November 13, 2017 07:42 GMT by theguardian.com

Sí, seniors: the Chilean city with grand plans to be the best place to grow old

Sí, seniors: the Chilean city with grand plans to be the best place to grow old

Promising supervised flats, nursing homes and levelled streets, Valdivia’s Gerontological Hub project is tackling Chile’s ageing crisis head-on. Can it offset the country’s shockingly low privatised pensions?

Imagine a city that allows you to live your final years with grace and dignity. Where, if you’re alone and facing challenges but still physically and mentally independent, you can move into an apartment complex with a supervisor to provide support and organise workshops and gatherings in a community room. Where there’s an affordable transport system adapted to your needs, along with well-lit and maintained streets that won’t cause falls, as well as extended crossing times at traffic lights, roofs over the pavements to shelter you from the rain and attractive plazas and parks offering exercise equipment.

If your health is impaired, you can receive home visits from caregivers, priority healthcare at clinics and hospitals, and access to rehabilitation centres. Where there are flexible opportunities to re-enter the labour market if your pension isn’t enough. And if you can’t care for yourself and have no support network, there are well-equipped and staffed nursing homes.

Such are the proposals for Valdivia, the picturesque capital of the wind- and rain-swept Los Ríos region in southern Chile.

“The idea is to create an age-friendly city that offers elderly people opportunities for real participation, and then extend the scheme to the rest of the country,” says Octavio Vegara, director of Fundación Oportunidad Mayor, the driving force behind Valdivia’s World Health Organisation-inspired Gerontological Hub project.

Libertad in central Valdivia.
Libertad in central Valdivia. Photograph: Yury Gubin/Alamy

The world’s over-65s will soon outnumber its under-fives for the first time in recorded history. This poses a critical question: will ageing populations stay healthy, with a sense of wellbeing, social engagement and productivity, or will they face illness, disability and dependency? Many countries are already struggling to look after their elderly, Chile among them.

The South American nation’s 3 million over-60s represent 17% of its 17.5 million inhabitants. In Valdivia, the proportion is even higher at 20% of a total 150,000 – set to rise to 25% in the next decade. Yet the city’s main public hospital has no geriatric unit.

According to WHO recommendations, Chile should have at least 500 geriatricians. But there are only around 80, three-quarters of whom work in the private sector, while the few that are employed in the public sector are all based in Santiago. The Gerontological Hub project aims to address this issue by helping to set up a dedicated unit in Valdivia’s public hospital, and a new geriatric studies department at the local Austral University, with the final aim of providing southern Chile with a constant flow of much-needed specialists.

In terms of housing for the elderly, Valdivia’s only supervised residence was opened in May 2013. Providing bungalows for 20 seniors, it was built in one of the most rundown districts of the city. Soon after the first residents arrived, a barbed wire-topped wall was placed around the complex, which looks a little prison-like but at least deters local thieves. A supervisor worked at the complex during the first year, but then the residents were left alone for the next three – which were, they say, rather grim. Finally, in June of this year, as part of the Hub project, they welcomed new supervisor Gabriela Castro.

Residents of the Valdivia supervised living apartments.
Residents of the Valdivia supervised living apartments. Photograph: Piotr Kozak

On the day I visit the complex, a group of seniors is waiting ready to be interviewed in their community room, their table laden with tea and cakes. Herminia, Fernando, José Miguel, Elisa, Claudio, Graciela, Erica and Andrés heap praise on Castro, who they say has transformed their small housing estate. “It was really rundown when I got here,” the supervisor remembers. “There’d been no maintenance for years and it was in such a bad shape, which was having a negative impact on relationships between the residents.”

When questioned about how the elderly are treated in Chile, most of those present say they feel ignored by wider society, although the biggest problem is trying to survive on a state solidarity pension of 104,000 pesos (£125) a month and pay for food, services, medication and heating fuel. “I spent all winter in bed just to keep warm,” says Fernando. “I simply didn’t have the money to buy gas for my heater.” In the case of the 84 year-old journalist Andrés Apolinario Sandoval Pineda, who has lived in the complex for four years and still works full-time for a local radio station, there is at least some light at the end of the tunnel. “At last people are starting to wake up in Chile,” he says. “They’re beginning to offer us what we deserve in terms of our age; there’s more attention to our needs than before.”

‘At last people are starting to wake up in Chile’ … Octogenarian journalist Andrés Polinario Sandoval Pineda.
‘At last people are starting to wake up in Chile’ … Octogenarian journalist Andrés Polinario Sandoval Pineda. Photograph: Piotr Kozak

Apart from the complex, there’s the newly built Padre Pío nursing home, catering to 100 dependent or abandoned seniors, as well as street repairs in two neighbourhoods where the majority of residents are elderly, and some city landscaping – which is only the start. Within the next three years, the city should have a rehabilitation centre staffed by fifth-year medical students that treats 80 patients a day, a local government-funded spa and recreation centre, and a hospital geriatric unit with 10 beds.

The city council is also in talks with local transport companies about updating a rundown bus service (for which seniors pay full fare), and exploring the introduction of a trolleybus system. However, larger initiatives such as these are dependent on central government funding, and so far a firm commitment has not been made at ministerial level. Upcoming presidential and legislative elections on 19 November mean it’s unlikely such issues will be resolved until after the next government takes office in March 2018.

The overall signs for Chile are positive, however, thanks to the upturn in the global economy and the forecast impact on the country – particularly the increasing price of copper, Chile’s main mining export. Experts say this will boost the revenue of next year’s incoming government, and allow it to increase social investments in areas such as Valdivia, if it wishes.

For Vergara, progress is being made to improve the lives of the elderly in Chile, albeit late in the day. “All of the key stakeholders are at least discussing the issue now,” he says, referring to government officials, the health service, academia and the business community. However, he warns that Chile lags so far behind in terms of elderly care that matters will get worse before they improve. “We have the fastest-ageing population in South America,” he says, “and at the moment we’re like a car driving at high speed towards a brick wall. What we’re trying to do with this project is at least provide a couple of airbags to cushion the impact.”

Vergara believes that the only long-term solution is that the private sector becomes more involved. “We need more people – such as a physiotherapist who forms a small business with an occupational therapist – to provide healthcare in people’s homes … because if the state is left to resolve such issues, it’s not going to be able to generate the level of care that’s really needed,” he says.

State provision for the elderly in Chile has certainly improved in recent years, but marginally so given the size of this portion of the population, and the poverty and ill health many are exposed to. Most pensions are well below the minimum monthly wage of 250,000 pesos (£300), while the state solidarity pension, awarded to those elderly who have no other income, is withdrawn altogether if the recipient takes up some type of formal employment.

In terms of resources at the national level, Chile is certainly not poor, thanks to its mining, forestry and pulp, wine, salmon, agriculture and financial services industries. However, given the nature of its economy, the inequalities in opportunities and income, and the government’s limited resources, funding for social welfare, healthcare and education are always stretched. Almost half of the state budget in Chile is raised via VAT (in the UK, the same figure stands at 17%), representing an acutely unfair sharing of the tax burden. Another 40% is raised through income tax on individuals and companies, and the contribution from the state copper company, Codelco, makes up most of the rest, varying according to the price of copper. Tax avoidance, as in most of the world, is rife.

A view of Valdivia from across the Cruces river.
A view of Valdivia from across the Cruces river. Photograph: Getty Images/iStockphoto

And while 1% of the Chilean population receives 33% of the country’s income, with multimillion and even billion dollar fortunes common among the elite, over half the workforce are paid less than 300,000 pesos a month. Thanks to the country’s controversial “AFP” private pension system – trumpeted by free-market devotees when it was rolled out under Pinochet, but which has turned out to provide shockingly low returns and sparks regular protests – low-income workers can be assured of future pensions that will barely cover their basic needs.

The issue of low incomes among the elderly is addressed by the Fundación Oportunidad Mayor project through a two-pronged approach. One is that the provision of improved healthcare will enable the elderly to recover their physical autonomy and be fit enough to go back to work and top up a low pension. The other is a lobby at the legislative level, seeking to allow the most vulnerable to keep their solidarity pensions if they do take up work, and to encourage companies to take on more seniors by relaxing employment laws. When asked about the latter, one government economist wryly commented: “All they want to do is tap into more cheap labour.”

However, the reality in Valdivia and the rest of the country is that many seniors who have no family support are obliged to keep working well past their retirement age regardless – otherwise they’d starve.

Such is the case for petrol pump attendant Isias Riquelme. Aged 74, his monthly AFP pension comes to 120,000 pesos. His rent in a boarding house is 90,000 pesos. Medication for acute pulmonary fibrosis after 50 years of exposure to petrol fumes costs another 150,000. At the petrol station he’s paid the minimum wage and receives the customary tips for checking oil and water levels and cleaning windscreens. “I’ve got no choice but to work and carry on inhaling the fumes,” he sighs. When I ask him what about his future, he replies: “I’ll just have to die.”

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