The former Ministry of Health and Social Care since long is divided, the present formula being a Ministry of Health and a Ministry of Solidarity and Social Security. The last one, besides a Secretary of State for Social Security, who administers the National Pensions Fund, also has a Secretary of State for Social Insertion upon which depends a newly formed National Council for the Third Age Policy. Standing at a national level, this is the one and only element for co-ordination between health and social care.

Until recently the general policy trend could be said to be keeping the patient as much as possible within its family… and whenever impossible send him to old asylums where quality of care is questionable and motivated professionals are hard to find [22]. But if it can be defensible to consider as a priority to keep old people living in their own usual environment, circumstances to implement such a policy must be clearly established under penalty of mere concealment for the adoption of the immediately cheaper solutions. And that clarification doesn’t really exist as one can infer from the lack of domiciliary support outside the main urban areas (determined by budget limitations), or from the non-existent formation for informal carers, or still more and conclusively from the conjure of the serious problem of the high-dependency elderly. For these not only there is no policy for the creation and support of residencies, as there is no efficient system for the surveillance of the few public and private (profit and non-profit - Mercy Homes -) that already exist. Besides there are no objective criteria established for the admission of the aged in need at those homes, be it through social, psychological and/or physical frailty indexes.

This is the old age contextual scenery that leads us to conclude for the almost absolute non-existence of any measures specifically intended to the health and social care problems associated with Alzheimer's disease and other neuro-degenerative conditions.

In the absence of such an integrated and specifically tailored policy, the framework of these conditions is consequently forwarded to the scope of the general measures regarding the old age support, on one side, the ill-person and/or handicapped, on another, or, finally, for their families.

Nevertheless, according with the prospects of some epidemiological studies, figures reporting the Portuguese situation probably will not be far from what has been reported in other countries: overall prevalence of about 4.3% for the cases of moderate to severe dementia among the population aged 65 years and over. Among those, and accounting for 3.3%, are the degenerative situations of the Alzheimer's type. The annual incidence of new cases is thought of as about 9.2 persons in 1000 at risk, 6.3 of which of degenerative type and the remaining of vascular, alcoholic and other aetiologies. Therefore, for the Portuguese population, these will result in 60 thousand demented ones, 45 thousand of which probably of the Alzheimer's type. And this number has a clearly established tendency to increase with the population at risk; even because it is estimated that the mortality rate is lower than the number of new cases: 12500 each year, 8500 of which from Alzheimer's type. These figures, along with the absence of any measures that could be thought of as a result from a credible integrated project, more than a huge and shameful discrepancy towards the other members of Economic Union, allow foreseeing a real catastrophic situation. However disparities go further and if we consider separately what happens with the population living outside the main urban areas, in some ways this totally uncontrolled situation is not very far from what they already have.

In Portugal there is no specific legislation concerning Alzheimer's disease by itself, thus applying to this situation the general legal measures regarding support for the handicapped, and in this situation with a handicap of 60% or more (according with the 1993 National Chart of Disabilities [23]). Dating back to 1989, the legal definition of handicapped person is as follows: "The one that, by means of a loss or deficiency, congenital or acquired, structural or functional, psychological, intellectual, physiological or anatomical, capable of resulting in capacity restrictions, can be regarded as in situations of disadvantage for the practice of activities considered as normal, having into account the age, the sex and the dominant socio-cultural factors." [24]

However, we have to go further back to 1979 to find for the first time in Portugal a system that guarantees a minimal social protection to all citizens beyond Providence contributors. Shortly after, although keeping all benefits, another legal measure comes to restrain those benefits to the really needed individuals. Under this framework it is then implemented a sharing regimen of Social Security from which Pensions stand out. And in the particular case of the Alzheimer's patient, we may point out the Disability Allowance [25], the Subsidy for the Carer of A Third Person [26] also known as the Major Handicap Subsidy and the Complement for Consort in Charge [27].

The Disability Allowance [25] accounted for 189,000,000 thousand PTE of the 1996 budget [19]. It consists in a fixed instalment (30,100 PTE minimum), annually actualised, intended to compensate those who cannot carry out their profession due to a permanent disablement. Not necessarily total, disability implies a permanent physical or mental incapacity that prevents the beneficiary from gaining more than 1/3 of the remuneration corresponding to the practice of his profession under normal conditions. Eligible to the Disability Allowance are those (1) who suffer from a permanent incapacity to work, meaning that it is presumable that, in the three years to follow, they wont recover their capacities to the point of being able to perform their profession in order to get paid in at least 50%. And (2) who have rendered their contributions to social security for at least five years (in a row or interpolated) with a record of at least 120 days of wages each year - guarantee period -. For purposes of calculation as well as to establish the incapacity, the attribution of the Disability Allowance is referenced to the last profession of the beneficiary. If there is more than one profession, it should be considered the better paid. Old age pension may be accumulated with other pensions and even with other optional regimens for social protection.

The Subsidy for the Carer of A Third Person [26] accounted for 340,000 thousand PTE of the 1996 budget [19]. Presently with an amount of 10,460 PTE, this subsidy is assured to the pensioners who are in a dependency situation. Meaning that are entitled to this Subsidy for the Carer of A Third Person those who are in permanent need of support from someone else to help them to accomplish common daily tasks such as personal hygiene, locomotion or feeding. The permanent need of support has to be shown and implies a daily attendance of at least 6 hours. For legal purposes carers are considered the relatives or anyone else who helps the dependent person, here including the so-called domiciliary support. Pensioners may not claim this subsidy if help is rendered in a context of official or private health or social support facilities in any way financed by some sort of public funding. If the pensioner already gets some money for that purpose, this subsidy will only apply if the amount he gets is smaller than the subsidy; in which case he will get the surplus computed from the difference to what he already received.

The Complement for Consort in Charge [27] is a mensal subsidy - of 4,400 PTE at present - bound for compensation of those who have the consort at their expense. To benefit from this subsidy the income of the consort must not be over the amount of the complement.

Thinking of legislative renewal, when bearing in mind the huge weight of the economical constrictions that cannot be kept apart, it is hard to foresee important changes if any at all. As a matter of the fact, if something is expected to change, it probably will be in terms of actual implementation and widespread of programmes such as the Integrated Programme for the Support of Old People [28, 29, 30] and other dispositions that already exist, here included the inevitable surveillance auditing measures. We are lead to think of it while considering the greatest part of the situations involving old age assistance, for this scenery has been insistently denounced as calamitous and inhuman, and frequently even as hurt by illegality. Be it in health forums [31, 32], in the media [33, 34, 35], but also by consumer defence organisations as well [36, 37, 38] and even by the competent official organism of justice promotion.

	Última actualização = 06/Abril/97