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Nursing homes in Cuba are few, poor and underserved

Hundreds of "maniseros," selling peanuts populate the streets of Havana. Almost all are elderly retirees.

Cuba's elderly population is growing, while the number of centers designed to serve them is tumbling.

Natalia was born in 1950. She earned her degree in economics and although she married, she had no children. She worked for 43 years until she retired. Today, she is a widow. For half a decade, she’s been on a waiting list for a nursing home. Her home, tired and worn by time, seems to fall on her. She has no family and by now, her friends are few. Her story is one of many.

A comparative study of the results between the Census of Population and Housing and the Health Statistical Yearbooks for 2002 and 2012, reveal the increase in the number of elderly people in Cuba and the decreased ability of nursing homes to care for them. Care takers are also on the decline.

In the decade between 2002 and 2012, the Cuban population aged almost four percentage points, moving just beyond 2 million people. At the same time, the capacity of nursing homes decreased by 10.5 % or 773 less available slots. According to official information, the capacity of the 127 nursing homes on the island decreased from 8,348 to 7,453.

In 2013, only 1 in 274 of the elderly had the possibility of being received full time into nursing homes. One in 1,579 were provided board for part of the day. “In order for you to be admitted to a nursing home, you have to have connections or have to be very sick," said Juan Antonio, an alcoholic elderly man from Cienfuegos, who was rejected by the community and his own family and has been waiting to enter one of these centers.

A report by Cuba’s Ministry of Public Health for the ECLAC reveals that nursing homes on the island are for those who are in need or require continuing care and lack any ability to remain in the community.

Alberto Fernández, head of the Department of Elderly, Social Assistance and Mental Health, acknowledged in late 2013 that demand is increasing. Applications to enter nursing homes are estimated at more than 20,000--about three times the current capacity.

Although nursing homes served by the Cuban government have accommodations, none of them are yet able to provide for the approximately 130,000 cases of those who suffer from a disability, such as dementia or Alzheimer's disease.

Life on the Inside

Life inside a nursing home in Cuba is determined by two main factors: income and the health and mobility of the elderly.

"Those who receive a minimum pension (200 pesos per month) can hardly do anything beyond buy their medicines or food on the street to reinforce their diet," said a nursing home patient of San Germán, Holguín.

"At least I can move and so I help others, but there are those who cannot even buy a bite to eat," he claims. “Retirees are better off," compared to those receiving a pension.

Another patient considers it abusive that the nursing home spent a week, "giving the old folks broth with two sweet potatoes that they threw out and did not have water for bathing.”

Although government agencies and various NGOs make donations to these centers, Lilian Ruiz from Havana claims that sometimes the workers themselves traffic with the few things that are given to them, such as sheets, food and soap.

A former government official, who preferred anonymity, said that these centers receive numerous resources from state agencies, including donations of medicine that usually end up in the black market.

The most critical in Cuba’s nursing homes are those cases where the elderly are bedridden and their sores appear on the skin because it's wet and not sanitized on time. Or it’s simply because there are many elderly people in the same room and they cannot be constantly repositioned as recommended.

It is true that nursing homes in Cuba offer various services, including podiatry and medical services of various types. However, the irregularity and lack of inputs affects the quality of life.

A study published in the Cuban Journal of Stomatology revealed that the main cause of tooth loss in over 53 percent of patients in a nursing home in Santiago de Cuba was cavities.

The shortage of specialists is another issue. The health system of the island has only 279 geriatricians and gerontologists, and 137 residents in training in that specialty.

By 2020, elderly people will outnumber children. The island will have the oldest population in Latin America. If the current rate continues, within 20 years, 3.6 million Cubans will be aged 60 or over.

For sociologist Miriam Celaya, the disinvestment of Cuban society is perceptible. Only 51 percent of the population works, while the emigration of young people is growing. That is why, Celaya claims, "we are seeing more of the elderly selling things on the streets or doing something that will bring them some income, because they can’t live on their pensions."

In 2012, Gretell Hartman Romero, a graduate in Economics and professor of the Department of Economics at the Universidad de Oriente, calculated the cost of living of the elderly based on the prices of food, medicines and toiletries. The average total expenditure of pensioners is $403.20 Cuban pesos and for retirees, it is $539.32 pesos. One in three of those receiving a pension lives alone and their only source of income is 200 pesos.

The so-called "updated Cuban economic model” promoted by Raúl Castro cut social programs under the premise that families should take care of their elders. The Home Care Social Assistance benefits 4,416 elderly persons with the service of 3,544 workers.

Cuban health authorities announced that in 2014, they will experiment with putting “grandparent homes” into service for people with disabilities. They expect to increase the capacity of nursing homes until 2015.
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    Adriel Reyes

    Adriel Reyes is a journalist, researcher and university professor whose experience spans the radio, television and Internet platforms at The Martis. Specialist in Cuba's social issues. Follow him on Twitter: @ElZunzun