TABLE 3. How long-term institutional care is implemented in the four selected Latin American countries, 2023.

Characteristic	Country
	Brazil	Chile	Costa Rica	Mexico
Scope and access to institutional LTC	SUAS, public prosecutors and local governments usually mediate access to public and private not-for-profit facilities, but there is no transparency about how this access is regulated. In private for-profit facilities, access occurs according to the ability of residents or their family to pay the fees, the availability of beds and factors such as the location and quality of care.	SENAMA and local governments prioritize access to public LTC facilities based on social vulnerability criteria. There is no centralized system for prioritization for private for-profit and not-for-profit facilities, and access is based on the user's ability to pay and personal preferences. However, not-for-profit establishments can receive payment subsidies.	There is no established profile for admission to institutional care. Older people are institutionalized due to abandonment, health conditions (dependency) or family decisions	The number of LTC facilities in Mexico is low and unequally distributed. States with large metropolitan areas have the highest concentration of LTC facilities for older adults. According to census data, in 2020 the overall proportion of adults aged ≥ 60 years living in these facilities was 0.19%. Most older adults in Mexico live at home, either alone or under the informal care of family members.
Statutory inspection bodies	ANVISA; SUAS; Municipal Councils of Older Adults; public prosecutors	SENAMA; Ministry of Health	Ministry of Health; CONAPAM	DIF; INAPAM
Information systems	LTC facilities should report to local inspection bodies the occurrence of events such as a fall with injury, suicide attempt, and incidences of acute diarrheal disease, scabies and dehydration among residents, but there are no regulations about collecting and publicizing this information.	LTC facilities are overseen by the Ministry of Health, which reviews quality regulations, including those for infrastructure and staffing ratios. Additionally, since the beginning of the COVID-19 pandemic, SENAMA has maintained an internal registry that contains information about the number and characteristics of LTC facilities.	The indicators and procedures for authorizing and evaluating LTC facilities, whether public or private, for-profit or not-for-profit, are the responsibility of the Ministry of Health. Outbreaks and mandatory reporting of diseases are notified to the Ministry of Health. CONAPAM keeps an updated registry, accredited by the Ministry of Health, of citizens and legal immigrants, but this includes only those who receive a subsidy from CONAPAM.	Information on LTC facilities is registered using a component of the 2020 national census conducted by INEGI, which evaluated Social Assistance Accommodation (Alojamento de Assistência Social). Data about LTC facilities include the number of beds, available spaces and facilities and equipment; civil protection services; number and type of toilets; number of showers; adaptations for people with disabilities; and overall capacity. Public LTC facilities register their data directly with DIF and INAPAM.
Financing of institutional LTC	No regulation defines the amount or percentage of financing that the government must transfer to fund public and not-for-profit LTC facilities. Most not-for-profit facilities rely on their legal prerogative to use up to 70% of residents' income to support their funding; donations and local public–private partnership funding cover the remainder of their costs. Residents’ and their family’s incomes pay for care in for-profit facilities, without tax reimbursement or financial compensation.	Multiple financing mechanisms are provided by SENAMA to subsidize private LTC facilities, including funds through FONASA for infrastructure improvement, operation, and payment for bed–days. However, there is no regulation about how facilities can use income from each resident.	For public LTC facilities, CONAPAM determines the technical criteria for distributing public financial resources for programs and services provided to older adults. The Social Protection Board (Junta de Protección Social) is empowered by law to transfer money to support programs for the management of organizations financing the basic needs of residents in LTC facilities. Pensions for older adults complement other sources of financing. In the case of private LTC facilities, costs are covered by the older person's family.	INAPAM and DIF concentrate on the 107 public LTC facilities receiving federal financing, which represent only 7.1% (107/1 504) of such facilities. The rest are privately operated (i.e. registered as civil associations, private assistance institutions, civil societies, religious associations, market associations or in an unspecified category). For all privately operated LTC facilities, costs are usually covered by residents, their families or donations provided directly to the facility.

ANVISA: Agência Nacional de Vigilância Sanitária (Brazilian National Health Surveillance Agency); CONAPAM: Consejo Nacional de la Persona Adulta Mayor (National Council for Older Adults); DIF: Sistema Nacional para el Desarrollo Integral de las Familias (National System for the Integral Development of the Family); FONASA: Fondo Nacional de Salud (public health insurance system); INAPAM: Instituto Nacional de las Personas Adultas Mayores (National Institute for Older Adults); INEGI: Instituto Nacional de Estadística, Geografía y Informatica (National Institute for Statistics, Geography and Information); LTC: long-term care; SENAMA: Servicio Nacional del Adulto Mayor (National Service for Older Adults); SUAS: Sistema Único de Assistência Social (Unified Social Assistance System).

Source: Table developed by the authors based on the results of their research.