Overburdened Health Care System Leaves Elderly Vulnerable in Brazil

Brazil’s elderly population has increased by more than 50 percent during the past decade.

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RIO DE JANEIRO, BRAZIL – Maria Alzira da Silva, 83, and her siblings, residents of the City of God, a notorious Rio de Janeiro slum, lost their father at a young age.

They grew up supporting each other and their mother. But now, as they age, they say they have no one to support them.

As adults, the three siblings remained close. Benedito da Silva, the oldest, married, but neither of his sisters ever wed.

Benedito died of throat cancer in 2004. Shortly after, Maria Alzira’s sister, Maria Marta, became ill because of complications from diabetes. She died in 2006, leaving Maria Alzira on her own.

Today, da Silva uses crutches after a fall. She has a small pension and spends her days at Casa Emilien Lacay, a day program in the City of God that provides seniors with activities and meals. The program is free and runs on donations.

But in the late afternoon, da Silva says she returns to her loneliness and her cats. She describes herself as independent and cheerful, but she worries about the future.

“My concern is tomorrow or after,” she says. “I can no longer be alone.”

Da Silva fears the day when she will be no longer able to live independently and will have to depend on others to help her to take a bath or to cook. She has already hired someone to sweep her yard and wash her clothes, but she says it’s difficult to find a trustworthy person to help for what she can afford to pay them.

“I know there are elderly who are afraid of receiving help from neighbors for fear of someone taking something from their house without permission,” she says, “and they get aggressive when someone tries to help them.”

Da Silva says she has heard rumors that there is a nursing home in a nearby neighborhood that cares for the elderly. But she has walked around the area and has never seen it.

She is hopeful that she can eventually move to a place where she would have care every day but still remain close to the area where she has lived all her life.

“I do not want to go to a nursing home in a distant neighborhood,” she says. “I no longer have my siblings, and having to lose the few friends and acquaintances I made in life, it is very sad!”

As Brazil’s population ages, the elderly in the City of God slum say that there is a lack of people and places to care for them. Privately run centers offer free activities for the elderly during the day. The government operates two health care centers, but nurses and social workers say they need more trained professionals to handle the volume of patients. They also call for more training at the community and family levels in order to teach people how to care for the elderly.


The number of elderly people in Brazil has increased from 15.5 million in 2001 to 23.5 million in 2011, according to research by Brazilian Institute of Geography and Statistics. People 60 and older now account for 25 percent of the population.

In the City of God, nearly 11 percent of residents are older than 60, according to the 2010 government census.

Eulalia da Silva, 76, who is not related to Maria Alzira da Silva, has lived alone in the City of God since her husband died. Her only son died young after becoming involved in narcotics trafficking.

She walks with difficulty through her untidy house, taking a minute to rest against the few items of furniture she has. Her hair and clothing are disheveled.

“I never thought the end of my life would be so lonely and sick,” she says as her eyes water. “I thank God for having dedicated neighbors as Doña Rosa, who always helps me, makes food for me and leaves my room tidy.”

She says she relies on her neighbor for almost everything.

“One day, I was falling down all night until Doña Rosa came and helped me raise and take care of my injured leg,” she says. “If not for her, I would have died. I’m here alone. I lose sleep at night. I have no one to talk to.”

Morão Amyntas, 86, who also lives alone in the City of God, asks for more support from the community as he ages.

His wife died in 1994. He has four children, but they do not live in the area.

“I stopped walking,” he says. “I do what I can here at home, but there are days when I don’t shower, not for lack of water, but because of pain in my body.”

He says that the elderly need more assistance.

“It’s very sad to be old, sick and alone,” he says. “I think older people need to have a place to sleep, to stay and have a nurse to care.”

Gertrude Therezinha Fabricio, 78, another City of God resident who lives alone, agrees that more care for the elderly is essential.

“The biggest problem for me is when I get sick,” Fabricio says. “I have nobody here.”

Fabricio separated from her husband many years ago, and she does not have children.

“I have nephews who live in Petrópolis,” she says, “but they have no obligation to me.”

She prefers not to bother anyone to ask for help, but sometimes she doesn’t have a choice.

“I know I will end up depending on the help of my neighbors,” she says.

Da Silva, Amyntas and Fabricio all take advantage of the free programs for the elderly at Casa Emilien Lacay.

Maria Luzia Nunes Pereira, who coordinates these programs at Casa Emilien Lacay, says that the community doesn’t try to understand the elderly.

“Their children have family and work,” she says. “But the elderly have no way to get to the doctor or to go out somewhere and need someone to help them.”


Striving to fill this gap, two privately run organizations serve the elderly in the City of God: Casa Emilien Lacay and Casa de Santa Ana, says Marcia Bogéa, a coordinator at Casa Emilien Lacay.

Founded in 1990, Casa Emilien Lacay serves 80 seniors in the area with programs such as theater, music, martial arts, yoga and dance, Bogéa says. There is also a space for lectures and arts and crafts.

Casa de Santa Ana offers similar activities, ranging from singing in a choir to writing.

Maria de Lourdes Braz, a social worker, founded Casa de Santa Ana in 1991 to fill the void senior citizens feel as they age. The program currently serves 120 elderly residents of the City of God.

“The goal of the program is to contribute to increased autonomy and quality of life for the elderly of the City of God through comprehensive care, health promotion and intergenerational integration,” Braz says.

She says the program, which relies on fundraising and donations for its operations, offers free activities daily for the elderly to strengthen their self-esteem and relationship with the community.

Braz also invites young people from youth centers in the area to visit, as the inclusion of children in the routine of the elderly enables them to be more socially conscious.

Braz also coordinates Casa de Geralda, an extension of Casa de Santa Ana. It welcomes senior citizens during the day for appointments to undergo physiotherapy or alternative therapies such as shiatsu, pranic healing and acupuncture. The space hosts gymnastics and dance for seniors as well.

But these programs are for independent seniors in good health. Though necessary, the great demand is for adequate health care for the elderly who suffer from illness, neglect, and cognitive or physical limitations, Braz says.

“The largest demands today are the lack of public nursing homes for admissions when necessary, health care deficit in the area of the City of God, and little family involvement with the institution and care of their own elderly,” Bogéa says.

The City of God has two public centers that offer health care, both funded by the government. Unidade de Pronto Atendimento handles emergencies, while Posto de Saúde Municipal Hamilton Land offers preventative health and outpatient care.

Nurse Ednéa Souza Gomes has worked at Posto de Saúde Municipal Hamilton Land for 17 years. Speaking with permission from the municipal government press office, she agrees that health care for the elderly continues to be a challenge.

Two ladies in the center’s waiting room, ages 56 and 63, who asked not to be named, were both angry that they could not get an appointment for several months.

Cilene Vieira da Cruz, a social worker and resident of the City of God, confirms that appointments are limited.

“In the clinic, each resident can only schedule two appointments a year,” she says. “But how can a person guess when they will get sick?”

Gomes attributes this to the lack of health care professionals.

She says there is a new home care program in which doctors visit the elderly who are unable or too ill to visit the center.

But this program also suffers from the lack of health professionals, she says. Only three people have received home visits since the program started in 2011.

The City of God does not have a system to monitor the health care of the dependent elderly, she says. And with only one health clinic and one emergency unit for the entire community, the elderly don’t receive priority.

Instead, it is common for elderly people to seek support of churches, Gomes says. For example, parishioners of Igreja Pai Eterno São José in the City of God donate food, visit the elderly and help to tidy their houses.

Pereira echoes Gomes’ call for more trained professionals.

“The greatest difficulty is to have qualified people to understand the problems of elderly health, both physical and mental,” Pereira says.


Da Cruz says that meeting the needs of the elderly requires increased training, commitment and collaboration on the community and the family levels.

“We know that in addition to increasing the number of medical professionals at the health center, you have to train people to take care of the elderly as well as train families to show a greater commitment to their elders,” da Cruz says.

Until they are able to bolster further support for the elderly, Pereira says the importance of places like Casa Emilien Lacay is even greater.

“Casa Emilien Lacay is like my home,” Maria Alzira da Silva says. “Here, I am treated very well. I have my friends, my food. I sing, I dance, I do theater. Now, my family is the people of Casa Emilien Lacay.”