A social care crisis
What does it mean to care?
Societies around the world approach the need to care for the elderly in different ways. In some it is common for elderly parents to live with their children and families take it upon themselves to care for the elderly; in others retirement homes and care facilities are the norm. However, almost every society is now grappling with an aging population and a much larger proportion of society that is elderly than ever before.
The Economist headlined this month that "social care for pensioners is in crisis" in the United Kingdom. By 2019-20 the funding shortfall for social care is predicted to be at least £2.8 billion a year there, and inadequate state-provided social care may force a cultural shift towards families and neighbours lending more support.
Two recent reports have focussed on what it means to ‘care’ for an elderly person: (National Academies of Science, Engineering, and Medicine, Sept 13) and (King's Fund and Nuffield Trust, Sept 15). The Lancet Medical Journal provides some interesting comments on them:
"Care is a wonderfully rich word that denotes health, emotion, quality, and thoroughness—each one of which contributes to clinical outcomes. Together, these reports address different aspects of the worldwide challenge to provide dignified, compassionate, quality care to older people in an era when population ageing outstrips economic growth.
The need for elderly care affects all societies. In the USA, more than 17·7 million people provide care for a person aged 65 years or older who has limited physical, mental, or cognitive function.
In the blurred boundaries between individual, family, and societal responsibilities, carers are the unrecognised heroes who improve quality of life for those they attend, relieve strain on social services, and reduce the likelihood and duration of acute hospital admissions.
In doing so, carers may incur considerable personal costs. An American woman in her 20s can expect to spend 6·1 years (10%) of her remaining life caring for an older person, with tasks that might range from housework to legal surrogacy to end-of-life care. In the process, she risks deteriorating physical and mental health, isolation, and financial loss from diminished earning opportunities plus an estimated US$5000 out-of-pocket expenditure annually."
Problems and potential solutions raised by the reports include:
- Further support for carers (including payments)
- Better data collection
- Flexible family leave for workers
- Health professionals better including carers in discussions about a patient's needs; many were inappropriately excluded from discussions about care because of misinterpreted patient privacy laws
- An integration of health and social budgets
- Mandatory public long-term health insurance so that the elderly are better equipped to pay for their own care more independently (this has now been introduced by Japan where 30% of the population is now aged 60 or more)
- In China, a pilot scheme of community outreach to support carers is already underway in Xiamen
- Better data collection
- Flexible family leave for workers
- Health professionals better including carers in discussions about a patient's needs; many were inappropriately excluded from discussions about care because of misinterpreted patient privacy laws
- An integration of health and social budgets
- Mandatory public long-term health insurance so that the elderly are better equipped to pay for their own care more independently (this has now been introduced by Japan where 30% of the population is now aged 60 or more)
- In China, a pilot scheme of community outreach to support carers is already underway in Xiamen
According to the article, society must immediately address the marginalisation of carers and provide greater recognition and support. It notes that “the degree to which a society cares about older citizens reflects its mores. In rethinking the centrality of carers, an opportunity exists to embed care more broadly within social attitudes”.
The debate between Hillary Clinton and Donald Trump was one of the most dispiriting events I have ever seen. Mrs Clinton had a bucket of foetid garbage ready for her opponent and she used it to full effect. Mr Trump retaliated, in spades, threatening to jail her if he wins the election. This is the man who said, only a few days ago, “The Clintons are the sordid past. We will be the very bright and clean future.”
What did Americans do to deserve this? They have spent around US$5 billion on this election and instead of listening to a debate about policy, they ended up watching a domestic. Zac Alstin has some very pertinent observations in our lead story.
Michael Cook
Editor
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