COVID-19 Salgını Döneminde Türkiye’de Uzun Dönemli Bakım ÖnlemleriCemre Canbazer Şanlı, Başak Akkan
Yakın dünya tarihinde benzeri görülmemiş bir sağlık krizine yol açan COVID-19 salgını ülkelerin uzun dönemli bakım rejimleri üzerinde ciddi bir baskı oluşturmuş; yaşlı, engelli ve bakım gereksinimi duyan tüm bireyleri refah sistemleri içinde daha da kırılgan hale getirmiştir. Özellikle, Kuzey Amerika ve Avrupa ülkelerinde uzun dönemli bakım kurumlarında gerçekleşen ölümlerin tüm COVID-19 ölümlerinin neredeyse yarısını oluşturması, uzun dönemli bakım politikalarını ve kurumlarını tekrar tartışmaya açmıştır. Türkiye yüzde 4’lük oranıyla uzun dönemli bakım kurumlarında gerçekleşen COVID-19’a bağlı ölüm oranının düşük sayıldığı ülkeler arasındadır. Ancak, Türkiye’de yaşlı nüfus ağırlıklı olarak kurum bakımı dışında aile temelli bakım almaktadır ve salgının ilk dönemlerinde uzun dönemli bakım kurumları dışında ölümlerin çoğunluğunu 65 yaş üstü bireyler oluşturmuştur. Makale, Türkiye’deki COVID-19 salgınının uzun dönemli bakım alanı üzerindeki etkisini Türkiye’nin aile temelli bakım rejimini temel alarak tartışmaktadır. Türkiye yaşlı nüfusunu korumak için uzun soluklu karantina önlemleri hayata geçirmiştir. Bu önlemler, COVID-19 salgınına yönelik birbirini izleyen dört dönem içinden tartışılmaktadır. Makalede ortaya konduğu üzere, uzun dönemli bakım alanında farklı aşama ve düzeylerde geliştirilen bu önlemler aileyi temel alan uzun dönemli bakım politikaları üzerine inşa edilmiştir. Salgının bir sonucu olarak öncelikli hale gelen uzun dönemli bakım rejiminin geleceği, alan yazınında ortaya konan tartışmalar ile paralellik göstermektedir.
Long-Term Care Measures in Turkey During the COVID-19 PandemicCemre Canbazer Şanlı, Başak Akkan
The COVID-19 pandemic has put a strain on long-term care regimes by rendering the aged, disabled, and everyone else in need of care even more vulnerable inside welfare systems, leading to an unprecedented health crisis in recent history. The issue of long-term care institutions and policies has come up due to deaths in long-term care facilities accounting for nearly half of all COVID-19 deaths in North America and Europe. Turkey, however, is one of the countries where the COVID-19 death rate in long-term care institutions is low, with a rate of 4%. However, the elderly population in Turkey mainly receives family-based care rather than institutional care, and people over 65 made up the majority of COVID-19 deaths in the early stages of the pandemic, not including long-term care institutions. This article discusses the impact COVID-19 has had on long-term care within Turkey’s family-based care regime. Turkey has implemented long-term quarantine measures to protect its elderly population for four consecutive periods. As discussed in the article, the long-term care measures developed at different stages and levels have been based upon family-based long-term care policies. The future of long-term care, which has been prioritized due to the pandemic, is presented in line with the discussions in the literature.
COVID-19 was declared a pandemic by the World Health Organization (WHO) in March 2020. This novel form of the coronavirus has placed global stress on social and economic conditions and caused disruptions in social care arrangements as a result of the deficiencies of diverse welfare systems worldwide. The COVID-19 crisis is likely to cause profound transformations in care arrangements around the globe, as one of the fundamental crises of the pandemic manifested itself in long-term care institutions. Under these circumstances, preventive measures and cushioning mechanisms, facilities, and the immediate effects of the disease have led to multiple challenges for the elderly people living in private homes and long-term care facilities, which became the epicenters of the care crisis in many countries.
In the context of the care crisis that has manifested itself in Turkey and all over the world, one may think that the COVID-19 pandemic will lead to important discussions about the future of the care regime that is currently under transformation in Turkey. Where does Turkey stand in this picture? With its considerable share of the elderly population and family-based care regime, Turkey might be an example of countries whose case fatality rates are high due to its strong intergenerational relationships, as discussed in the literature (Bayer & Kuhn, 2020). In line with its family-based care regime, a small percentage of the elderly population reside in long-term care institutions in Turkey. This low rate may be explanatory in terms of the comparably low rate of the officially declared COVID-19 deaths in long-term institutions.
This article critically assesses the long-term care response mechanisms that were mediated at four different phases within the aspects of institutional care, home-based care, and community-based care during the COVID-19 crisis in Turkey. During the first phase between January 2020 and May 2020, the central government adopted stringent curfew measures targeting the 65+ population. Local errand services were provided as compensation. Some essential services such as bathing that municipalities had provided were severely disrupted. Regarding institutional care, new guidelines regulating long-term care facilities based on social isolation and symptom screening were circulated by the Ministry of Family, Labour, and Social Services (MFLSS). The second phase, during which measures were relaxed to a certain extent as a response to the decline in COVID-19 cases and mortality rates, covers June-October 2020. The third phase covered November 2020-May 2021, during which time partial curfews were introduced for elderly individuals, and MFLSS reminded the long-term care institutions about the COVID-19 guidelines. The vaccination process started in January 2021, during which the Ministry of Health prioritized longterm care institution workers and residents, followed by all individuals over 65 years of age. The final phase started in June 2021 and still pervades. This period also entails normalization measures developed in response to declining COVID-19 cases and higher vaccination rates.
Turkey’s long-term care response has had several shortcomings in different phases and at different scales. Firstly, ambiguity appeared to exist regarding which various actors were responsible when dealing with regulating the realm of long-term care due to the privatization of the sector, as the literature has suggested (Milne, 2020). How the long-term care institution residents and individuals over the age of 65 were prioritized within the order of vaccination in Turkey can be considered one positive development. However, vaccinations alone are not enough to protect individuals over the age of 65 from the negative impacts of the pandemic. Home-based caregivers have not been provided with any supporting mechanisms and have been particularly let down by the disruptions in many community-based care arrangements.
Moreover, the link between long-term care and palliative care is not wellestablished. Preventive measures were primarily based on symptom screening and social isolation measures during the first phase of the pandemic, and these obviously were unable to sufficiently take the spread of the disease in long-term care facilities under control on their own. Up-to-date and complete data regarding the spread of COVID-19 within long-term care facilities and the age breakdown of COVID-19 figures need to be shared with the public transparently to enable more accurate academic studies and constructive discussions on the matter. Within this framework, the current article demonstrates Turkey to have attempted to address the challenges posed by the pandemic within the limits of its family-based care regime and to have implemented long-term care measures within four periods.