By Peter Lloyd-Sherlock and Karla Giacomin. 

With contributions from the Poliana Fialho de Carvalho, Wanderson Bomfim and Renan Amaral

October 2025

Caring for an older person with a high level of care need is an incredibly demanding, exhausting and often soul-destroying job. This is especially true when the person responsible for performing this role has to do it almost entirely on their own, unable to afford private care assistance or support from the state. And this is the reality facing fast-growing numbers of poor Brazilians, most of whom are women.

Here is a typical example of the daily situation faced by a woman in a poor neighbourhood of Salvador, Bahia, as recounted by a local social assistant. The woman herself was too busy and exhausted to provide an interview:

Every morning, she goes out early to work in another part of town and gets back at about three. The house has two floors and at night she sleeps upstairs with her two young daughters, while her mother prefers to stay downstairs. If she hears any noise she has to go down and check. This arrangement makes her very tired. There are days when her mother does quite well, but then there are weeks when she talks to herself and sees people who are not there. The daughter says she is always turning the gas stove off, but her mother knows how to put it back on again. Before she goes upstairs to sleep, she has to close the windows and make sure everything is locked up and switched off.

She is always multi-tasking. She needs to worry about her job, so there’s enough money for the family, there are the two young girls to look after, the house and then she has to do so much for her mother. She says her mother has a lot of medical appointments and that managing the medication is a lot of work. And all of this puts pressure on her job, because she has to ask for time off to take her mother to appointments. This is an exhausting routine, but she says the hardest thing is to see her mother so affected by this disease and knowing it will just get worse. She says that the emotional overload is much greater than the physical one.

Experienced day after day, this constant level of stress and exhaustion leads to more specific health conditions, like depression. This testimony from a woman in a poor neighbourhood in Belo Horizonte who cares for obese, bedbound mother in very representative:

I started to use medication because I was having some kind of breakdown. I couldn’t take it. It was just too much for me. My body was in a mess and I just I couldn’t handle it. The pills helped for a while.

The heavy toll of unpaid caregiving for older people on women’s mental health has been widely documented across Latin America, including in Brazil (Sandoval et al, 2019; Mendes et al, 2019). It is well-understood that the consequences of poor mental health are profound and multi-dimensional. In the case of unsupported family carers, this is also likely to have negative effects on the quality of care received by frail and vulnerable older people. In our research in poor urban neighbourhoods, we have been made aware of many cases when constant stress and anxiety spills over into conflict and violence, if unaddressed. According to one social assistant in Contagem:

Both the family caregiver and the older person get so stressed. Because you pick up the stress of the person next to you. Everyone gets into a state and is afraid to say anything which might cause a fight. They stay silent and get angry because they need to talk it over. And it ends up snowballing.

What is the best way to respond to this growing problem? One potential model has been developed in Belo Horizonte, Brazil: Programa Maior Cuidado (PMC). PMC supports dependent older people in poor communities. Health posts and social assistance centres identify eligible families and provide integrated support. Trained paid caregivers provide families 10-20 hours of support a week. More details about PMC are available here (https://publications.iadb.org/en/programa-maior-cuidado-integrated-community-based-intervention-care-older-people).

We have been studying PMC for several years, with a particular focus on how it affects older people in need of care. Among other things, we have found that PMC improves older people’s health and eases pressure on hospitals and primary health care (Lloyd-Sherlock et al, 2022; Lloyd-Sherlock et al, 2023). But what about the health and wellbeing of their family caregivers?

The 10 to 20 hours of care offered by PMC often represents a window of freedom, respite and sanity for family carers. They may use the time as a moment to rest and emotionally recharge, or as an opportunity to engage in other activities in a less hurried, worried and stressful way. Here are some testimonies from female family caregivers about their experiences:

I think I have more peace of mind at work. When the PMC carer visits, I feel in a better condition to work or do something in the house. I know I will feel calmer… I need to go out and earn, regardless of whether we get PMC. But now I have more peace of mind to work during the four-hour visits. I have this peace of mind to do what I have to in the house and then go to my job. Because I know there is a person in the house who I can count on to help with the care.

I even have better visits to the market because I have more time to shop. Before PMC, I had to hurry there and back, so my mother wouldn’t be left alone. These days I can be more organised, thoughtful and relaxed when I shop. They may be quite small things, but they make all the difference in life.

My head started to feel lighter! I felt relieved and less worried. When your head is full of worry and things keep going on and on, it can end up wrecking your own life just as much as the person you’re looking after. There used to be times when I would just watch her sleeping there and my mind would be going a thousand miles an hour just watching.

I started to feel like giving up. I said to myself “Wow! I’ve given up on all my things, I feel bad, my health is getting worse, and all so I can take care of her so she might be able to walk again.” And then we got the news she would never walk again, and I just felt exhausted. But now, thank God, I’ve accepted in my head that there is no way she will walk. I just need to make sure she has a peaceful life at home. With the PMC carer I can make her happy until the day God decides to call.

Another important way PMC supports the mental health of unsupported family carers is through the daily presence of the social carers. Although their main focus is on caring for the care-recipients, they often provide an important source of emotional support for the overwhelmed family carers.

I am leaving my mother more time just with Ju [PMC carer]. But then Ju and I talk a lot too. She’s someone I feel I have the intimacy to talk to. And doing that helps calm me down… We’ve become fond of each other. It’s nice because she understands. She knows what we really go through, you know, at home, that we both want the best for my mother.

Talking with the PMC carer is so good. My God! I realised I was falling into a depression. Then, when PMC arrived, I said “Dear God, what a blessing!” I’ve been letting go, letting go, you know? I had just kept on thinking about him. “My God, why are you on top of that bed there? OK so you’re ill. Fair enough. We are all going to hurt in life, yes. Why are you talking like that? All day talking, right? I kept asking God about this, day and night… But after talking to the girls [PMC carers], you know, I just stopped doing that and things got better.

Returning to the woman whose situation we described at the start of the paper, this is what PMC meant:

PMC brings her a breathing space, relief and company. When she gets home from work, she can lie down, take a shower or a nap. And know that her mother is fine, know that her mother has someone there. She has someone to share her troubles with. She told me “Mari, it’s like a dream come true now having this person in my life”. She didn’t have anyone who she could talk with about these things before PMC.

There is robust evidence that PMC generates a wide range of positive effects on those older people who need care and those family members who struggle to provide it. This short paper extends this evidence to demonstrate how PMC often represents an emotional and psychological safety-net for many of the most vulnerable women in Brazilian society.

For more information about this project, please contact Peter Lloyd-Sherlock
(peter.lloyd-sherlock@northumbria.ac.uk).

[1] This brief is part of a project developed within the framework of the project Initiatives to Strengthen Care Policies in Latin America and the Caribbean, led by the Group for the Analysis of Development (GRADE), in collaboration with the Global Alliance for Care (GAC), the United Nations Research Institute for Social Development (UNRISD), and with funding from the International Development Research Centre (IDRC). For further information, see https://sites.google.com/view/carefundeconomyla

REFERENCES

Cafagna G., Aranco N., Ibarrarán P., Oliveri M., Medellín N. And Stampini M. (2019) Age with Care: Long-term Care in Latin America and the Caribbean. Inter-American Development Bank https://publications.iadb.org/en/age-care-long-term-care-latin-america-and-caribbean

P.Lloyd-Sherlock, S.Sasat, F.Morales and A.Pot (2017) “Long-term-care policy in Thailand and Costa Rica and the role of volunteers: Key success factors for development and implementation”. Bulletin of the World Health Organisation 95(11): 774–778.

Sartini CM, Correia AM. Programa Maior Cuidado: qualificando e humanizando o cuidado. Pensar/BH Política Social, 2012;31:10-13.