Although life expectancy in emerging countries is rising fast, the demands of an aging population are more immediate in the developed world. This paper focuses primarily on countries that together provide a broad spectrum of different approaches from around the globe. The insights and examples from 46 interviewees across Australia, Canada, China, Finland, France, Germany, Hong Kong, Japan, the Netherlands, Norway, Singapore, Taiwan, the United Kingdom and the United States can point the way for other countries around the world.
Compared with other areas of social and medical policy, long term care has received relatively little attention and investment, which reflects broader attitudes to the elderly. By ignoring the problem of aging, societies risk depriving an increasing proportion of their citizens of the basic rights of dignity, respect and healthcare.
Policy makers and opinion leaders need to come up with new approaches and change perceptions of the elderly, as well as encourage more saving and forward planning to cope with the challenges of old age.
Providers must seek new and improved ways to deliver services and conduct administrative functions, while governments should establish well defined financial and quality targets for long term care programs. To overcome the fragmented state of long term care provision in many countries, care facilities will have to expand, merge, or form networks to scale up, in order to become more efficient.
The governments of some countries, such as Australia, have pulled ahead and started implementing a few of the following recommendations. In April 2012, the Australian Government announced a reform package aiming to build a better, fairer, more sustainable and more nationally consistent aged care system. The Living Longer Living Better aged care reform package provides $3.7 billion over five years and is the start of a 10 year reform program to create a flexible and seamless system that provides older Australians with more choice, control and easier access to a full range of services, where they want it and when they need it. The reforms give priority to providing more support and care in the home, better access to residential care, more support for those with dementia and help in strengthening the aged care workforce. There is an urgency for governments to act and the time is now.
- Bobbie Sackman, Director of Public Policy Council of Senior Centers and Services of New York City, US
An agenda for action
- Create a holistic elderly policy rather than differentiate between welfare, health, housing and social care
- Seek a sustainable funding model
- Address workforce shortages with education and training and support informal carers financially and/or non-financially
- Regulate quality and promote transparency about outcomes and costs
- Consider changing regulations to make homes and communities more age-friendly and dementia-friendly.
Payers (national/local governments, social and private insurers) should:
- Encourage providers to focus on the value they provide to the individual
- Reward quality and professionalism rather than cost cutting
- Incentivize integration, care planning and specialist medical input
- Give more control to users and carers including support for care coordination.
- Integrate care to make it more person-centered
- Invest in staff training and support and recruit staff based on values and attitudes as well as skills and experience
- Embed the right organizational values through staff recruitment and appraisal
- Improve the level of medical input to long term care
- Work with carers to develop a care plan for every care recipient
- Embrace technology to help people or their carers self-manage and maximize staff productivity.
- Build the skills to deal with complex health and social care needs
- Raise the awareness, status and prestige associated with the professions responsible for long term care
- Rethink the use of medication, with less emphasis on cure and more on managing a decline in a way that maximizes quality of life
- Develop new approaches to goal oriented medicine for people in long term care.
- Investigate new models of care delivery, technology, pharmaceutical and other health services
- Research the effectiveness of drugs for the elderly and people with multiple pathology
- Produce international comparisons of developments and data.
Users and carers should:
- Assert their rights, demand information and participate in planning.