Having sought the views of some of the world’s leading thinkers on the subject, it is apparent that there is no single, breakthrough idea. However, our search has come up with a number of highly innovative and interesting approaches that together can form the building blocks of a new era in elderly care. As with all complex interventions, many of these blocks have to be put in place concurrently, which calls for a high level of implementation expertise.
Three findings stand out as being critical and relevant to every society, regardless of where they have progressed in their journey:
Firstly, the debate over finance threatens to obscure the scale and gravity of the overall challenge. Nevertheless, funding is a critical issue, as most governments are cash-strapped and the next generation may be unable or unwilling to foot the bill for care. Increasingly innovative new mixes of public and private finance are needed, along with new ways to allow older people to save more for retirement.
Secondly, care should be redesigned to break down organizational boundaries through greater integration. The medical model has to change in favor of a new philosophy and practical methods that pay more attention to people’s needs and aspirations, rather than to the treatment of disease.
And finally, given the societal impact of elderly care, the discussion should take center stage and involve government, private and non-governmental bodies and providers, as well as the wider public. Only through such wide scale involvement is it possible to address the critical issues of public policy, models of care, housing and personal preparation for old age.
A growing threat
The rising proportion of elderly people will put an enormous strain on societies around the world. Between 2012 and 2050, the number of citizens aged 60 and above will more than double to 2 billion; almost a quarter of the global population. In economies such as Japan, a dwindling base of working age people has to support more and more elders. Other countries are experiencing the growing phenomenon of ‘the newly aged poor,’ where 50- and 60-somethings are forced into early retirement through lack of job opportunities, adding hugely to health and welfare bills.
Changing demographics and lifestyles mean that families are less likely to care for their elderly, yet governments cannot afford to bear the extra costs and insurers’ premiums are often prohibitively high – and likely to remain so, given the risks involved. The sector also faces a resource crisis and the importation of cheaper foreign labor is only a temporary solution that shifts the problem elsewhere.
An over-emphasis on costly government-funded residential care in certain countries stretches budgets and raises providers’ expectations that the state can care for all its older citizens. And the quality of care varies widely, with many traditional medical approaches ill-suited to the conditions of the aged.
If societies are to give their elderly citizens a dignified and fulfilling life, they have to rethink the way that long term care is funded and managed and change cultural attitudes to aging, by considering a number of actions.
Deliver person-centered care
The transition into long term care is a difficult journey for elderly people which may damage their health and sense of self-worth. Care must therefore be oriented to meet the unique needs of each individual to ensure elderly people are treated with respect and given as much autonomy and independence as possible. Outcomes and quality of life should take priority over systems and procedures. This will require a significant change in the culture and skills of care home staff, with improvements in recruitment and training and greater support from management for those carrying out difficult jobs on low pay.
The focus of medical care for the elderly needs to shift from providing a ‘cure at all costs’ to managing a gradual decline with an emphasis on wellbeing and happiness. Clinicians need to exercise greater discretion in prescribing and pay more attention to causes (rather than effects), side effects and pain control. Further studies are required to assess people with multiple conditions receiving longer-term medication.
Value and outcomes have to become higher priorities. Pressure on budgets has led to an emphasis on cutting prices, which can impact quality. As healthcare’s goals move towards value, long term care will have to follow suit by focusing on outcomes, which in turn should lead to greater efficiency and lower costs. Regulators will expect complete transparency over costs and quality and will monitor provider performance carefully. One way to improve value is to give the user control of his or her own care and many systems are experimenting with direct payments to care recipients in order to personalize care and avoid waste. However, this can lead to some confusion, so the elderly and their families may need help in managing their personal budgets.
Innovative ideas can only succeed with the right supporting infrastructure. For example, the Chinese government gives out subsidies to the elderly and their families, yet these recipients often struggle to find suitable available and affordable long term care services in their region.
Invest in human and technological resources
Many developed nations rely on cheap, imported labor in a sector that is associated with low pay, an unattractive image and a lack of career advancement opportunities. There is an urgent need for training and professional development to attract more talent into long term care and improve productivity, wider medical skills and empathy for recipients. Governments should also consider funding alternative training and certification programs that draw on underutilized groups such as retirees and neighborhood volunteers. It’s vital to maintain the vast army of informal carers by providing appropriate financial and non-financial support, involving them in care planning and offering holidays and time off from their full-time jobs.
Advances such as remote monitoring and assistive devices are giving elderly people greater independence and reducing the level of care needed. Information technology can improve the performance and administrative efficiency of care providers, helping detect problems earlier, coordinate workers and monitor trends and outcomes. However, the long term care sector has been slow to adopt new technology and needs to invest not just in the hardware and software, but also in centralizing fragmented organizational structures. Another untapped area is products and services tailored to the ‘silver market,’ which calls for specialized skills and understanding of these consumers’ needs. However, technology cannot replace the need for person-to-person contact and all providers
Change attitudes and policies towards aging
National conversations on aging are few, mainly due to a reluctance to acknowledge the fact that we will all eventually grow old and die. All stakeholders – politicians, policymakers, opinion leaders, professionals, patients’ representatives and charities – should enter into debate and recognize that the elderly can make a major contribution to society and should not just be seen as a problem.
There is relatively little substantial research into long term care, especially when compared to healthcare policy. The sector could benefit from a truly global think tank that expands upon the excellent work of organizations such as the International Longevity Centre Global Alliance, to bring together research, trial results and analysis of policy and influence governments and policy makers to share thinking and experiences and come up with creative new solutions. Products for the elderly can improve quality of life but also stimulate economic growth, so governments need to encourage this market.
The challenge of long term care is incredibly significant, with far reaching implications. Without urgent action, the legacy for subsequent generations could be severe. Not every system is ready for radical change, but the ideas and examples in this document point a way forward for further with a national conversation as the minimum starting point.