CENIE · 31 August 2020

Geriatric system and health in the post-covid society

I write my articles from a business and entrepreneurial perspective, from a sociological and marketing perspective and with a political and social vision that, I try, is constructive, measured and oriented towards collective improvement.

Therefore, I avoid blaming people, parties, institutions, sectors or any other actor for the crisis that has been with us since the beginning of the present and fateful year 2020. I will not participate in the funeral feast of throwing bodies at each other's heads. Rather, I will try to learn from what has been done well and badly by all, presuming good faith and better intentions, given that technical expertise was sometimes called into question in the harsh examination to which the pandemic subjected us.

Some say that the system has proved to be a failure and that it does not work. Others call us to imagine the disaster that could have occurred and that was mitigated, thanks to the fact that the system is robust and demonstrated it.

There are also those who speak of a generation that left us in a good-natured manner, in my opinion exaggerated in form and content; those who directly insinuate gerontocide; and those who, under the banner of "we did what we could and we're still going to do it", try to manage in a leap of faith. What we all agree on is that the slightest hint of ageism must be eliminated in the health triage, and in all areas of life.

Be that as it may, I believe that the intelligent thing to do is to learn quickly and "speed up" the system. Rapid adaptation is urgently needed, as the virus does not give us any respite, does not allow us to meditate or reflect, or to generate round table discussions in search of points of agreement, but rather calls for rapid decisions. I propose, to the extent that COVID 19 allows us to implement them, God willing, the foundations of a reform that maintains the good (sometimes excellent) aspects of the system; and I suggest that the authorities, dispersed, decentralised and uncoordinated, look for the head of the chicken and try to bring sanity to the system. 

The ten measures to improve the geriatric system by 2021

I consider them all important and I do not propose them with an ordinal intention.

  1. Redefining the role of primary care. Amongst other things, to commit to interoperability, which is famous in the sector and which nobody has yet seen. The political fragmentation must be reviewed once and for all and a national gerontological system must be achieved. A properly coordinated plan, in which the Autonomous Regions have the last word on the tactical detail of its implementation. From the point of view of information technology, engineering and political intention, interoperability is urgently needed to ensure that the public health system (which includes public and private health) and the geriatric system of residences, care and technology for dependency are understood.

  2. Medicalise with prudence. This is an easy sentence to write and difficult to implement, but we must consider the need to provide facilities, equipment and people, technological resources and the proper coordination already suggested in the previous point to the health system.  Older people should have the feeling that they are living in a medicalised home in a non-invasive, non-invasive and friendly way. It is not, or yes, this is not the discussion, that they live in semi hospitals, but that in case of alert, alarm or health emergency there is sufficient autonomy to guarantee full coverage to people and managers of institutions who can no longer see, powerless, how the elderly are going. The residence cannot be, like Laguna Estigia, the place where life or death is decided by the existence or not of basic hospital instruments and resources.

  3. To inspect and certify minimum requirements. It is a matter of creating rules, standardizing and normalizing their implementation, with moderation, but with urgency. Resources, personnel and procedures must be in place, as well as normal inspection (with the desire to improve prevailing) and preparation of the system before the imposition of sanctions or collection through fines and penalties, to which the State has accustomed us so often. 

  4. Achieve public-private coordination. This is vital. The discourse "public is good and private is bad" is outdated. But, in addition, it is useless, because cooperation is essential for the private to reach where the public or state does not. And this observation makes sense in the double axis that makes up the gerontological system: the geriatric health system and the residential and care system. Insurance companies, mutual societies, companies in the residential sector, companies in the "dependency sector", if any, or care companies, are taking time to coordinate efforts to prepare our country for the best cooperation to avoid wasting lives and resources.

  5. Implementing crisis protocols. We have never lived through a similar situation before, and the inexperience in the face of what was never foreseen, except by the hottest minds in science fiction cinema series B, is not to be blamed. We now know that the unpredictable must be foreseen and that, perhaps inspired by the worst serials, novels or literary myths of calamities, plagues and epidemics, we must create protocols, procedures and processes and provide, legislatively and at the level of regulations and rules of action, the best guidelines for when the unexpectedly expected event arrives. As Marta García Aller points out in the book The Unpredictable.

  6. Working to make the residence a mother ship, interdependent with the health system and closely related to the primary care system. The elderly must be controlled, but so must the workers and all the professionals who pass through it.

  7. Extend the use of Big Data. The creation of statistical models and the use of mathematics/data science is an urgent matter that cannot be postponed. Models of crisis anticipation, prevention and trend periscopes allow us to anticipate crises and not get caught up in demonstrations or in the theatre (which will not be easy in the coming years, moreover).

  8. Strengthen the care system. It is not acceptable to read impassively that old people appear dead alone in their homes, sometimes mummified.  Dependence, care, attention of all kinds will be required by the elderly in their homes. Confined or not, it is to be expected that the elderly will live in their homes, where goods and services must be provided for their subsistence, comfort, vital facility and, as far as possible, pleasure and enjoyment. 

  9. Develop 'age TECH', home automation technologies, based on artificial intelligence, sensorics and biometrics. In particular, e-health is here to stay. It is an urgency, a priority, to invest and undertake in solutions to facilitate the life of people in their homes. Fighting loneliness and telemedicine (which must change the face to face with the doctor and implement new monitoring) are emergencies that cannot wait, as has been demonstrated in the crisis of the first half of 2020.

  10. Improve home hospitalisation. It deserves to be mentioned separately, as the pandemic has shown that older people who entered the hospital badly, came out dead, because far from improving they got worse in environments with a much higher viral load than they would have had at home. In successive crises, the system has to be equipped, and it is not easy in the very short term, with technologies for the hospitalization and home monitoring of the elderly.

Without negative ageism, without condescension, with moderation and focused on the enemy, which is the disease and not the political adversary, in short: we must accelerate for better coordination, technological and process/procedure modernization, medicalization, standardization and inspection of a system that must be made even more robust. Our life is about that.

In order to prepare this article, in addition to my personal reflection, I have used the notes taken in the telephone interviews with Dr. Ribera Casado, an academic of Gerontology and Geriatrics of the Royal National Academy of Medicine; the economist José Antonio Herce; the director of Inforesidencias.com Josep de Martí; the president of UNESPA, Pilar González de Frutos; and the president of the Board of Trustees of the EI University of Segovia, Rafael Puyol.

To all four of them I give my heartfelt thanks.



Under the framework of: Programa Operativo Cooperación Transfronteriza España-Portugal
Sponsors: Fundación General de la Universidad de Salamanca Fundación del Consejo Superior de Investigaciones Científicas Direção Geral da Saúde - Portugal Universidad del Algarve - Portugal