. Day-care centers provide opportunities to socialize, exercise, and participate in religious and recreational activities as well as important community-based social care to those requiring LTC. The NSE supports 662 day-care centers around the country.³⁸ The NSE also provides each center with financial assistance (up to SLRs25,000) for the purchase of equipment and materials. HelpAge Sri Lanka and other NGOs have also supported day-care centers. Potentially, day-care centers can provide care and support to elders and their family caregivers, although currently they generally aim to provide elders who do not need ADL/IADL support a place to socialize and remain active. This helps improve well-being and prevents the decline of functional ability.

There may be other day-care centers and Elders’ Clubs operated by small NGOs and village-level committees, but the time and scope of this CDS did not allow for the compilation of a comprehensive list. In other countries, adult day-care centers are part of core service provisions. They provide care support, facilitate social participation and activities, and allow family caregivers to engage in paid employment or have some respite from caregiving.

An example of community-based care is the home care volunteers program conducted by HelpAge Sri Lanka. “Young-old” people (defined as elders between 60 and 70 years old) identified by the Elders’ Committees are encouraged to visit and monitor other elders who live in their area. Volunteers participate in a 5-day residential training program on basic first aid, hygiene, and health care, where they learn to (i) identify vulnerable elders and mental illnesses, and (ii) advocate the rights of the elders. They visit homes and gather information on the living arrangements of the elders. They are linked with the Office of the Medical Officer of Health, to which they can provide information about elders in need of care. They also liaise with HelpAge Sri Lanka if an older person requires an assistive device. The full cost for this program is borne by HelpAge Sri Lanka. It has been operating since the 1990s and trains about 200 volunteers every year. Currently, approximately 2,000 volunteers provide these services in the community.

Additionally, different NGOs and government institutions conduct small-scale training programs for caregivers. HelpAge Sri Lanka also trains in-home care assistants in a program for paid caregivers.

Another example of community-based care is HelpAge Sri Lanka’s meals on wheels program in Ratmalana. Former members of the HelpAge Ratmalana Day Care Centre who are no longer mobile or able to independently attend to their own needs receive daily meals prepared and delivered by someone from the day-care center.

The Protection of the Rights of Elders (Amendment) Act, No. 5 of 2011 required the establishment of Elders’ Committees at the level of the Grama Niladhari Divisions, the smallest administrative division in Sri Lanka, as well as at divisional, district, and provincial levels. Currently, two-thirds of divisions (no.=9,269), 64% of divisions (no.=214), 17 of 25 districts, and 4 of 9 provinces have an Elders’ Committee (Ministry of Social Empowerment Welfare and Kandyan Heritage 2017). Elders’ Committees aim to empower and advocate the rights and welfare of older persons in the relevant area. The National Council for Elders (NCE) establishes and provides financial assistance (SLRs5,000) to each Elders’ Committee. Some Grama Niladhari Divisions have more than one community. Some community-level Elders’ Clubs have been established with support from NGOs. They have many benefits (e.g., improving social participation, health promotion, and income-generating activities).³⁹ Currently, their role and responsibilities in relation to LTC are not defined, but they potentially could help coordinate care and support for elders who need help from younger, more fit elder volunteers, or as an income-generating activity. For example, they might deliver a midday meal to elders who cannot cook for themselves, provide company, assist with physical exercises, or offer foot care for diabetics.

Care provided by nursing care services and in-home care assistant services. The types of services provided by private nursing care and in-home care assistants vary, ranging from simply preparing meals to 24-hour nursing care. An in-home nursing care service provides a trained nurse to care for an elder, while in-home care assistant services provide untrained caregivers. Duties vary according to caregiver qualifications and the fees paid to the service provider. From the 2017 CDS survey of eldercare provider institutions, it is estimated that there are about 25 home nursing care service providers, although the exact number is not known due to gaps in the implementation and monitoring of the formal registration system of such providers and regulation of the industry. These home nursing care services provide 24-hour nursing care to about 900 older clients. The services are usually expensive and not affordable for lower-income families.

Care provided by eldercare homes. Sri Lanka has two main types of residential facilities: those primarily designed to provide housing for older people who lack shelter, and those that aim to provide LTC support and nursing care. In the Sri Lankan context, most facilities fall into the first category and are known as “elders’ homes” or “eldercare homes.” Even if the primary aim is to provide shelter, some residents have or develop needs for LTC support over time. Sri Lanka currently has around 255 eldercare homes serving approximately 7,100 elder residents, two owned by the central government and three by provincial councils (Table 12). The private sector operates around 20 homes; others are not-for-profit and funded by private donations and some government funding. Not-for-profit eldercare homes are usually operated by faith-based organizations and NGOs. Homes for elders registered under the Department of Social Services increased from 68 in 1987 to 162 in 2003.⁴⁰

Table 12: Estimated Number of Eldercare Homes and Residents by Type, 2017

ADL = activities of daily living.

Source: Institute for Health Policy. 2017. Survey of Elder Care Provider Institutions. Colombo.

Five public eldercare homes house 7% of all elder residents, and 220 private (i.e., not for-profit) eldercare homes house 85% of all elder residents. Out of 7,100 elders living in eldercare homes, 14% need assistance with ADL.

Although only 0.2% of older persons’ population lives in an eldercare home, 0.6% of male elders and 0.7% of female elders aged 80 years or older live in such facilities (Figure 6). Most people who live in eldercare homes are over 70 years of age (Figure 6). According to CDS survey estimates, over 50% of elders in eldercare homes live in the Western Province, where 28% of the population of the country resides.

Figure 6: Residents of Eldercare Homes by Age and Sex, 2017 (%)

Source: Institute for Health Policy. 2017. Survey of Elder Care Provider Institutions. Colombo.

Only 18% of the homes that responded to the CDS survey accepted elders who need 24-hour nursing care, and 30% accepted elders who need assistance with ADL. Most eldercare homes lack the necessary staff or financial resources to care for elders who need 24-hour nursing care and assistance with ADL. In practice, most residential eldercare homes that provide such assistance do so because they continue to accommodate elders who once were physically able but now need assistance. Most eldercare homes take residents to the nearest government hospital for medical and nursing care.

A few private eldercare homes offer respite care, but there is little information about how this service is used. Figure A4.2 in Appendix 4 presents further information.

Comprehensive data on the health and social profiles of elders who receive services from in-home nursing care services and eldercare homes are not available, but the understanding is that most residents at public and not-for-profit eldercare homes have no family support. In the Sri Lankan context, the primary purpose of eldercare homes is to provide residence to elders who have shelter or family support. No systematic and representative study describes the health and social profiles of elders who receive LTC. However, useful qualitative studies have been conducted.⁴¹

1. Coordinated and Integrated Care

Delivering person-centered, integrated care requires a coordinated and comprehensive LTC system. Integrated care entails promoting communication and sharing information between service providers, smoothing the path from acute care to transitional care to LTC, and building holistic care services based around the entirety of a person’s needs. Integrated care requires (i) participatory care assessment and planning, (ii) named care coordinators, (iii) multidisciplinary teams to develop and implement care plans, (iv) investment in information technology and payment systems that favor care coordination, and (v) patient follow-up. Although Sri Lanka currently lacks this degree of coordination, the National Health Strategic Plan 2016–2025 details the MOH’s plan to improve vertical integration within the health system and strengthen the primary care in response to population aging and the related epidemiological shift.⁴² A Shared Care Cluster model for primary health care, which could link with LTC efforts, is curren...