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The Efficient Development of Long-term Care and Palliative Care: The Responsibility of Government or Society?

25 May 2018
Эффективное развитие системы долговременного ухода и паллиативной помощи: ответственность общества или государства?


The palliative care grows more urgent

“Each year we see the growing number of palliative care consumers. By 2025 one third of the population will be out active working age,” Mikhail Alashkevich, Vice-President, Head of the Project Office of Agency Function, Bank for Development and Foreign Economic Affairs (Vnesheconombank).

The long-term care goes beyond medical care

“This is not a healthcare issue. There is only 20 percent of medicine here, until the symptoms are alleviated and the pain is gone. As soon as severe symptoms go away, palliative care steps in for spiritual and social assistance,” Nyuta Federmesser, Head, Moscow Multidisciplinary Centre for Palliative Care of the Moscow City Health Department.

“The moral paradigm of our society is more attuned to compassion rather than to deliverance from suffering,” Yury Krestinskiy, Director, Health Economics and Management Centre, Moscow School of Management SKOLKOVO.

“The long-term care system is a large complex system of medical and social assistance, which includes revitalization, rehabilitation, medical care, and family support. A person in need is in the centre of this system, and its goal is to provide the highest possible quality of life and preserve human dignity of a person in any condition,” Elizaveta Oleskina, Director, Old Age for Joy Charitable Foundation.

Palliative care is for the patients of any age

“In general this system has no age limits, so the methods, principles and ideologies are the same,” Elizaveta Oleskina.


The palliative care system falls short of what the society needs 

“What do we need to develop any kind of care? First and foremost, it is a regulatory and legal framework, infrastructure, personnel and a source of financing. <…> The concept of palliative care has emerged only 2011, and the primary legal and regulatory base only in 2015. We only have 200 geriatrists in the whole country. Today we have the capacity for about 12 thousand palliative care patients, whereas in 2011 we literally had only a few,” Tatyana Yakovleva, Deputy Minister of Healthcare of the Russian Federation.

“When we train medical personnel, part of this training is that they distance themselves from the value of compassion and become just a cog in this medical machine that is focused on making money,” Robert Twycross, Founder member, European Association for Palliative Care.

“There are four issues to address before palliative care reaches everyone in need at the end of life. First of all, personnel training. <…> The fundamental principle of palliative care is exactly that – care! Nurses are unskilled. <…> The second issue is the lack of access to anaesthesia. <…> The answer to this issue lies not in funding or the drugs themselves, but in the angst of the medical community of the Article No.228.2 of the Criminal Code, and in the unbelievable stigma of morphine in the patient’s community. <…> The third issue is the lack of protocols and standards. And last but not least, it is the lack of infrastructure,” Nyuta Federmesser.

Society has a negative attitude towards those in need of care 

“The most difficult thing is to alter the public attitude. <…> Disabled are unwelcome; the elderly get in the way. Why care for the dying, let them die,” Vladimir Pozner, Anchor, Journalist.


Palliative care needs uniform standards

“In the coming 5 years we will be working on the unified standards, procedures and approaches. <…> Palliative care office is not the care itself; people is what counts, and the first thing we need to do is to create a record keeping system,” Nyuta Federmesser.

Palliative care needs more volunteers

“Palliative care needs a lot more volunteers than anywhere else. It is not just trained personnel, but the people who are really willing to deliver,” Robert Twycross.

“We stand for the informal care system, which is impossible without a strong community, which in turn also needs to be cultivated,” Xenia Frank, Chairman of the Supervisory Board, Elena and Gennady Timchenko Charitable Foundation.

“Philanthropy is most often a non-monetized interaction within the community,” Dmitry Butrin, Deputy Editor-in-Chief, Kommersant Publishing House.

Finance long-term care from a specialized saving fund

“We do not have an old age insurance system. We are inclined to believe that the financial ground should be laid at a young age. Just like with pension insurance there must be a solid understanding of financing: the insurance rate principle for the end of life care services when relevant,” Alexey Vovchenko, First Deputy Minister of Labour and Social Protection of the Russian Federation.

“We need additional funding to solve this issue,” Alexei Sidnev, General Manager, Senior Group.

Palliative care system needs private investment

“We need business involved in public assistance domain. We need to separate palliative and long-term care financing and their sources. Palliative care should be point blank free to a certain point, until there is enough of it for everyone in need,” Nyuta Federmesser.

“Business should have an opportunity to develop this system, compete with government agencies in order to provide an alternative service and enable private consumers to make choices,” Gleb Biserov, Founder, Chief Executive Officer, Adorno Companies.

“We need private investments that come with new technologies,” Mikhail Alashkevich.