COVID-19 and older people in Mexico City: the response of the city’s Department of Welfare and Social Inclusion  (English version)
Mexico City (CDMX) contained just over 9 million inhabitants in 2015 (INEGI, 2019), with a population aged 60 and over of 1.2 million INEGI, 2015). Older people in the city face great challenges in terms of gender equality, education, health, mobility, access to employment, decent work, care, spaces for participation, violence, among many other issues. These have worsened during the pandemic. The current city government of has a Department of Welfare and Social Inclusion (SIBISO) which includes the Institute for Dignified Aging (INED). Mexico City government’s programs and actions for older people have become a benchmark for other cities and for the design and implementation of policies at the federal level.
INED has looked to develop innovative perspectives in terms of care, not only for older people, but as its name indicates, with reference to aging. It places a strong focus on community action.
To carry out these tasks, it has an administration of approximately 80 people and a team of 1,200 people, almost entirely women (only two men), known as Professionals in Services to Older People (PSAM) . The PSAM began operation 15 years ago as health promoters, originally attached to the Ministry of Health. Their profile has been professionalized with training and constant updating to apply a social as well as clinical approach. PSAMs are the heart of the Institute and their main activity is the care older people. This entails neighbourhood monitoring, house by house, developing personalized and direct contact not only with beneficiaries but their families and environments. PSAMs operate as a direct link between older citizens and the government, passing information about older people’s situations and needs back to government agencies.
This community work has been severely disrupted since the COVID-19 pandemic. The work of registering and monitoring beneficiaries has continued, but given the recommendation of social distancing, these have been carried out through a telephone service strategy, trying to maintain closeness and daily monitoring to know if people have any specific needs.
Support for older people living alone or in a situation of abandonment.
During the pandemic, a special program was launched to carry out specific support actions aimed at older people who live alone and who, from the records of the PSAM, are known to lack a social support network and family. In Mexico City, between 10% and 12% of people over the age of 68 live in single-family homes. Although we know that living in a single-family home does not always mean older people lack a support network, it is estimated that this is the case for between 8% and 10% of them.
A dedicated team of 200 PSAM was formed, who are in charge of following up through telephone calls, twice a week, to 5,844 older people addressing aspects of basic needs (food and medical), health care, emotional support and support in carrying out procedures or services. In case people do not respond, a specific follow-up of daily calls is carried out until the person is contacted. Between March and December 2020, 1,793 people were supported who requested help with medicine, food, and errands.
Not all older people who live alone without a support network have financial resources to purchase a telephone or to hire airtime in order to have access to these services. Faced with this reality, the city government worked with foundations and telephone companies to donate devices and airtime to avoid the isolation of this group of older people.
Also, SIBISO has separate focus on “Attention to Priority Populations” which is in charge of offering temporary shelter  to people in a situation of social abandonment. It is estimated that 50% of this population is over 60 years of age.
Support for long-term care facilities (LTCFS).
In the face of the health emergency caused by COVID-19 and given the devastating experiences in different countries, a second special INED program was launched: “Daily monitoring and support of shelters and LTCFs”. INED identified 159 active LTCFs which are monitored on a daily basis in order to strengthen their capacity to face the health contingency. This covers the bulk of the city’s 203 registered LTCFs, although there are many more unregistered ones.
This program is especially relevant as it involves the coordination between the Ministry of Health, the Ministry of Inclusion and Social Welfare, and the Private Assistance Board that regulates Private Assistance Institutions (IAP). The biggest challenge of this collaboration is defining the scope of action of each agency but, thanks to a disposition to cooperate and to work creatively it has been possible to implement the following actions:
- Training in online mode to the staff on care and prevention measures on the COVID-19, its characteristics and measures of prevention, control and care of suspected and confirmed cases.
- Design and delivery of the Action Protocol against COVID-19  and other informational materials.
- Support for the disinfection of spaces through the delivery of cleaning materials (brooms, bleach, antibacterial gel, liquid soap).
- Monitoring and targeting of preventive measures according to the specific needs of institutional care to long term.
- Guidance and telephone support in case of suspected and / or confirmed cases of COVID-19.
- Support for stays in hospital transfers.
- Remote emotional support of caregivers through the Gerontology Coordination Unit, in which a psychology professional conducts an initial interview to assess any problem and, where appropriate, makes a follow-up plan based subsequent telephone calls.
- Medical advice from the Geriatrics Coordination Unit.
In addition to the above, SIBISO through INED, reinforced these actions as of May 2020 through an Inter-Institutional Protocol that consists of:
- Daily telephone follow-up to the 159 LTCFs, regarding their needs for support and action in scenarios of suspected outbreak or contagion.
- Immediate support in cases of suspected infection. The calls are made in the morning and in case of reporting a suspicious case or contagion, the dispatch of the health team is immediately managed to make an on-site review of the situation of both the residents and the staff of the LTCF through the application of tests and medical care.
- On-site identification of the need to transfer to hospitals. This focuses on ensuring that older people with symptoms receive timely care in the shortest possible time. This is due to the fact that cases were observed among people aged 80 and over, which progressed from mild to severe symptoms in a very short period of time.
- Delivery of support / services requested. It was identified that a significant number of LTCF lack the resources for the acquisition of basic supplies, for which reason they are provided food products, basic protective equipment for personnel, and cleaning and disinfection equipment.
Despite these efforts, the progress of the pandemic brought suspected and confirmed cases of COVID-19 inside LTCFs. By December 2020, 38 LTCFs had reported suspected or confirmed cases, with a total of 475 confirmed cases.
By way of conclusion.
Without a doubt, care for older people in one of the largest cities in the world is a challenge. The efforts of LTCFs in the face of the health emergency stand out. There were initial difficulties in establishing communication with the authorities as LTCFs feared being sanctioned, judged, or penalized for their deficiencies. However, following the advice of the 2nd edition of the Technical Guide for the Prevention and Control of COVID-19 Infection in the WHO LTCFs (WHO, 2021), efforts were made to develop a constructive engagement with LTCFs, to enable contact and appropriate responses.
The pandemic has shown the need to update official data on LTCFs and to overcome the technological exclusion of older persons. On the other hand, this crisis has made it clear that the community approach that has characterized INED is its main strength. It has allowed it to carry out work in the territory with knowledge of the economic, emotional, social and family conditions of the beneficiaries of its programs. This has helped the monitoring and implementation of these programs and also informed the design of emergency measures.
Prompted by the crisis the creation of a Public Care System for Mexico City involving various government agencies such as the Secretary of Inclusion and Welfare, the Secretary of Health and others is now being discussed. Perhaps there is no more propitious moment than this health crisis, to value the human right to care and public health among the most disadvantaged populations.
 The authors acknowledge the participation of Diego Ruiz Adoney and Karen Madrigal for the compilation of statistical information and information transcripts for this document.
 Interdisciplinary University Seminar on Aging and Old Age (SUIEV), U NAM.
 Secretariat of Inclusion and Social Welfare, Government of Mexico City.
 Institute of Worthy Aging, Secretariat of Inclusion and Social Welfare, GCDMX.
 Social Research Institute and Coordinator SUIEV, UNAM.
 This program began in 2000 with the current president of Mexico as Head of Government and recruited health advocates, women and men alike, but were on the the they got the job and over 20 years they have been maintained, now with a base position in the Government.
 This temporary home is Espacio TECHO (Transition between the Street and the Home), it is a temporary shelter that offers case-by-case support to people in the process of integration and social inclusion. In this temporary home, people have previously been valued at the Valuation and Channeling Center (CVC), they can continue advancing in their process of social inclusion, if required. It offers quality social services such as: social care, medical care and specialized care on a case-by-case basis, where a social worker provides accompaniment to 20 cases of people who have decided to start their process of social inclusion.
 https://www.jap.cdmx.gob.mx/portal/index.php?option=com_docman&view=download&alias=3969-si-ntesis-de-las-medidas-de-prevencio-ny-control-frente -al-covid-19-in-asylum-or-residence & category_slug = 2020-misc & Itemid = 262 & lang = en
Legislative Assembly of the Federal District (2000). Rights Act of Older Persons in e l Federal District. Available at: http://aldf.gob.mx/archivo-5d5da3bf9e7789d0a15995a3ac41c83d.pdf
INEGI (National Institute of Statistics and Geography) (2019). Statistical and Geographic Yearbook by Federal Entity 2019.Available at: https://www.inegi.org.mx/contente/productos/prod_serv/contenidos/espanol/bvinegi/productos/nueva_estruc/AEGPEF_2019/702825192242.pdf
INEGI (National Institute of Statistics and Geography) (2015). Intercensal Survey. Available at: https://www.inegi.org.mx/programas/intercensal/2015/
WHO (Organization World Health) (2021) Infection prevention and control guidance for long-term care facilities in the context of COVID-19 update. https://www.who.int/publications/i/item/WHO-2019-nCoV-IPC_long_term_care-2021.1