Palliative care is a right, not a privilege

"Palliative care does not mean giving up. It means refocusing the focus on the quality of life that remains!" (Author Unknown)

Palliative care is an approach that improves the quality of life of patients facing an incurable illness, as well as their families, through the prevention and relief of suffering through early detection and prompt treatment of pain and other problems - physical, psychosocial and spiritual (World Health Organization).

The lack of palliative care for older, and not only older, residents represents a huge social, health and humanitarian problem, not only in Montenegro. The number of chronic, incurable patients, oncological and others, who spend the last days and months, and rarely even years, of their lives in severe pain, without adequate medical, psychological and systemic support, is constantly increasing. This problem directly affects not only the patients but also their families.

In addition to health institutions, which are primarily responsible for the care of palliative patients, it is necessary to include all segments of society that can contribute to the provision of palliative care. While efforts are being made in the world to improve palliative care as much as possible, with Great Britain, Austria, Germany, the Netherlands, Norway and other countries leading the way, in Montenegro it still remains a government “information” on paper. The most seriously ill patients, those for whom medicine can no longer offer a cure, but can provide relief, are most often left to the family, which is unable to provide them with all the care, such as pain relief, etc. There are frequent examples where the sick, unhappy themselves, take care of the sick, untrained and without the support of society and competent institutions. Or, simply, there is no one to take care of them, due to single life, or, often, due to discord in the family.

In March 2022, the Government of Montenegro adopted the Information on the Establishment of Palliative Care in the Health System, the aim of which is extended hospital care, rehabilitation and palliative care for patients in the terminal phase of the disease, which would improve the quality of life for them and their families, until the patient's death. The then Law on Health Care stipulated that health care, which is provided at the primary level, also includes palliative care for patients, through field multidisciplinary teams (doctors of medicine, psychologists, physiatrists, nurses/technicians, etc.). Health institutions that provide hospital health care can also organize long-term - extended hospital care, rehabilitation and palliative care for patients in the terminal phase of the disease. "Nothing has been done on this issue so far," the Government stated, so the then Ministry of Health planned to establish a Council for the Implementation and Monitoring of Palliative Care in Montenegro.

While in the world (especially in Europe) palliative care is developing and improving in line with the aging process of the population and the progression of not only malignant diseases, in Montenegro no one pays attention to these devastating facts. According to Monstat's estimate, in Montenegro the number of people over 65 years of age was 108.493 in mid-2025, and around 110.000 at the end of 2025.

Our health system has apparently been freed from caring for palliative patients, which does not only include the elderly, unlike in an earlier time, when many patients spent their last days of life in the SP “Brezovik” Nikšić, general hospitals and KCCG, while social work centers referred their residents to the Home for the Elderly “Grabovac” in Risan. Today, there is a lack of appropriate specialized institutions and medical staff, we still do not have specialization in the field of palliative care, we do not have educated nurses and technicians, we do not have caregivers... simply, our society and health system do not have the will or knowledge to devote themselves to this pressing problem. They even shut down home treatment services at health centers, among whose patients there were many seriously ill people. The importance of these services is demonstrated by an example from Nikšić in 1997, when the Home Treatment Service with Palliative Care, led by the head, Dr. Ljiljana Adžić, received the “18. September” award, at the suggestion of patients and their families.

It is obvious that our authorities, led by the Government and the Ministry of Health, are relying on nursing homes, with a total capacity of 1.038 beds, because the Nursing Home in Plav (with 62 beds) has not yet opened. What can we say - 1.100 beds for 110.000 residents over 65?! Sad and inhumane! The even sadder truth is that not all palliative patients are elderly and have no place in nursing homes! It is true that these institutions, with a shortage of medical and other staff, are trying to serve palliative care departments within their structure, but nursing homes cannot take on the role of the public health system, within which they do not work!

The Report for 2025, as of December 1, 2025, for the Nikšić Home for the Elderly, contains the following data: a total of 138 beneficiaries, of which 62 in the Geriatrics Department, 35 in Palliative Care, 6 in Dementia, and 35 in the Psychogeriatrics Department. It is estimated that, since the day the first beneficiaries were admitted (the period was not specified), 59 beneficiaries have died.

In the Home for the Elderly in Podgorica, at the end of 2025, there were 250 beneficiaries, of which: 120 in geriatrics, 20 in dementia, 108 in palliative care. Since psychogeriatrics cannot be formed due to a lack of staff, two beneficiaries were placed in the Palliative Care Department. There were 279 potential beneficiaries waiting to be admitted to this Home, of which 107 for palliative care.

The above figures tell us that the need for palliative care for patients in Montenegro is enormous, while the healthcare system sends us a clear message that caring for the most seriously ill patients is not a priority. “Palliative care is not a question of statistics or economics, it is a question of humanity and dignity. A country that does not know how to take care of its most seriously ill members shows that it has not yet learned the basic lesson of social solidarity...” (etoportal.me.)