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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
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
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
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
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
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
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
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
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).
The Philippine government caters to the elderly needs through several legislations and social protection
programs.
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
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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
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
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
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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
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
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
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
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
RECOMMENDATIONS
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.
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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
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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
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
20
ANNEXES
21
TABLE 4 Retirement benefits under GSIS
22
0
TABLE 6 Grounds and supporting documents for delisting social pension beneficiaries
23
TABLE 7 Senior citizen membership to Philhealth 2014-2018
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ANNEX 9
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(2) United Nations World Population Prospect Report: The 2019 Revision
(3) un.org
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(7)Cruz, G. and Camhol, A (2014). Family and State Roles in the Promotion of Well-Being of Older Filipinos.
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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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