San José, Costa Rica, since 1956

Caja program subsidizes family hospice care

One year ago, 57-year-old Olga Mejía was diagnosed with an advanced stage of bowel cancer. Her daughter, Kathia Badilla, made sure to be at Mejía’s side when she was diagnosed to provide support and company. But she had time for little else.

A mother herself, Badilla worked both day and night shifts at a local Pizza Hut call center in Pavas, a western district of San José. Her job and obligations at home left her little time to care for her ill mother.

Badilla took days off of work to take her mother to doctor visits. As Mejía’s condition worsened, Badilla needed more time to help her mother. She asked for vacation time. Soon, doctors at the hospice clinic at Calderón Guardia Hospital said Mejía’s cancer was terminal. 

“The doctor asked me if I was going to be able to take permanent care of my mother. I was perplexed. I told the doctor that I was already struggling with my work. I live in Desamparados, and at the time it took me two hours to travel from my house to work, and two more to get back. That’s when the doctor told me about the possibility of a work-release permit to take care of my mother full time,” Badilla said. 

The program the doctor referred her to is called “Benefits for Caretakers of Patients in End-of-Life Care.” It helps patients receive hospice care from family members or friends. The program encourages wage earners to take a leave of absence from work to provide loved ones with hospice care. If both patient and caregiver meet the program’s requirements, the Costa Rican Social Security System (Caja) pays caregivers a subsidy to fully dedicate time to providing care. 

In order to be part of the program, both patient and caregiver file a request to the hospital. Participants do not have to be relatives. A doctor conducts a medical examination determining the patient’s terminal condition. According to the law, if workers earn less than the total of two minimum wages, they receive a full month’s salary. If they earn more than the sum of two minimum wages, they receive the sum of two monthly salaries and 60-80 percent of the difference between salary and the sum of two minimum wages. Participants remain on employer payrolls at zero salary. This measure allows them to return to work when possible.

The permit is renewed every month, and payments are directly deposited in caregivers’ bank accounts every six days. “Last year, the Caja issued 4,679 permits to caregivers. A total of ₡582 million [$1.2 million] was invested in this program,” said Gerardo Arias, head of the Caja’s Benefits Assessment Office. An average of 405 permits was assigned every month during the first six months of 2011. This year’s budget is ₡983 million ($2 million), but according to estimates, only ₡712 million ($1.4 million) will be spent. 

The program was created by a 1998 law and is financed through the Family Allocation Program Fund. Yet, many people don’t know it exists. 

To increase awareness, Caja officials launched a new campaign called “Cuidémoslo Juntos” (“Join Together to Provide Care”). According to a Caja spokeswoman, “the campaign aims to remind people about the existence of the program and promote care from family members or friends, who tend to have a bigger impact on the clinical and psychological condition of sick people.” 

Badilla says she is grateful for the assistance the program has given her in the past 10 months. While still a difficult situation, Badilla says she is happy for the time she now has to care for her mother. Having Badilla around has also helped her mom battle depression. “I believe it is a great advantage to be able to spend more time with my mother and enjoy her company while I can,” said Badilla.

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