Ecuador's Ambitious Program for the Aging Poor
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Ecuador's Ambitious Program for the Aging Poor

Cristobal Diaz died on Monday. The next morning, one hundred of his newest friends lean their elbows on long tables in a cheerful mess hall and look to Manuel Ibarra for the morning announcements – and eulogy.

“Nobody knows when it will be our turn, but we have to live on, and we have to live on together,” says Ibarra with cheerful fatalism.

Ibarra is the director of a geriatric center in Ecuador’s Chimborazo province, which admits daytime patients and permanent residents. Constructed in 2012, it is the government’s first response to a global demographic shift.

In every continent except for Africa, the world is aging. By 2050, the over-60 share of the global population will have nearly doubled, from 12% today to 22%, according to the UN.

Latin America is no exception. In fact, in rapidly developing countries like Ecuador, the change is particularly dramatic. While an average Ecuadorian in 1950 lived to only 48, today the life expectancy sits at 75, The Economic Commission for Latin America (CEPAL) reports.

In response, Ecuador and governments around the world are scrambling to adjust their policies: raising the age of retirement or transitioning to private pensions to forestall budget drains.

Left out of the loop?

But what to do with today’s elderly – a generation that lived through military dictatorships and economic instability – over eighty percent of whom are functionally illiterate and did manual labor with no pension attached?

In 2008, Ecuador launched a program directed at the needs of the quarter of its elderly population living in extreme poverty.

The program is four-pronged. First, there are residential and day centers, like the one in Chimborazo. According to Nilka Perez, the Subsecretary of Intergenerational Care for Ecuador’s Ministry of Socioeconomic Inclusion (MIES), the government has constructed 14 model centers, providing an option for seniors living in extreme poverty who have been abandoned by their family.

Many seniors in the residential program are found on the streets, selling chewing gum and living on less than a dollar a day. “Sometimes they don’t remember where they live or who they are. Sometimes we have to give them a new name and ID number,” said Perez.

On top of the centers, which accommodate from 100-200 seniors between their residential and day programs, government social workers conduct twice-monthly home visits to some elderly citizens living in isolation. There are also around 300 “espacios alternativos,” locally organized clubs where seniors get together to talk, dance, eat and make music.

The day program at the Chimborazo center has a packed schedule. After breakfast at 8:30a.m., seniors are divided into groups. A few go to physical therapy, but most go to class.

During the lesson I sat in on, participants were led through some light stretching, and then set to work on a word search, highlighting the names of common fruits in colored pencil.

Maria Pilar explains the agenda for the day: a word search. Photo: Gustav Cappaert.

Maria Pilar explains the agenda for the day: a word search. Photo: Gustav Cappaert.

The majority of residents have no education beyond primary school. Which is why, said class leader Maria del Pilar, activities directed at second graders can be repurposed for 70-year-olds.

The mid-day dance session. Photo: Gustav Cappaert

The mid-day dance session. Photo: Gustav Cappaert

After a quick snack, the midday program is a stretch routine followed by dance. Those able to stand dance with the staff to traditional Sanjuanito music. The day ends with lunch and another course, for me a rhythm and singing exercise built around Daniel Lazo’s South American classic, “Ojos Azules.”

Rosa Irene Lliugin, a resident of the Chimborazo center.

Rosa Irene Lliugin, a resident of the Chimborazo centre. Photo: Gustav Cappaert

Rosa Irene Lliguin moved into the center in March 2015, after her debilitating arthritis made her solitary life in the community of San Andres untenable. Her hands and feet are badly deformed from a life of farm work and washing laundry.

“In the health post they measured my bones and gave me pills. The nurse told me, ‘Rosalita you shouldn’t be up here alone. Let’s go,” said Lliguin. Never married, Rosa is childless. Her family consists of a sister and scattered network of cousins and nephews.

In the center, she says, she has found a surrogate family. “We all get along,” she said, “[other residents] help me, they comb my hair, which is hard for me.”

Humberto Vizuete, a former cane-cutter from the coast, told me: “This distracts a person…you don’t think so much of the life that has passed you by. It’s all new. Here they teach you to live another day.”

Apart from the realities of aging, there is nothing sad about life in the center. Every resident I spoke to told me that they are happier there than alone at home. The Quito center has seen at least five weddings.

“I always say, this is not an asilo de ancianos,” said a social worker at the center, using a phrase with the negative connotation associated with mental hospitals or warehouses.

“Abandonment and neglect is pervasive,”

But the government does not plan to build additional centers. For one, they are expensive – at least $8.60 per day for residents and $3.25 for participants in the day program, according to MIES figures. For another, the Ecuadorian government has made it clear that the family should assume responsibility for their elder relatives.

The 2008 constitution devotes three articles specifically to the well-being of seniors, and names “adultos mayores”  as a group that demands special protection. It also makes abandonment a crime.

There is a reassuring myth that tighter ties among poor families in Africa, Asia, or Latin America mean that families take better care of their elders; that despite meager conditions, an old person in a poor country can rest assured that they have a place in the family.

In fact, abandonment and neglect is pervasive the world over. Eleven percent of Ecuadorian seniors live alone. In 2009, about fifteen percent of Ecuadorian seniors responded “yes” to survey questions like, “Has your family threatened to take you to a nursing home?”, “Have they stopped giving you money that you need to survive?”

A resident at the Chimborazo center gazes out the window. Photo: Gustav Cappert

A resident at the Chimborazo center gazes out the window. Photo: Gustav Cappert

Sub secretary Perez told me that the government is focused on the long term: changing a culture that leads to abandonment. They organize “tértulias” in downtown Quito, a chance for young people to meet with the elderly and ask them questions about the past.

Perez finds a model in indigenous communities, which place a higher value on the elder. “With whites and mestizos, it’s different. They say, ‘they’re not useful, they don’t matter,’ and they’re hidden in the last room of the house.

Back to family life?

One of the jobs for workers in the center – each employs a psychologist, social worker, and a day and night staff in charge of care and programming – is to convince families to take responsibility for their relatives.

In Rosa Lligun’s case, social worker Nancy Brito at the Chimborazo center holds regular meetings with the few family members she does have. Her goal is to form an agreement: the family will bring Rosa to the center during the day for meals and physical therapy, and pick her up in the evening.

“If it’s at all possible, we try to reintegrate them back into the family, because Ecuador’s constitution says that the obligation rests with them, and then the state,” Brito said. She is optimistic that Rosa will be with family half-time by September.

While MIES’ direct service programs reach only 70,000 Ecuadorian seniors in poverty, about 500,000 others take advantage of the Bono de Desarrollo Humano, a $50 per month government pension for adults over 60.

Similar countries have instituted pension programs – examples are Pensión 65 in Perú and the Renta Dignidad in Bolivia – but not the kind of organized direct-care effort sponsored by Ecuador.

But Esteban Calvo, a professor of public policy in Chile who specializes in aging, said that Latin America is still in the early stages of old-age policy, with most countries focused on providing the most basic of safety nets.

“Pensions in general are low,” he said, “In Chile, people retire with very little money. Once you’re out of poverty, there’s a long way to go.”

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