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Lotus workshop in session

No, not a posh sports car but a research workshop held in Botucatu, in the state of São Paulo, Brazil. The full name of Lotus was Improving care in Long-term Care Institutions in Brazil and Europe through Collaboration and Research, funded by the Academy of Medical Sciences, Global Challenges Research Fund. The organisers from the UK side were my colleagues Prof Adam Gordon and Drs Reena Devi and Kathryn Hinsliff-Smith and, at the Brazilian end, Prof Alessandro Jacinto, Dr Paula Azevedo Gaiolla, and Karina Chamma. A small group of European researchers, from Austria, Netherlands and the UK, were invited to attend and we were joined by Brazilian colleagues with interests in care home research.

The workshop took place at FMB UNESP – the medical faculty in Botucatu of the State University of São Paulo – over three days. The overall objective was to raise the profile of research in long-term care institutions in Brazil and to develop potential projects for future collaborations. Lotus followed on from an earlier workshop (OPAL) held in 2018, which had considered a range of topics across the heath and care of older people.

On day 1, the Lotus group received presentations about long-term care in Brazil and in the European countries represented at the workshop. Brazil, like other very large middle income countries, is undergoing rapid population ageing. Long-term care has until recently been a position of last resort for those who lack families to support them. It is only recently that private providers of care homes have started to become a significant economic presence. The availability and costs of long-term care are greatly variable across Brazil. The first afternoon was spent in workshops to discuss further issues such as funding and regulation, staff training and medical input into long-term care.

On day 2, the first session discussed the originally Dutch LPZ audit and quality tool. I’m glad you asked(!): LPZ stands for Landlijke Prevalentiemeting Zorgkwalitet (or National Prevalence Measurement of Quality of Care). The LPZ is an annual, independent measurement of the quality of care in the healthcare sector, which can also include care homes. LPZ provides measurable care indicators for certain conditions: pressure ulcer, incontinence, malnutrition, falls, restraints, and pain. LPZ is now used in five countries – Netherlands, UK, Switzerland, Austria and Turkey – and clearly has potential for wider use.

There were then several presentations on examples of collaborative research with care homes, from Brazil, Wales, England and the Netherlands. The afternoon was spent in workshops to discuss related topics like benchmarking quality of care, and how to establish a care home research network in Brazil. The discussions were enlivened as we had been joined for the day by a group of gerontology students from the Federal University of São Carlos and they contributed in a positive and enthusiastic way.

In the third day of the Lotus workshop, a smaller group (it was a public holiday in Brazil!!) divided into three workshops to develop proposals around dignity for residents and staff in long-term care; multidisciplinary working; and the importance of art, music and gardens in long-term care facilities. Arrangements were made to pursue these ideas beyond the workshop.

On day 4, the European visitors were taken on a visit to two long-term care facilities in Botucatu. These illustrated the immense range and contrasts in long-term care. One facility was described as an ‘asylum’: it is charitably funded and caters for people who have limited family and other resources. The buildings and general fabric were very basic though it was evident that residents had plenty of access to outside space and the interactions with care staff were warm and genuine. The other facility was more like a residential care home in the UK, with individual or small shared rooms and far more space for residents’ personal belongings.

We also managed a day of tourism and were able to appreciate that they eat a lot of beef in Brazil!

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