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MC COVID-19 Governmental Response to the COVID-19 Pandemic in Long-Term Care Residences for Older People: Preparedness, Responses and Challenges for the Future

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MC COVID-19 Governmental Response to the COVID-19 Pandemic in Long-Term Care Residences for Older People: Preparedness, Responses and Challenges for the Future MC COVID-19 Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future Greece Costis Prouskas Aktios MC COVID-19 WORKING PAPER 07/2021 Contents 1. DESCRIPTION AND ANALYSIS OF THE ROLE OF THE RESIDENTIAL CARE SECTOR FOR THE OLDER-AGE POPULATION 3 1.1. The historical trajectory of LTC 3 1.2. Current arrangements in LTC 4 1.3. Debates around the development of a LTC system 12 1.4. LTC governance 18 1.5. General functioning of the residential care system 21 2. DESCRIPTION OF THE EVOLUTION OF THE PANDEMIC IN THE GENERAL SOCIETY AND IN THE RESIDENTIAL CARE AND HEALTHCARE SECTORS MORE SPECIFICALLY 24 2.1. General description of the epidemic: detection, scope and some data 24 2.2. The effects of the epidemic on the healthcare system 27 2.3. The epidemic in public and political debate 30 3. DESCRIPTION AND ANALYSIS OF THE MEASURES ADOPTED TO ADDRESS THE IMPACT OF THE PANDEMIC ON THE RESIDENTIAL CARE SECTOR FOR THE OLDER-AGE POPULATION 32 3.1. Background of preparedness for the Crisis 32 3.2. The General Impact of the Epidemic on the Residential Care Sector and Policy Responses 37 3.3. Analysis 46 3.4. Examples of developments in specific care homes 49 CONCLUSION 53 REFERENCES 54 MC-COVID19 text of institutionalized older-age care (age Project Coordinators: Coordination mechanisms in Corona- group that appears particularly vulnerable Eloisa del Pino Matute virus management between different in this epidemic context), in Spain as well Francisco Javier Moreno-Fuentes levels of government and public policy as in the rest of the EU-15. This study fo- sectors in 15 European countries cuses on the articulation of resources be- Research Team: tween health and social policies, and aim Gibrán Cruz-Martínez The political and administrative manage- to contribute to improve the effectiveness Jorge Hernández-Moreno ment of the healthcare crisis provoked by of the decision-making process and cru- Luis Moreno the COVID 19 is a key issue in preventing cial aspects in the fight against the pan- Manuel Pereira-Puga the spread of the disease. The Mc-COVID demic. Findings also aim to be useful to Roberta Perna 19 project is set to analyse the socio-san- inform other public policy sectors involved itary co-ordination procedures in the con- in crisis-related situations. https://www.mc-covid.csic.es/ How to cite this publication: Prouskas, C. (2021), ‘Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future: Greece’, MC COVID-19 working paper 07/2021. http://dx.doi.org/10.20350/digitalCSIC/13695 Costis Prouskas 1. DESCRIPTION AND ANALYSIS OF THE ROLE OF THE RESIDENTIAL Aktios CARE SECTOR FOR THE OLDER-AGE POPULATION1 [email protected] 1.1. The historical trajectory of LTC Greece was the first Balkan country to gain full independence from the Ot- toman Empire in 1830. Initially the independent territory was only a small part of what is now considered to be Greece. Areas like Crete, the Ionian islands, central Greece, Epirus, Macedonia, Thrace and the Dodecanese were gradually incorporated, up to the late nineteen forties, with the ex- ception of Cyprus which gained its own independence in 1960 (Press and Information Office, Republic of Cyprus, 1995). Greece, after the revolution against the Ottomans and the fight for inde- pendence, became successively an absolute and then a constitutional monarchy (Clogg, 1992; Kokkinos, 1972), and a republic from 1968. The country was involved in almost every war that took place in the region, including the 1897 war against Turkey, the Balkan Wars (1908 -1912), World War One (1914-1918), the Catastrophe of Asia Minor (1921-1922), World War Two (1940-1944), the Civil War (1944-1945), and the Turkish invasion of Cyprus (1974). Most of these wars and tension periods influenced the development of the newly founded Greek state. For example, 70 percent of the land was added after the Balkan wars. The catastrophe of Asia Minor, as well as the Young Turks Movement in Turkey caused the resettlement in Greece of over one million refugees from Asia Minor and the Black Sea (Kokkinos, 1972;). Ac- cording to the censuses of 1907 and 1928, the population of Greece more than doubled (from 2631,9 thousand to 6204,6 thousands respectively) (National Statistical Service of Greece, 1991). The Second World War led to large numbers of people dying in battles and from famine. The flourishing Jewish community of Northern Greece was virtually annihilated (Clogg, 1992). 1 These events influenced the country, and its development in many ways. This series of reports is one of the Economic underdevelopment, bankruptcy and political instability stopped research results of the Mc-COVID-19 project, “MC-COVID19: Coordination adequate planning and development of educational, social, and develop- mechanisms in Coronavirus ment policies and services. management between different levels of government and public policy sectors in 15 European countries”, The problems and the political instability of the 1950’s and 1960’s, caused funded by the Spanish National by the wounds of the civil war, large scale migration and the Palace’s inter- Research Council (CSIC) within the ference with the democratically elected government reached their peak in CSIC-COVID-19 programme, as well as 1967 with a military coup. This contributed to a further disorganisation of of the GoWPER project, “Restructuring the Governance of the Welfare State: the social services, and of the weak administration system in general. The Political Determinants and Implications restoration of democracy in 1974 which followed the Turkish invasion of for the (De)Commodification of Risks”, Cyprus, as well as the public vote against the restoration of the monarchy CSO2017-85598-R Plan Estatal de opened a new chapter in the history of the modern Greek state (Clogg, Investigación Científica y Técnica y de Innovación. 1992). 3 4 ℅ MC COVID-19 Finally, from the late 1980s large number of immigrants from Albania, Eastern European countries, and ethnic Greeks from Albania, Romania, the Black Sea (Pontic Greeks), as well as from Russia and Ukraine, settled in Greece. To summarise, over the course of the last century the Greek population has experienced five major wars, at least four resettlements (refugees from Asia Minor, Alexandria, Constantinople, Albania/Black Sea) and mass em- igration to Germany, the United States of America, Australia, Canada and, in recent years, France, Italy and England (for political and educational rea- sons). The Greek population also suffered five years of German Occupa- tion, three military dictatorships, and a Civil War and went bankrupt several times from the inception of the state. The circumstances above mentioned help explain Greece being poorer and slower than some other European countries in the development of a com- prehensive system of health and social services for all of her citizens, in- cluding those over the age of 65. The modern Greek state started with poor resources and the need to deal with the repercussions of wars, cholera, and absent and destroyed infra- structure. The 1960’s, saw many more facilities for older people begin operation. Most of the residential units currently operating are licensed under an 1980’s law. According to the Ministry of Labor report, in 2020, approxi- mately 300 Long Term Care Units were licensed in Greece with an average of 45 beds in each. Of these 53% are private (for profit) and the remainder (not for profit) are operated by NGO’s and the Church (Ministry of Labour, 2020). The country has no publicly owned elderly care facilities. Services provided in registered units include nursing and medical care, hospitality services and some recreational activities. Elderly care units operate under the supervision of the Social and Welfare Services of the Regions. The 2007 law set specifications and standards of operation as far as buildings and staffing is concerned. In general terms, the state and the insurance funds do not pay for the cost of staying in care units with fees being paid by the elderly person and/or their family. The current legal framework does not include any quality indicators and quality standards (Government Ga- zette, 2007). 1.2. Current arrangements in LTC The Greek state is the main mechanism for ensuring social well-being and the redistribution of economic resources. It is also the exclusive insurance institution and through three mechanisms i) the social security ii) social care and iii) health care, it supports the social security system. After the fall of the dictatorship of the colonels/junta in 1974, the process of normalization of political life and the modernization of the basic insti- tutions began, part of a general process of achieving Greece’s accession ◂ back to table of contents GREECE ℅ 5 to the European Community. In this context, the construction of the state that includes the law and welfare is included. (Stathopoulos, 2005, Rapti, 2007). Even though there has been a growing awareness amongst Greek govern- ments of possible problems associated with the rapidly increasing number and proportion of elderly people in the Greek population, there has been no overall national plan for the development of health and social services for elderly people. Some programmes were initiated by service providers such as local authorities and NGOs, and wider policy measures are currently un- der review by the Ministry of Labour and Social Solidarity. Long-term care in Greece is based on a mixed ‘quasi-system’ of services, comprising formal (public and private providers) and informal elderly care. Formal Care providers include: a. Primary Health Centers (Local) b. Hospitals (State, Regional and University) c.
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