The SAD+Saúde pilot brings together social home support and health care for people in situations of dependency, incapacity or disability who cannot, temporarily or permanently, meet their basic needs or health care needs.
It started with protocols between Portugal's Social Security Institute and five social-sector organisations, one per mainland region: Associação de Solidariedade de S. Pedro (North), Santa Casa da Misericórdia de Arganil (Centre), Fundação AFID Diferença (Lisbon and Tagus Valley), Santa Casa da Misericórdia de Mora (Alentejo) and Santa Casa da Misericórdia de Portimão (Algarve).
Services include meals, personal hygiene, medication support, laundry, house cleaning, accompaniment outside the home — pharmacy, supermarket — and psychosocial support. The teams are multidisciplinary, drawn from social, behavioural and health fields.
What it signals
Five institutions do not change a country. What changes is the design: for the first time in a pilot of this shape, social support and health care come through the same door, in the person's home.
Anyone working in this field knows the absurd boundary this is trying to erase. The lady has home support from the Misericórdia, which brings lunch and helps her wash. She has a health team from the health centre, which visits when it visits. The two rarely speak. The person is the same and the problem is the same, but there are two records and decisions are made blind on each side.
Integrated care does not fail for lack of goodwill. It fails because there are two budgets, two ministries and two information systems — and the person is in the middle.
What it means for anyone thinking about technology
Something uncomfortable, worth saying: the home is the hardest context for any equipment.
In a care home there is a room, a known socket, a responsible person and a routine. At home there are stairs, a sofa pushed against the window, a carer who is already exhausted, and a professional who stays forty minutes and has six more visits that day.
We have written about what technology does — and mostly what it does not — in informal carers: what technology does at home. The conclusion stands: at home, the most valuable thing is rarely a new device. It is somebody's time, and information that crosses the boundary between social care and health.
Where RVer fits into this
Honestly: today, not in the individual home. The system is used by clinical teams in institutions — hospitals, clinics, care homes, continuing care and palliative units. That is where the routine, the training and the responsible person an accompanied session requires actually exist.
What SAD+Saúde signals, and what matters in the medium term, is something else: care is moving into the home. Anyone designing tools for this sector has to assume the activity room will not be the only place they are used — and that a tool needing internet, technical configuration and an IT person nearby will not get there.
It is one of the reasons playback works with no internet and the device runs in kiosk mode. It was not designed for the home; it was designed for institutions where the network is poor and nobody has time. It turns out the second condition describes the first rather well.
Sources: Government launches the SAD+Saúde pilot, Portuguese Government; SAD+SAÚDE project, Fundação AFID Diferença.