Older residents say reorganized services are making care harder to reach, while IESS says the changes were required.

Retirees take their complaints to IESS

Retirees in Cuenca are challenging changes at the city’s IESS Centro de Atención al Adulto Mayor, saying the reorganization of medical and physiotherapy services has made it more difficult for older residents to receive services they previously found in one location.

The complaints were formally submitted to the Azuay provincial office of the Ecuadorian Social Security Institute, or IESS, on September 18th.

Among the retirees’ primary concerns is the transfer of two medical professionals from the senior center, commonly known as the CAAM, to an IESS dispensary near the San Alfonso church in central Cuenca.

Retirees say the change now requires some older patients to travel between facilities for services that had previously been available at the CAAM.

They are also objecting to changes in physiotherapy. According to their complaint, three professionals who had been providing services at the center are no longer working there, a change retirees say is affecting treatment and recovery for elderly users.

The dispute involves a facility with thousands of registered users. Retirees put the number of people associated with or benefiting from the center at 3,723. IESS provincial director Claudia Ortega said the CAAM has 4,177 registered users, of whom 2,544 are currently active.

IESS says the center is not a medical facility

IESS officials dispute the suggestion that medical services are simply being taken away from retirees.

Ortega said the Cuenca CAAM is part of the agency’s Active Aging Program and is not classified as either a medical or rehabilitation facility.

The distinction is important because it determines which services the center is legally authorized and equipped to provide.

According to Ortega, the reorganization of consulting rooms and other spaces followed requirements and observations made by Ecuador’s Agency for Quality Assurance of Health Services and Prepaid Medicine, known as ACESS.

IESS says the changes are therefore intended to bring the center’s activities into compliance with the type of facility it officially operates as and with its authorized portfolio of services.

The CAAM continues to provide physical, cognitive, cultural and recreational workshops Monday through Friday, according to IESS.

Those activities are intended to help older adults maintain mobility, independence and social connections rather than function as conventional medical treatment.

IESS operates similar programs throughout Ecuador. Its national senior program includes occupational therapy, recreational and social activities and other programs intended to promote active aging.

Separately, IESS pensioners remain entitled to healthcare through the agency’s regular medical system, including general medical treatment, diagnosis, rehabilitation and specialist care when appropriate.

Retirees say the building itself is a problem

The dispute extends beyond where doctors and physiotherapists work.

Retirees have also raised concerns about the physical condition and suitability of the Cuenca CAAM and have requested that the facility’s operation be reviewed with participation from the Cantonal Council for the Protection of Rights and the Ombudsman’s Office.

Those concerns received support from the Azuay Citizen Health Observatory, which says the existing facilities are inadequate and poorly suited to the activities offered to older adults.

The organization has called for construction of a new gerontological center designed specifically around the needs of Cuenca’s elderly population.

The accessibility issue became particularly visible during a recent visit to the facility when an elderly woman lost her balance at the entrance, fell and was injured.

For retirees, the incident illustrated a broader concern: programs designed specifically for older adults need buildings and services that account for the mobility limitations many of those users inevitably have.

A center with a long history in Cuenca

The CAAM has been an established part of IESS services in Azuay for years.

As far back as 2020, IESS reported that approximately 3,000 retirees were active participants in 34 senior workshops in the province. The agency said at the time that the Cuenca center had undergone improvements intended to adapt the building to the needs of older adults.

The national IESS program has since expanded considerably. By 2025, the agency reported operating 110 senior centers around Ecuador, offering activities ranging from exercise and dance to memory stimulation, music, painting, gardening, theater, yoga and computer classes.

The programs are intended not only as recreation but also to help retirees maintain physical and mental independence and reduce social isolation.

That makes the current disagreement in Cuenca partly a dispute over what the CAAM should be.

IESS maintains that it is an active-aging center rather than a clinic and that medical and rehabilitation services must be provided through appropriately classified healthcare facilities.

Retirees, however, argue that reorganizing services may satisfy administrative requirements while making life more complicated for the elderly people the program was created to serve.