title: Long-term care institutions for elders and the health system.
abstract: OBJECTIVE
  Analyze Long Term Care Institutions for Elders (ILPI) organizational social system and its relation to the National Health System (SUS). To identify communication that occurs in the structural couplings between the ILPIs and the SUS and to analyze resonances of the structural coupling between the SUS and the ILPIs.
  
  
  METHODS
  A descriptive, exploratory qualitative study using the functional Niklas Luhmann's method. The data were collected using second order observations, through interviews with seven managers and eight elders, communication analysis of 52 Brazilian ILPIs and third order observations in national literature.
  
  
  RESULTS
  The exclusion of the institutionalized elder from the programmed health actions occurs in the health system. There is mutual lack of knowledge between the ILPIS and SUS, and stimulus is necessary for a more successful structural coupling.
  
  
  CONCLUSIONS
  The little sensitiveness of the SUS regarding the ILPI communications was identified as impediment to the performance of these institutions' social function.
authors.affiliation: College of Nursing, Nutrition and Physioterapy, Pontifícia Universidade Católica, Brazil. marionc@pucrs.br
authors.forename: Marion
authors.initials: M
authors.lastname: Creutzberg
authors.forename: Lúcia Hisako Takase
authors.initials: LH
authors.lastname: Gonçalves
authors.forename: Emil Albert
authors.initials: EA
authors.lastname: Sobottka
authors.forename: Beatriz Sebben
authors.initials: BS
authors.lastname: Ojeda
mesh_terms: D000368:Aged; D001938:Brazil; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008134:Long-Term Care; D009735:Nursing Homes