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CONCEPT PAPER ON THE RISING NEED FOR LONG TERM CARE SUPPORT FOR THE

TRADITIONAL FILIPINO CAREGIVER


Chen, T., Jimenez, K, Jimeno, J, Padua, A., Tesorio, C.

EXECUTIVE SUMMARY

The Philippines is considered a slowly aging country, with only 5.5 % belonging to the
people aged 65 and above. However, recent studies have shown that by 2032, the country has transitioned into
an ageing country. How the economy and the Filipino Family (who mostly takes care of the aged population),
welcome the shift is still unexplored. Existing policies and regulations in the country have focused on the
support for the frail elderly, but recent studies suggest that accessibility is still limited, and for that, dependency
on the Filipino Family increases. The need for Long-Term Care Support (LTCS) extends programs and
regulations from the Senior Citizen (recipient of care) to the Traditional Unpaid Filipino Caregiver
(workforce). An efficient LTCS could broaden global policy instruments, including the United Nations’
Sustainable Development Goals which contribute to sustainable development through poverty alleviation
(Goal 1); universal health coverage (Goal 3); gender and age equality (Goals 5 and 10); and promoting
economic growth and employment (Goal 8). (8) A brief review of several long-term care programs in China,
Japan, Canada, Europe, Sub Saharan Africa, and US are described in this paper. Focus on the current policies
and laws in the Philippines are discussed as well. In conclusion, it is best to view LTCS not just in the elderly
perspective, caregiver standpoint, (unpaid ones) should also be sought. Recommendations on how to improve
the current senior citizen situation include raising the monthly allowance from 500 pesos a month to 2, 000
pesos a month, with enhancement of target population, making the program more accessible to the poor, frail
senior citizen. Traditional caregiver support can be established by looking into key pointers in an efficient
LTCS by the Sub Saharan Africa Region: family involvement, access equity, caregiver training for the
informal caregivers, and integration with health care services, and sustainability could serve as guide in
developing a more specific framework for LTCS. A long way ahead, but with the right key persons and movers
at the national level, a system can be established. Most significantly, acknowledgment of the problem, which
is the need for long-term care support for the traditional Filipino caregiver, must be prioritized. Case studies
can be conducted. Further studies and results can be presented to wide range of key stake holders, both public
and private, to entice a network that could work for and by the system. While informal caregiver support can
help assist the traditional Filipino caregiver in taking care of the senior citizen. Allowances, paid leaves,
adjustment of work schedule can help alleviate the burden of the Filipino family. This paper aims to pay
gratitude to our senior citizens who have once worked hard, stood by, fought life for families, for loved ones,
and for the nation. After all, each and everyone of the population inevitably, will soon age.

INTRODUCTION

Global population is ageing rapidly and the demographic transition is placing new demands on societies

to provide comprehensive systems for long-term care at home, in communities or in institutions. Based on the

United Nations World Population Prospect Report for 2019, by 2050, one in six people in the world will be

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over age 65 (16%), up from on in 11 in 2019. By 2050, one in four persons living in Europe and Northern

America could be aged 65 or over. The Philippine population is 108,116,615 as of 2019 with 5.5 percent

belonging to the people aged 65 and above. (1) Life Expectancy at birth in the Philippines in 2015-2020 is

71.0 years which is 1.3 years lower than the world average of 72.3 years and is the 7th highest among Southeast

Asian countries. (2). The size and age composition of a population are determined jointly by three

demographic processes: fertility, mortality and migration. While declining fertility and increasing longevity

are the key drivers of population aging globally, international migration has also contributed to changing

population age structures in some countries and regions. (3) The Philippines’ fertility rate is expected to

decrease from 2.82 to 2.76 in 2020 to 2050. (2)

A December 2018 PIDS study showed United Nations data from 2017 to project that the

Philippines is becoming an "ageing society." By 2032, the elderly, or those aged 65 and older, would comprise

at least 7% of the total population (WHO definition of an Aging society), the percentage of the population 65

years and above reaches 7 percent of the total. By 2069, the study said, the Philippines would have become an

"aged society," with at least 14% of the population aged 65 or older.

A large and significant proportion of the population will require long-term care which can

be provided in a range of settings, including the community. Meanwhile in the Philippines, families provide

for most long-term care without any organized training or support. This type of dependence on families alone

results in inconsistent care quality and places a particularly heavy burden on women and girls. Quality of life

for both the elderly and the caregiver both suffer. It can become unsustainable given the rapidly increasing

number of older people. During the Sixty-Ninth World Health Assembly in May 2016, the WHO Global

Strategy called for every country to develop a system of long-term care. Each country will vary, therefore the

context of each will all be different, however, shall be based on general principles. The available resources

and societal choices with consideration on the distribution of the overall would total the costs of care.

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According to the Department of Social Welfare and Development (DSWD), a nearly a third (31.4%) of older

people were living in poverty in 2000. Currently, estimated to be 1.3 million older people. The Philippines,

like many developing countries, does not have sufficient government-funded institutional support for its

elderly population. The Filipino elderly have historically been dependent on their children or co-resident kin

for economic, social and physical support. In a traditional Filipino family, grandparents are commonly seen

living with their children. It is believed that traditional familial care and support for the elderly is still widely

practiced. (5)

Healthcare assistance to Filipino elderly is mainly family-based and family oriented which

is currently under threat. Globalization and international migration impact on traditional caregiving. (6)

Families struggle to retain their status as traditional caregivers. Even then the family as the country’s

traditional social security mechanism for the old maybe falling short of its duties and responsibilities to the

elderly. (7) With the demands of time for work, most families tend to forget about the ageing population. The

need for the caregiver’s time, attention, and financial support should be able to support the frail bodies of the

elderly. Specific needs most especially to the ones with chronic illnesses would require medication and more

so, physical assistance. As Filipinos, the tradition of caring for the elderly is a way to give back all the support

that the parents or grandparents have provided for the children all when they were younger, as well. The

advocacy of the Filipino family is such that in the process of caregiving, the burden of having to resign from

work, or having to sacrifice one sibling to take care himself, oversees the need of the caregiver to also look

after oneself. Questions arise: will the tradition be worth it? Where will the financial support come from, will

it be from the other family members who are mostly abroad? What if the caregiver also has his own family to

support? Who shall shoulder the financial assistance for the aged family member? In the coming years, a

decade from now, the Philippines will become an aged population. Caring for the informal caregiver who takes

care of the aged family member will have a significant effect on the quality of life on the aging population of

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the country. Preparation should be undertaken as early as possible. Planning ahead may help identify problems

which will become foreseeable, and therefore, recommendations and solutions may become readily available.

PROBLEM DESCRIPTION

Long term care is not an easy task. It is considered an obligation that one must learn to master

and cope up with. The burden stems from several factors such that socioeconomic, behavioral, sociopolitical,

environmental and biological all interplay with each other. In all of these categories, two sides of the coin are

taken into consideration. The side of the caregiver and the elderly standpoint. On caring for the elderly, both

sides of the coin are taken into account to, nature of work, economic status, health insurance coverage,

educational status, and the number of household members. Behavioral factors, which include kinship of the

caregiver to the elderly, decision making capacity of the elderly, religious and traditional beliefs of both elderly

and caregiver, are all significant in affecting the outcome of providing long term care. Current supporting laws

and policies have sprung in some countries yet only a small percentage have taken action. Where the long-

term care takes place also matters to the type of health service accessibility. It could be urban or rural, or

whether community based aged care residences are available, or, and if there are government nursing home

care available, (all under the environmental factor). Lastly and most importantly, the gender, age, and health

status of the caregiver and elderly stresses the fact that burden is heavier for those older women taking care of

the elder. All of the things mentioned affects the type of long-term care that can be provided and the quality

of life one endures for both the caregiver and the elderly. (Annex 1)

Long-term care is a broad topic. This concept paper focuses on three major points: on the

need for a system, the informal caregiver, where certain problem areas may be targeted, and the elderly,

who is the recipient of the care. The burden of the informal caregiver is oftentimes neglected, when there is

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no other support. And the existing policies and laws involving the support for the elderlies are still yet to be

experienced by the Philippine aged population.

POLICY OPTIONS

WHO’s Global strategy and action plan on ageing and health called upon all countries to

develop a system of long-term care. Governments need to take into account the number of older people and

the need for long-term care, existing models of service delivery, the availability and skills of unpaid caregivers.

Despite the diversity, WHO has general principles of which identified were the ones that apply in all contexts.

Long-term care must be affordable, accessible, must uphold the human rights of care-dependent older people.

When possible, long-term care should enhance and maintain older people’s intrinsic capacity, as well as help

them to compensate for losses of capacity, person-centered and oriented around the needs of the older person,

rather than the service structure. The long-term care workforce, both paid and unpaid, should be treated fairly

and receive the social status and recognition it deserves. The principles mentioned are consistent with a number

of broader global policy instruments, including the United Nations’ Sustainable Development Goals.

Establishing systems of long-term care would contribute to sustainable development through poverty

alleviation (Goal 1); universal health coverage (Goal 3); gender and age equality (Goals 5 and 10); and

promoting economic growth and employment (Goal 8). (8)

China

China has the fastest-ageing population in human history. In recent years, China has continuously

improved the social security system for the elderly and practically improved their income and security level.

A study from Health Qual Life Outcomes. 2016; 14:99 talks about family caregivers with chronic diseases

spending about a minimum of one hour of daily care for at least three months for care recipients. A spouse,

child, relative, neighbor, or friend can be a caregiver. For these reasons, China has all the basic old-age

insurance system fully covered. At present, it has established a social assistance system covering all the

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population, and the coverage of endowment insurance is constantly expanding. Social assistance system for

the elderly has been dominated by the minimum living guarantee system, which guarantees the quality of life

of low-income elderly families. Social welfare policies for the elderly has actively encouraged local

governments to establish systems such as old age allowance, old-age service subsidies and old-age care

subsidies, so as to improve the purchasing power and living standards of the elderly. The elderly care service

system with Chinese characteristics has gradually taken shape and is currently being established with a multi-

level aged care service system based on home care, supported by communities, supplemented by institutions

and combined with medical care. However, there is no data on long-term care support for the caregiver in

China.

JAPAN

Japan has the highest proportion of people more than 65 years of age in the world. Policy makers

traditionally expect the country’s younger generation to respectfully care for the aging parents in multi-

generational households. However, such public long-term care programs were mostly restricted to low-income

elders without family support. At the approach of the 21st century, Japan’s family-centered approach

foundered, due to demographic and economic changes. Women, who are daughters and daughters-in-law-the

primary caregivers-grew overwhelmed by the task, especially with the trend toward fewer children and more

women joining the workforce. The universal elder program in Japan is now funded half by general tax revenues

and half by a combination of payroll taxes and additional insurance premiums paid by everyone aged 40 and

above. The family remains the key source of caregiving, with the system supporting the adult children with

subsidized services whose fees and co-pays are relatively moderate. Support is given with adult day care, home

help, respite care and visiting nurses. The emphasis of long-term care is now put on home and community-

based services. Major Japanese employees are also starting to help families manage caregiving duties and ease

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their burden. The clothes retailer Uniqlo has begun experimenting with a four-day, 10-hours-per-day

workweek in Japan, for instance.

CANADA

Informal Caregivers in Canada are well defined. The demographics include 8 million informal

caregivers in Canada, representing 25% of all Canadians. 2 million informal caregivers provide heavy care

(20+ hours/week). 6 million of these provide care to a senior (75% of all informal caregivers). 70% of all care

to seniors in the community are provided by informal caregivers. Majority of the caregivers is female (54%)

and aged 45-64 (44%) which seems to be of concern because they tend to outlive their spouses and suffer

higher rates of work drop-out and poverty later in life. The intensity of caregiving is identified into 2

categories, Light or Heavy. Light being defined as 3 hours per week, supporting the care recipient’s

independence by assisting with daily activities such as running errands, providing transportation, cooking

meals, and grocery shopping. Heavy/intense as an average 20 hours or more per week, more functional support

in addition to the care provided in less intensive care, such as assisting with clothing, bathing, toileting,

medications/injections, and feeding. Currently, existing Federal Programs start with the Family Caregiver Tax

Credit, a non-refundable tax credit providing a maximum of $300/year for caregivers caring for the confirmed

dependent relatives, spouses, common-law partners and minor children (applies only to caregivers with taxable

income). Ontario’s Family Caregiver Leave Bill provides up to six weeks at a maximum of $514 per week.

Basic benefit rate of 55% of average insurable earnings, up to a yearly maximum insurable amount ($48,600

in 2014) are received by the caregiver as well. Canada has given a set of criteria for a qualified informal

caregiver such as: those who have experienced more than 40% decrease in their regular weekly earnings from

work, those who have worked at least 600 insured hours of work in the last 53 weeks or since the start of the

last claim. Those who have provided care or support to a family member who is gravely ill and who has a

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significant risk of death within 26 weeks (six months). CARP Caregiver Recommendations provides for

financial Support, by having a current tax credit increased and made refundable. Financial supports are also

made available for all caregivers who provide heavy care and not limited to certain type of care, such as the

Compassionate Care benefit’s “terminal illness” requirement.

Canada’s Long-term care insurance provides caregivers with cash and/or in-kind benefits. Workplace

protection is being given to enable caregiver to balance caregiving and work responsibilities. Ontario’s Family

Caregiver Leave Bill provides 8 week of job-protected leave for employees providing care for a family member

with a serious medical condition (not limited to the elderly). Federal regulations are even required to subject

to job protection coverage while the proactive caregiver is on leave respite care options for heavy care

providers which allows usage of insurance benefits, cash and/or in-kind service, up to 4 weeks of vacation

reducing high risk of physical, mental and emotional health deterioration of the caregiver. The funding for

home care is increased and an integrated training and support for caregivers with formal health care system

are instituted. Formal training and support are provided for informal caregivers via different healthcare hubs.

North America-USA

About 34.2 million Americans provided unpaid care to an adult aged 50 or older with the majority (82 percent)

care for one other adult, while 15 percent care for 2 adults and 3 percent for 3 or more adults (National Alliance for

Caregiving and AARP, 2015). Almost half (15.7 million) care for someone who has Alzheimer’s disease or other form of

dementia. (Alzheimer’s Association, 2015). A growing trend of the value of services provided by informal caregivers

was observed over the last decade with an estimated economic value of $470 billion in 2013, up from $450 billion in

2009 and $375 billion in 2007. (AARP Public Policy Institute, 2015). In 2013, the observed value of unpaid caregiving

exceeded the value paid home care and total appropriated Medicard spending in the same year and nearly matched

the value of the sales of the world’s largest retail company, Wal-Mart. (AARP Public Policy Institute, 2015) Further, the

value of unpaid caregivers for those with Alzheimer’s disease or other dementia was $217.7 billion in 2014, which

raised the question if the caregivers are equipped with appropriate tools and skills to deal with people suffering from

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said diseases. Government efforts to support informal caregivers was strengthened by the fear of flooding public

nursing homes which averages about 86 percent occupancy rate. Government appropriations, which provided public

facilities, are limited and rebalancing of long-term care away from institutions and toward home and community-based

services was a policy shared by different public officials. Federal programs notably in California, New Jersey and

Pennsylvania, have well-established family caregiver support but lacks funding. Four main areas needs urgent attention

of policymakers especially during discussions of health care reform. The first is, information, comprehensive data

regarding family caregivers must be surveyed nationally and disseminated to different commercial avenues. Direct

surveys of family that captures different caregivers’ experience and interactions with the current healthcare system

must be included in the data collection process. New surveys and report cards dealing with chronic care issues should

directly engage family caregivers and not just the patients. Secondly, training for informal caregivers are needed to

develop the proper continuum of care with a defined core competency for built into professional and primary

education. Program development that ensures the attention to family caregivers’ needs is explicitly included in

proposals for transitional care and medical home programs, with appropriate funding and staff training. Lastly,

financing with the focus on various approaches to pay-for-performance should be incorporated in well-defined

protocols.

EUROPE

Informal care, also known as unpaid care or family care, constitutes a significant share of the total

long-term care (LTC) provision in European countries. Estimates suggest that as much as 80% of all long-

term care in Europe is provided by informal caregivers. The available estimates of the number of informal

caregivers range from 10% up to 25% of the total population in Europe. Informal caregivers are often women,

either providing care to a spouse, parents or parents-in-law, and a large share retirement age (9). In general,

the least caregivers are found in the 18-34 age category. Informal care forms a cornerstone of all LTC systems

in Europe. It has also been gaining increasing recognition in international policy circles as a key issue for

future welfare policy. LTC policy is increasingly recognizing informal caregivers and provide services

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benefiting informal caregivers. Defining what a service is for informal caregivers is complex, as caregivers

are often not the direct recipients of services. Services which support caregivers are often channeled via the

user and their needs. Cash for care schemes, as discussed. Cash allowances which can be used to pay informal

caregivers can either be given directly to the family caregiver (indirect support for informal care). The latter,

indirect financial support, is the most common approach in Europe, and in the countries such as Czech

Republic, Germany and France (10). Policies which recognize and to some extent “formalize” the role of

informal caregivers can be done either through payments (cash allowances, cash for care policies), social

security (pension and health insurance), legislation (recognition of status and rights to being assessed as an

informal caregiver), statutory employment related rights and training/certification of skills schemes. Given

that formalized informal care is mainly publicly funded, it is an argument that the governments’ responsibility

for quality of the care provided should be further explored. Respect for the private realm needs to be

maintained, while seeking innovation in new approaches to understanding and ensuring the quality of the care

provided by informal caregivers.

SUBSAHARAN AFRICA

Families are the main caregivers in the Sub Saharan Region in Africa, while some have unregulated

domestic workers caring for the elderly. Quality of care has been questioned due to the lack of organized

systems. Hence, there was an implication for building a long-term care system. New approaches to organized

care were established. Efforts were made by the nongovernmental sector, community based and private

sectors. Case studies were done and key elements were identified such as family involvement, person centered

care, caregiver training, integration with the health care service, access equity, workforce conditions and

sustainability. The Care for Aged Foundation was born in 2006 to address the needs of the frail older people

without the traditional family support. Individualized care plans with an initial assessment were developed

with the elderly. The unpaid young ones, living in the same community pay home care visits to fulfill the plan,

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but they benefit from free health care at partner facilities. Assistance with activities of daily living such as

bathing, grooming, cooking, light housework, shopping, accompanying the elderly to hospital appointments

and providing companionship are all part of the long-term care program. Other programs in the region, include

private nursing, Rand Aid (stock sharing nursing home), and in Mauritius, the government acknowledges the

family caregivers do require support, a monthly allowance is allocated to the caregivers of older people

experiencing significant declines in capacity.

PHILIPPINES

Filipinos, like many other Asian cultures, value caring for older family members later in life. Filipinos

are predominantly Catholic, and family members are expected to contribute to the family through various

means (12). In contrast to the more maternalistic role of caregiving seen in many cultures, multiple Filipino

family members are often vested in the caregiving process and serve various roles. For example, older Filipino

male caregivers may ask their adult children to assist with the more physically demanding caregiving tasks,

while they themselves take on more of the household tasks (13). Families would opt to provide care themselves

rather than resort to any health or social services for assistance in providing care. Filipino caregivers who do

not utilize external services fear that society will deem them unable to adequately care for a family member if

they utilize support services (13). Families believe that the care provided by relatives is sufficient for the needs

of the care recipient. The social support that Filipino caregivers have in the community and at home can

moderate the negative impact of care recipient problematic behavior on caregiver strain (14). Therefore, the

Filipino caregiver’s social support may act as a protective factor and make them less likely to seek or utilize

support services. Christian Filipinos’ core-belief system in religion, rooted mainly in Catholicism, also

reinforces the concept that caregiving is expected of family members (13). Catholicism instills a “self-

sacrificing” ideation of caregiving (13) where the family caregiver selflessly sets aside his or her personal life

to provide quality care to a family member. Many Filipinos also use religion as a means to provide coping for

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the daily stresses and strain of life (14). Religion is an integral component of many Filipinos’ cultural identity,

and it bolsters societal views of family caregiving. Filipino caregivers also report positive aspects of caregiving

and are able to manage the challenges of caregiving and integrate the new role in their lives (15). Some of the

positive benefits reported were personal growth and finding meaning by overcoming obstacles (15). The

beneficial aspects that Filipino caregivers discover through caregiving may be attributed to how they center it

around a value system (13) where they derive personal fulfillment from caring for a loved one. (Adrian N.S.

Badana, 2018, Vol. 58, No.2 ). Majority of policy focus for elderly in the Philippines is focused on social

welfare and the high poverty rate is attributed to low worker education, lack of skilled work, rural living, and

high dependency on the working age population (Bayudan-Dacuycuy & Lim, 2013). As a large percentage of

young adults and children depend on the working age group, few Filipinos are able to save for retirement.

(Duaqui, 2013).

EXISTING POLICIES AND LAWS

The Philippine government caters to the elderly needs through several legislations and social protection

programs.

SENIOR CITIZEN DISCOUNT AND TAX INCENTIVES

Republic Act No. 9994, known as “Expanded Seniors Citizen Act of 2010″, an act granting additional

benefits and privileges to senior citizens, further amending Republic Act No. 7432 and otherwise known as

“an act to maximize the contribution of senior citizens to nation building, grant benefits and special privileges

and for other purposes”. (17) TABLE 3

CONTRIBUTORY PENSION- GSIS AND SSS

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The GSIS, which is a social insurance program provides for all the employees of the public sector. RA

8291 states that GSIS was established to promote the efficiency and welfare of employees of the Philippine

government under a defined benefit scheme by insuring its members against occurrences of certain

contingencies in exchange for their monthly premium contributions. Membership is compulsory for all

government employees, except Armed Forces of the Philippines and Philippine National Police, contractual

workers with no employee-employer relationship with their government agencies, and members of the

judiciary and constitutional commissions who are covered by other retirement laws. Current rate of monthly

contribution payable by the member and government agency is at 9% and 12% respectively, of the actual

monthly salary of the member.(17) (Annex 4)

The SSS, takes care of the workers in the private sector, RA 8282, SSS was established to develop and

promote a sound and viable tax except social security system that provides protection of its members and their

beneficiaries in times of death, old age, sickness, maternity, ad other contingencies resulting in loss of income

or financial burden. 2 types of coverages are available- compulsory, which applies to employers, private sector

employees and voluntary, which applies to the overseas Filipino workers, non-working spouses of employed

and actively paying SSS members, and members separated from employment. Both GSIS and SSS benefits

for senior citizens are focused on the retirement packages which are the monthly pensions paid not less than

sixty months. .(17) (Annex 5)

Non-Contributory Pension (Social Pension for Indigent Senior Citizens SPISC)

Institutionalized through RA 9994 or the Expanded Senior Citizens Act of 2010 to provide for

additional government assistance by the monthly stipend for the indigent senior citizen. Since 2011 to 2014,

the frail, sickly, disabled with no regular income or support from family and relatives, with no GSIS, SSS,

Armed Forces and Police Mutual Benefits, private insurance, seniors aged 77 above were the only

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beneficiaries. In 2015, seniors from 65 years above were eligible. The program aimed to augment the senior

citizens’ capacity to meet the daily expenses and medical needs. A monthly stipend of 500 pesos are given. In

2018, after the TRAIN Law, under the Unconditional Cash Transfer Program of the Environment, an

additional 200 pesos allowance was added. This shall also increase to 300 pesos in 2019 and 2020 (DSWD,

2018). A legislation is pending regarding the increase to 1,000 pesos Senate Bill 1865 by Senator Angara. The

beneficiaries of the program are identified through the Barangay Senior Citizens Association and consolidated

by the Office of Senior Citizen Affairs or City/Municipal Social Welfare Development Office. If not included

in the list, referral to the OSCA or DSWD Field Office for assessment is done. Payouts are conducted every

six months at 500 pesos per month, making the 3,000 per semester. Three modes to receive the stipend: direct

provision through a special disbursing officer in the DSWD FO, door to door delivery scheme through a service

provider accredited by the Bangko Sentral ng Pilipinas, and lastly, through the pension to cash cards authorized

by the Authorized Government Depository Bank.(17) Currently, the SPISC have an allocated 23.18 B

allocation for 2019 for the 3.8 million senior citizens. (18) (Annex 6)

Philhealth

The National Health Insurance Program (NHIP) or PhilHealth is a government corporation attached to

the Department of Health (DOH) that aims to provide health insurance coverage and ensure affordable,

acceptable, available, and accessible health care services for all citizens of the Philippines. Philhealth coverage

includes members in the formal economy, members in the informal economy, overseas Filipinos, lifetime

members, sponsored members, indigent members, and senior citizens. Premium contributions of the ones

enrolled in the Senior Citizen category are sourced from the proceeds of the Sin Tax Law. However, if

currently employed or those who have remained in employment, premium contributions are paid to Philhealth

under the applicable membership category. .(19) (Annex 7)

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Other programs include:

Republic Act No. 7876 entitled “An Act Establishing a Senior Citizens Center in all Cities and

Municipalities of the Philippines, and Appropriating Funds Therefore” provides for the establishment of

Senior Citizens Centers to cater to older persons’ socialization and interaction needs as well as to serve as a

venue for the conduct of other meaningful activities.

The Philippine Plan of Action for Senior Citizens (2011-2016) aims to ensure giving priority to

community-based approaches which are gender-responsive, with effective leadership and meaningful

participation of senior citizens in decision-making processes, both in the context of family and community.

This plan of action aims to ensure active aging for senior citizens where preventive and promotive aspects of

health are emphasized in communities and where health services are accessible, affordable and available at all

times.

Department of Social Welfare Development (DSWD) has issued Administrative Order No. 4 series of

2010, “Guidelines on the Home Care Support Services for Senior Citizens”, establishing community-based

health care services for older persons.

In 2017, Administrative Order 2017 0001 was issued by the Department of Health to provide standards

of care for the elderly in all healthcare settings. The provisions in the policy guidelines, specifically outlined

all requirements for a nursing home to fulfill.

Republic Act No. 11350 was passed on July 2018, which is an act creating the National

Commission of Senior Citizens, providing for its functions, abolishing the National Coordinating council

and monitoring board, amending for the purpose of Republic Act No. 7432, as amended, and

appropriating funds.

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GAPS IN THE POLICIES AND PROGRAMS

Existing policies and republic acts, grant additional benefits and privileges to senior citizens, with

almost all state provisions of comprehensive healthcare and rehabilitative services to the disabled elderly. But

as prices of medicines, hospitalizations, daily expenses increase, funds for the elderly Filipinos coming from

the present policies are insufficient, with most of the elder Filipinos chronically ill. The lack of institutional

care in the Philippines means that the elders are often cared for my family members at home (16). The informal

caregiver network is a potential gamechanger that it is becoming a vital subject on the ageing matter. Although

caregiving is expected of the Filipino families, the lower socioeconomic status continues to be financially

strained in providing adequate care to the elder Filipino. The Caregivers Welfare Act exist; however, the

demands of Filipino informal caregivers are not met specifically on issues such as having paid family leaves,

or even an allowance for those caring for the elderly to pay for personal needs. The caregiver burden and strain

issue can make use of a more supportive environment.

With the focus on the Philippine current situation, much of the policies and programs do provide

income support (retirement packages, SSS and GSIS pensions, social pension, discount privileges, and

incentives in tax) and health care support (solely by Philhealth) to the senior citizens, the accessibility to the

programs still needs to be addressed. According to a household survey of the PSA in 2017, Philhealth allows

coverage of only 51.4% of the total elderly population as members and dependents, even if it was already

mandated in the Universal Health care Act. Meanwhile, for the SSS or GSIS, coverage is at 27.7% in 2017,

social pension beneficiaries cover 21.5% of the total population aged 60 years and above. Only about 67.9%

are covered by at least one of these social programs, only 30.2% covered by Philhealth and any of the three

income support programs. These finding suggest that there is still a great percentage of senior citizens without

any access to any of the programs of the government. The programs do not define what is long-term care.

Moreover, a system is yet to be developed in order to connect all the republic acts, administrative orders, and

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discounts and benefits. The way us researchers see it, there is a big puzzle picture waiting to be filled up by

the existing programs and policies. (Table 9)

RECOMMENDATIONS

SENIOR CITIZEN BENEFITS AND PROGRAMS

Social pension programs for the elderly protection should be towards improving the access of those

sector which have lower access. The laws and programs are useless without it being implemented. The elderly

would benefit from the health, income protection, intended benefits through the awareness of the existence or

guidelines in accessing the programs. The subsectors which have the lowest access include the female senior

citizens and those in the lowest income category. Awareness should be increased to the poor senior citizen.

Reexamination of the implementation of the social pension program with emphasis on the eligibility

requirements can be considered. The benefits received by the pensioners also receive some forms of income

support, with the given limited budget of DSWD, the high leakage rate becomes a barrier for the indigent

senior citizen not in the program. If a good database is accomplished, a better targeting system may be

improved, everyone shall have access to the social pension program. The 500 pesos monthly stipend given

only every six months, corresponds to only 24% of the per capita poverty threshold of 34.1 % of the per capita

food threshold in the first trimester of 2018, which is not adequate to the day to day expenses of the indigent

senior citizen. A reevaluation on the amount and frequency of payouts may be done. A 1,500 pesos increase

may be considered sufficient. The program, when done in properly targeted population, may be more effective

for the social protection of the poor and disadvantaged elderly Filipino. (18) With the current budget of 23.18

Billion pesos allocated for 2019,(19) and the National Commission of Senior Citizens taking over the

appropriation of funds. Monitoring of the implementations could be strengthened to assure that the budget is

allocated properly.

17
TRADITIONAL CAREGIVER SUPPORT

. Filipino culture also views institutionalization of an elderly as somewhat negative. This leads to the

fact that most government aged care services are below standards. Therefore, families take in their elderly,

without any organized care. Moreover, when social pension programs are inadequate, the senior citizen would

not be able to take care of himself, dependency on the family and community ensues. Elderly abandonment is

not uncommon and with only a few government nursing homes on board, high occupancy and overcrowding

occurs. This is the reason why steps in empowering the care giving capability of the family should be

empowered. Long-term-care systems aim to give the aged population experiencing a significant decline in all

aspects of life capacity, to receive care and support, consistent with basic human rights, freedom and dignity.

A sufficient system can help reduce the inappropriate use of acute health-care services, help informal

caregivers, mainly the families prevent disastrous care expenditures. An efficient system also frees women,

usually the main caregivers – to have and keep broader social roles. The Filipino caregiver are mostly unpaid,

have too their own families to support, and some have work. If burdened, most give unorganized care. Quality

of life of both the caregiver and the elderly suffer. Through appropriate programs, which are cost effective and

compatible with the Filipino culture, the burden that is experienced by the Filipino caregiver may be alleviated,

having a significant impact on the quality of life of both the caregiver and the one being cared for. However,

an important first step the Philippines can do is to build comprehension of the issues facing the country as the

number of care-dependent older people continues to grow. Long-term care should be recognized in the society,

as well as politically. There is an economic neglect on the area that needs to be acknowledged. Long term care

should be looked into as a two-way street, the caregiver and the one being cared for. A potential in the “care

economy” shall be sought through to create a positive influence on the socioeconomic development of a

country.

18
Policies from Canada, Japan, and US LTCS involves not just the government, but the private

sectors as well. If criteria for eligibility is well defined, such that the work hours spent by the informal caregiver

with the senior citizen, activities that involve in the caregiving process, allowances for them shall be properly

allocated. Experts on the field of caregiving, on elderly care can be consulted on this matter.

Based on the Sub Saharan Long-term care framework, key elements can be used in a

community-based program for the elderlies, here are some recommendations: Getting the family involved,

Patient Centered Care, Caregiver training for the informal Caregivers, Integration with health care

services, Accessing equity, and Sustainability. Case studies can be done, to ensure financial sustainability:

well-established donors, willingness to pay out-of-pocket and the public sector can all contribute.

Commissions such as the Coalition of Services to the Elderly Inc (COSE), and Confederation of Older Persons

Association of the Philippine (COPAP) can help promote constructive regional debate by disseminating

information about the current informal caregivers situation . At the national level, multisectoral dialogues can

be initiated to take stock of the status of long-term care provision and to identify further emerging challenges

and opportunities for policy and action. Awareness-raising initiatives can also be implemented to stimulate

and inform public debate on long-term care. The WHO Regional Office for Philippines and WHO country

offices can provide leadership and technical support to hasten the development of sustainable and equitable

systems of long-term care which shall entice treating partnerships with relevant stakeholders. International

development partners can support implementation and testing of innovative approaches; conferences on

ageing, health and universal health coverage; on social protection, gender equality and advancement of human

rights; and education, employment and entrepreneurship opportunities for youth. In reality, governments have

an essential if not the most vital coordination role in building and implementing systems of long-term care.

Although the initiative does not necessarily mean that it is the government that must fund or provide all

services, a mix of public-private partnership can be made. In all cases, however, effective and integrated

19
partnerships between governments, families, volunteers, nongovernmental organizations, professionals and

the private sector are all essential. National authorities should take overall responsibility for ensuring that the

system functions well. An essential first step will be to identify the people and/or departments within

government who will spearhead these efforts. Regardless, primary responsibility for coordination must be

clearly designated. Once primary responsibility for spearheading the effort has been determined, a

multisectoral coordinating body or mechanism needs to be established and – importantly – adequately

resourced which may include a range of government departments and/or sectors (for example, health, social

welfare, housing, education) as well as local/municipal levels of government. The framework may encompass

civil society, community-based, faith-based and private sector stakeholders actively involved in the provision

or receipt of long-term care. All the stakeholders should be engaged in constructive debate on long-term care

in order to consolidate the national policy architecture on long-term care, and to pursue and monitor its

implementation. It is imperative to include the input of older people themselves in this process. The WHO

Regional Office for the Philippines and WHO country offices may provide the technical support for building

capacity and establishing national coordination mechanisms. If possible, get support in setting norms and

standards, monitoring provision of long-term care, developing evidence-based policy options, setting

investment priorities, shaping the research agenda and stimulating the generation, translation and

dissemination of valuable knowledge. There is also a need to develop a set of indicators which will capture

and predict long-term care needs and services across the country. The African Union has recently

recommended the development of an Internet-based platform for the sharing of resources and knowledge on

long-term care policy and legal agendas, interventions, care models and systems approaches for its member

states and stakeholders. The Philippines can model after that and with the present administration’s legislation

of the National Commission for Senior Citizens signed on July, 2019 under the Republic Act 11350, such a

start seems promising.

20
ANNEXES

TABLE 1 CONCEPTUAL FRAMEWORK

TABLE 2 KEY STATISTICS ON THE PHILIPPINE’S POPULATION OF OLDER PEOPLE

TABLE 3 Discount and Vat exemption privileges of senior citizens

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TABLE 4 Retirement benefits under GSIS

TABLE 5 Types of SSS coverage

22
0

TABLE 6 Grounds and supporting documents for delisting social pension beneficiaries

23
TABLE 7 Senior citizen membership to Philhealth 2014-2018

TABLE 8 : Senior Citizen coverage of various social protection programs , 2013-2017

24
ANNEX 9

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(3) un.org

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(5) Philippine Country Report. 12th ASEAN and Japan High Level Official’s Meeting (HLOM) on Caring

Societies. A Collaboration of the Department of Social Welfare and Development, Department of Health

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Philippines. University of Bremen: Bremen.

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(14) Nakonz, J. & Shik, A. w.y. (2009). And all your problems are gone: Religious coping strategies among

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(16) Duaqui, Y. (2013). Growing old gracefully: A Filipino Family;s grandmother story. Asia Pacific E-journal

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(18) Philippine Information Agency, 2018. DSWD reports 2018 accomplishments. Available at

https://pia.gov.ph/news/articles/1016310 )

(19) Angara,S. Social pension and our senior Citizens, Business Mirror. November, 2019.

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