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Australia needs to transform how it cares for older people

The World Health Organization predicts that by 2050, the global population aged 60 and over will double to 2.1 billion people, with those aged over 80 tripling to 426 million. Similarly, in Australia, 20% of the population will be aged 65 or older by 2030. By 2050 this group will represent 25% of the population (Intergenerational Report 2020), challenging the adequacy of pension systems, healthcare, and the workforce. This is the beginning of powerful and world-changing demographic trend that will continue beyond 2030 until at least 2050. The time to prepare our society and economy is now.

The World Economic Forum's Longevity Economy Principles, unveiled in January 2024, underscore the economic significance of longevity. These six principles, ranging from ensuring financial resilience to addressing longevity inequalities, establish a comprehensive framework for navigating the intricate web of challenges and opportunities presented by longevity.

Australia is at a critical juncture: in 2030, the ABS says we will have more people aged 65 and older than those aged under 18, a surge in retirement across generations, and a declining workforce on the horizon. Despite the alarm sounded by six Intergenerational Reports produced by the Australian Treasury since 2002, Australia is unprepared to meet the fundamental needs of its ageing population.

Living longer does not necessarily mean living better

The support older Australians need as they age under the burden of chronic illness is already exerting severe and increasing pressure on carers. For many years Australia’s focus of funding and attention has been on residential aged care - nursing homes - yet over 90% of people aged 65+ are living in the community, according to the Australian Institute of Health and Welfare. The fundamental premise underlying care and living support and funding for Australia’s ageing population is - at best - incompatible with the desires and needs of Boomers and Gen X. At worst, this approach is fundamentally outdated and misguided.

Confronting as it is, we need to accept that residential aged care is end of life care - whether that be 6 months or 6 years. The average age of residents is 85 and average stay 2.5 years with exit due to death.

Residential aged care absorbs most of the funding and attention aimed today at longevity, but it only meets the needs of a very small slice of Australia’s older population.

With such a high proportion of older Australians choosing to age in the community, not in aged care, we need a fundamentally different system of support and funding. Ageing successfully in the community takes a multi-generational village, anchored in strong connections within community and family. The opportunities and benefits have been widely viewed on the ABC in Old Peoples Home for Teenagers which pairs teens with older people in retirement villages for an intergenerational experiment.

For family carers who are still working and have infants, toddlers, school, or university-aged children still at home, the pressure is immense, whether their parents are in aged care or in the community. Care responsibilities are a leading factor in the decision of mid- and high-level working women to reduce their working hours or leave the workforce entirely.

Technology can help

In the home, the ‘Internet-of-Things’ can connect devices to set medication and other reminders, turn on lights and many other functions that become difficult for less mobile older people. Wristbands can track health status and send instantaneous messages to paid and family carers. Voice-activated devices can assist less mobile people to live independently longer. The availability of inexpensive, over-the-counter hearing aids - costing a fraction of the price of high-end devices - can expand accessibility and use to restore a functional level of hearing and delay physical and psychological decline associated with hearing loss in old age. In practice, hearing aids reduce social isolation, falls and potentially slow the rate of cognitive decline. Older tech like personal alarms will soon be superseded by technology in accelerator- and IoT-enabled mobile and wearable devices that are already here and more like the ‘Apple’ watches so many younger Boomers and Gen X already rely on.

For now, we have a generation of older people ageing in the community with some tech skills. Most have mobile phones which keep them connected to family and the wider community. Around 30% of seniors are not tech savvy, but their children and grandchildren are, and with their help seniors can use and benefit from devices and apps like iPad, Alexa, and FaceTime to stay connected and monitor wellbeing.

Younger Baby Boomers (those born from 1955-1964) are much more technologically fluent than outworn stereotypes lead many to believe. Many people approaching 65 or 67 are still in the workforce, utterly self-reliant with technology, and curious and eager to keep learning.

Working and ageing

Australia’s pension age increased from 65 to 67 for those born after 1957, leading to the implicit expectation that Australians will generally remain in the workforce until then. In theory, working even longer will presumably be encouraged. In practice, however, working longer is not well accommodated.

While the focus is on creating productive intergenerational workforces, the reality is that people over the age of 50 face overt and unconscious bias in employment. As a result of the decline in births over several decades and the barriers to employment of older workers there will be a 6% shortfall in Australia’s workforce by 2030 according to Australia 2030: Prosperity through innovation – A plan for Australia to thrive in the global innovation race.

Without policy and practical interventions, the gap is likely to increase. Experts predict a greater likelihood of a shortage of workers than a shortage of jobs. For this reason, policies and initiatives to accommodate older workers may well be decisive for Australia’s future economy. Bunnings has already tapped into mature aged workers, and startups like Maturious are pioneers in improving the employment outlook for mature age workers, benefiting organisations desperately seeking experience as well as talent.

Dealing with social issues

Australians are lonelier than ever: the Australian Institute of Health and Welfare in a report on Social isolation and loneliness (2023) found loneliness across all ages, young and old. We understand the causative link between loneliness and physical and mental wellbeing. Transport is a powerful enabler or inhibitor of people’s independence and ability to participate in community activities as they age. Those who lose their ability to drive need access to affordable and community transport to remain connected and mobile in the community. Tackling loneliness requires a vibrant multi-generational local community that works to keep seniors active and engaged. Local government has a crucial role to play in supporting older people in the community by providing transport and opportunities for engaging in social and cultural events and physical activity through community facilities including libraries, parks, arts and cultural and community centres.

Initiatives like social prescribing are gaining momentum in Canada, the UK and more recently Australia. Social prescribing involves providing non-medical support to boost a person's wellbeing and can include exercise, meditation, social clubs, art or pet adoption. Social prescribing has been found to be effective in the treatment of older people with chronic illness, depression and dementia. There is a movement in Australia led by Dr JR Baker Chair of ASPIRE the Australian Social Prescribing Institute of Research and Education is leading the way to promote understanding of the benefits of social prescribing.

A 2020 report by the Royal Australian College of GPs and the Consumer Health Forum recommended that social prescribing be included in routine healthcare (incorporated in the Federal Government’s 10 Year Primary Health Care Plan) and that Primary Health Networks expand pathways to include social prescribing pathways for patients.

 

This is an edited extract from a recently released report, Longevity 2030: A Global Crisis and Opportunity

Anne-Marie Elias and Dr. Abby Bloom are founders of PrimeLife Partners, an Australian company aimed at transforming how we live, age, care and retire. Further information on PrimeLife Partners services, events, and papers can be found at: https://primelifepartners.com/news/.

 

6 Comments
tom
March 12, 2024

There is another way to look after the elderly that is coming in our lifetime. Canada changed its euthanasia law in 2021 & 2023 to includer the terminally ill and mature minors. There have been a number of reported cases of offering medically assisted suicide for Afganastan war veterns who suffer from PTSD (post traumatic Stress), others with mental illness and yes the elderly and the homeless.

This is the crazy world we live in today its called cost-benefit analysis. Healthcare is gradually being hyper-secularized

Graham Wright
March 08, 2024

I am long retired and live in a vibrant community of retirees with a mix of residents in all age groups. Out street has new-borns and children while we are great-grandparents. Nearby, We have a multitude of retirement villages for all socio-economic groups.
We live in the open community (renting, not home-owner) but regularly associate with our many friends in the villages. Our social life is so well catered to in our community and is very low cost so we have no wish to move elsewhere. Walking is good free exercise with our Walk For Heart Foundation walking group and the social chitchat over coffee afterwards is medically and socially very beneficial (in many instances, more so than the walking) for all, but more so for the living-alone members of our community. This group socialisation also leads to more periodic activities such as other hobbies and interest activities as well as theatre and other entertainment.
Living independently is preferable as we can live life today as we have always lived it with no need to consider by-laws or needs of others. We can still practice normal living skills, cooking, gardening, hobbies etc, and feel happy for our many small achievements. In our case we live walking distance from shops, buses, medical, post office, pub, fast food and all necessary daily service providers. So we can remain here as long as we can function independently. If necessary, we can learn to use technology to supplement our deficiencies but perhaps we will need to consider moving closer to family as our independence wanes. But nursing home, as we learned via a close family member, is a circumstance of last resource when independence is gone and outside support by family and community services cannot meet our needs.

So, I fully agree with the author but I would highlight that we need to enter this phase of life with no concern for maintaining past living or social standards. It is a time for living a lifestyle of independence within the constraints of our own capabilities and accepting that our now achievements today are far more important than who or what we used to be or wish to be. When we are surrounded by friends and looking after ourselves and our life love, we are richer and freer than any King in any kingdom.

Peter Bayley
March 08, 2024

I'm old and I can work out how to live in the final decade without being nannied by others.

CC
March 10, 2024

for so many old people that is not the case, as they severely decline both physically and mentally

John
March 07, 2024

There is a fundamental flaw in the user pays system of aged care

Consider two people and ultimately their families when they die

One old person gets dementia and goes into a nursing home. They have to contribute to their care costs. And that care lasts years

The second has several heart attacks and surgery. All paid for by Medicare.

At the end of their days one family's inheritance is finished the other isn't

That isn't equitable.

My suggestion limit the user pays component of nursing home care to the aged pension figure (or a significant proportion of it). Maybe increase it for the rent received from the former home (as it is no longer needed). But no more

And compensate for the loss of revenue by bringing in some sort of aged care levy (like we have for Medicare) that we all pay over our lifetimes

OldbutSane
March 08, 2024

The aged care system limits the total amount you contribute over and above the base fee (85% of age pension) to a relatively small amount (under $100k) and there is a yearly limit too. Accomodation deposits are fully refundable (indeed don't even need to be paid upfront). There is no reason why those who can afford to pay some of the cost should not contribute, if for no other reason than they would bear costs just living at home (eg maintenance, rates, the insurance, food, etc, etc).

 

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