In as much as the ageing population has serious economic and financial consequences, the human and social dimensions of an ageing society poses serious challenges to the state and society. A high proportion of the aged would require to be cared for in th coming decade when the proportion of the elderly population would exceed 20 per cent. Already there is evidence of inadequate health care and accommodation for the elderly.
The ageing of the population necessitates public policies to develop institutional methods as well as community-based facilities of caring for the elderly, gearing the health system to cope with the illnesses associated with old age and the revamping of social-security systems to generate adequate incomes for old age sustenance. These are serious challenges that require government interventions, public-private partnerships and community endeavours. The next few years during which these problems are not so serious, should be used to design the needed policies and programmes.
Institutions for the elderly
The caring for the elderly has been rendered particularly onerous owing to increased longevity occurring, at the same time as customary social values of caring for the elderly within the family household are weakening. This implies the need to expand institutional means of caring for the elderly. More homes for the aged need to be established. This could involve significant public spending, as most senior citizens would not be able to pay the cost of such services.
Cost-effective methods of institutional caring need to be developed with state and community organisations sharing responsibilities. Besides finance, new capacities for caring for the elderly require to be developed and human resources have to be mobilized through voluntary and community participation. There are many caring services that have been developed recently, but these are far too expensive for the vast majority of elders.
Adequate institutional capacities to care for the larger number of elderly requiring such facilities should be planned. These should include expansion of state facilities; increased state assistance to community and religious institutions, encouragement of community initiatives for elderly care, and incentives for private-sector development of elders’ homes for the middle classes and the relatively affluent. Organisations such as HelpAge, Sarvodaya, Christian churches and charitable trusts run elders’ homes. The inadequacy of these to accommodate the elderly is clear from the long waiting lists for entering homes for the elderly.
Residential Elders’ Homes should be supplemented with day care services. The provision of such facilities is both more cost-effective as well as psychologically and sociologically more satisfying. Day centres enable elders to still live with children. This may be a preferred option for elders in the Sri Lankan cultural context. Such day services should include paramedical care and meals served at their own homes.
Non-institutionalized caring
We must learn from the experiences that other countries have had in developing systems for elderly care and adapt successful methods to our conditions. The modern practice in countries is one of moving their systems of senior care away from institutional care of the elderly towards care provided at their own homes. This does not mean that institutions like residential homes and nursing homes have no place in a modern system of senior care. They are important but should not be the only means of such caring of the elderly.
There should be a combination of institutional care and home-and-community-based care. Increasing numbers of elderly and new modes of living of children create a growing demand for beds in elders’ homes and for the provision of community-based services. There is also a need not only to increase the provision of services but also enhance the quality and conditions in elders’ homes, many of which lack basic facilities and even adequate food and amenities. One way to achieve the delicate balance between quantity and quality of care is by establishing partnerships with the private sector for the running of residential homes.
Mobilizing the active elderly
The active elderly should be mobilized to assist in the provision of facilities for the inactive elderly. Programmes similar to “Meals on Wheels”, popular in the US, should be adapted using the dana concept in Buddhism. A programme that enlists the elderly and gives recognition for their services, sometimes in small honorariums, titles and entitlements could help reduce the financial burden of programmes to cater to the elderly, as well as improve the quality of services, owing to their interest and commitment in the caring of the elderly.
Early healthy lifestyles
The roots of many health problems of the elderly arise during youth. There is evidence that unhealthy lifestyles are already leading to serious health problems in youth. These include child diabetes that is high and increasing. The onset and severity of osteoporosis, diabetes and cardiac conditions could be delayed and mitigated by good dietary habits, exercise and early medical advice. These problems have to be addressed among youth, and in early years rather than at the time of onset of old age.
Health-awareness programmes should be launched to change the lifestyles of youth and address ways for the elderly to cope with these problems when they surface. It is important to have a campaign to promote healthy lifestyles among the young to ensure they live longer and free from chronic diseases. Such a lifestyle would also help avert the onset of what could well become a health crisis in the country soon, if no preventive action is taken immediately.
Health policies
National health policies should prioritize the potential increasing demand for health facilities for the elderly. Medical training, specialization in geriatric care and other medical needs should be planned early. Nursing care, paramedical training and medical facilities for the elderly should receive immediate attention. Despite the ageing problem and the increasing need for medical facilities for illnesses associated with old age, there is still a lack of specialized training in geriatrics at hospitals. The medical colleges do not have a specialization in geriatrics and not a single medical college has a chair in geriatrics. This displays a lack of awareness of the emerging needs of the ageing population.
Awareness and actions
New modes of thinking, public awareness of the emerging problem and new priorities need to be developed. A strong community awareness of the emerging implications and problems of ageing need to be engendered. This must necessarily extend beyond academic and elite realms. An effective awareness programme would prepare individuals and families to cope with impending longevity, assist the design of timely individual and family solutions and would be a basis for community-based programmes to care for the elderly and would help influence public-policy formulation.
The next decade is a period when the full momentum of the ageing process would not be felt as there would not be an appreciable increase in the old-age dependency ratio. This opportunity must be seized immediately, as in about two decades, the increase in old-age dependency may require diversion of funds for the care of the elderly. A proportion of government expenditure should be earmarked for developing infrastructure and assistance for the elderly.
This proportion would have to increase over the next two decades on an annual incremental basis. This is the time for preparing to deal with the problems of ageing. Any postponement of policy changes and development of institutional capacities to face the problem would be seriously detrimental to the coumtry’s social development.
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