Case Study

Formalizing integrated care systems for older adults: Uruguay’s National Integrated Care System

Aging In Place
Long-Term Care

Uruguay’s National Integrated Care System provides a range of services to older adults, including personal assistance, day care, telemedicine and financing for improving the built environment. The program was established in 2015 and has been expanding since then.

The focus: Uruguay wants to ensure access to quality care that promotes autonomy and inclusion for the estimated 64,000 from among its 490,000 adults ages 65 and over (as of 2020) who need assistance with their care. A proportion of these needs remain unmet, as do the care needs of the subset of those older adults who require assistance and also have disabilities.

How it works: The system offers personal assistance (care workers), day care services and medical alert monitoring for older adults who would have difficulty accessing these services otherwise. The system also incorporates government accreditation for long-term care centers, which can then access financing for projects to improve their services, such as built-environment upgrades or equipment. As of 2020, the personal assistant program had been extended to those aged 80 and over, and the program incorporates training, assistance and quality assurance for caregivers.

Enabling environment: Civil society actors and academics initiated a long-term conversation—in large part about the role of women as caregivers in Uruguayan society—that led to substantive government action, guaranteeing by law the right to care and be cared for. Starting in 2010, a group of national and international stakeholders joined the planning process to collaborate on a policy agenda around care, enshrined in law in 2015, when implementation began. The system also obtained periodic input from an Advisory Committee on Care, comprising civil society groups such as the Pro Care Network, academic institutions and business groups like the Uruguayan Chamber of Companion Service Companies.

Impact: The Inter-American Development Bank reports that “the creation of the SNIC has served to revitalize the private provision of [long-term support] services and revalue work in care” in Uruguay, and the International Labour Organization has referred to the system as providing a “model for care work in the future”. The system expanded its reach between 2015 and 2020, with older adults benefiting from each of the constituent programs. As of December 2019, there were nearly 4,700 personal assistants serving roughly 6,100 (mostly older adult) users, from over 20,000 applicants. The day care centers (11 as of October 2020) were serving around 200 older adults by March 2020, from roughly 600 applicants, and the telecare program was supporting about 1,500 individuals from around 3,500 applicants. By March 2020, 343 long-term care centers had received accreditation.

Sources Include

Sources include:

S. d. Cuidados. Cuidados rinde cuentas - Marzo 2020. Ministerio de Desarrollo Social, 2020. Available from: https://www.gub.uy/sistema-cuidados/datos-y-estadisticas/estadisticas/cuidados-rinde-cuentas-marzo-2020.

S.d. Cuidados. Informe de la Secretaría Nacional de Cuidados. Available from: https://www.gub.uy/ministerio-desarrollo-social/sites/ministerio-desarrollo-social/files/documentos/publicaciones/Anexo%20Sistema%20de%20Cuidados.pdf.

Normativa y Avisos Legales de Uruguay. CREACION DEL SISTEMA NACIONAL INTEGRADO DE CUIDADOS (SNIC). 2015. Available from: https://www.impo.com.uy/bases/leyes/19353-2015.

IDB. PANORAMA OF AGING AND LONG-TERM CARE 2019. Available from: https://publications.iadb.org/publications/english/document/Panorama_of_Aging_and_Long-term_Care_Summary_Uruguay.pdf.

How a new law in Uruguay boosted care services while breaking gender stereotypes. International Labour Organisation, 2018. Available from: https://www.ilo.org/global/about-the-ilo/mission-and-objectives/features/WCMS_643905/lang--en/index.htm