Helping Hand
With an ever-ageing UK population, care of the elderly is in turmoil. Andrew Cole asks what lessons can be learned from other countries
Long-term care for elderly people in the UK is facing a crisis. Health care may still be free, but social care – ranging from help in the home to living in a care home – is anything but. So while someone with cancer will expect to be treated for free, a neighbour with dementia could be left destitute. The system has been called unfair, bewildering and a national disgrace. It is also unsustainable.
The number of people aged 65 or over already represents 15% of the population and that is expected to expand hugely in the next 20 years, with the proportion needing long-term care rising even more steeply. At the same time the working population is shrinking, leaving fewer people to pay taxes and to shoulder the burden of informal caring. The government has promised a major review of the whole issue, with a much-anticipated Green Paper now expected early next year.
If it’s any consolation, the UK’s situation is far from unique. In fact every developed country in the world faces the same explosive combination of a rocketing elderly population and a diminishing workforce to support them.
Most are asking the same tricky questions: should long-term care be the responsibility of the individual or society? Should it be means tested or a universal right? What is the role of informal carers? And, perhaps most critically, how are we going to pay for it all?
France
The shocking deaths of nearly 15,000 elderly people during the hot summer of 2003 helped institute a major overhaul of elderly care based on a tacit recognition that this was everyone’s responsibility. Those in work agreed to give up one bank holiday each year to help pay for better long-term care.
More funding has been pumped into long-term care, although there remains a shortage of care homes and most are expected to pay something towards domiciliary care. Most ‘retirement homes’ are run by the state and if you can’t afford the care, you won’t be forced to sell your house – it will be paid through your pension or the local authority. Over 90% of over 75s continue to live either on their own or with their families, sometimes supported by domiciliary care.
Sweden
Sweden spends significantly more per head on long-term care than any other European country – 2.8% of GDP compared with 1.3% in the UK – and it shows. Most of that care is financed by municipal taxes or government grants with just 4% coming from patient charges. The result seems to be a healthier elderly population.
Between 1980 and 2005 the number of people using care homes or domiciliary care almost halved. Generous support is also offered to caregivers, who are not only paid if their care duties exceed a certain number of hours, but also receive pension and social insurance credits and are entitled to 60 days’ paid time off work.
On the face of it the Swedish system looks to be the most effective – if you can afford it. But that’s a big “if”. Introducing direct payments, for instance, placed a big strain on the system and led to its near collapse in 2004 because of ballooning costs and perceived fraud. Although this has now been controlled, latest figures suggest costs are still 11% more than under the old system.
Combined with more general demographic and economic pressures this has raised grave doubts about whether the present universal entitlements can be maintained. It is widely expected that means testing will soon have to be introduced to keep a lid on costs.
Japan
Around 19% of Japan’s population is already 65 or over and this is expected to rise to 40% by 2050. It means that while three people of working age ‘support’ every elderly person at the moment, the ratio will be 1:1 in 50 years.
One response has been to encourage elderly people to stay in work longer. But it has also led to the radical reform of a care system where, traditionally, elderly people were looked after by their family.
In 2000, a national insurance scheme was set up resulting in a big expansion in long-term services, especially in the community.
Those who qualify for state assistance also have access to a care manager who can provide advice and help on managing the finances.
Just how impartial they are is another matter, given that they are usually employed by a care provider organisation. There are also inbuilt incentives to obtain care from formal providers, many of whom are private.
As ever, there is a potential tension here between the interests of older people themselves and their families. Cash payments can help to empower older people. However, extra services reduce the burden on the informal carers.
Japan is one of the few countries in the world to institute a special day to celebrate its elderly population. National Respect for the Aged Day became a national holiday in 1966.
Further reading
Find out how Germany and the US tackle this issue.
