Community support necessary for long-term elderly care

Community-based long term care for the elderly is seen by countries struggling to cope with population ageing as a crucial mechanism to ensure health and social care for the senior people.
“What the health administration will be able to do in elderly care is limited, so support from the community will be necessary,” said Naoyuki Kobayashi, a senior assistant director of Japan International Cooperation Agency’s (JICA) Human Development Department.
He was speaking at a side session of Prince Mahidol Award Conference (PMAC) 2020, an annual international conference focusing on policy-related health issues.
Entitled “Ageing and Elderly Care: Experiences of Countries in Asia and Latin America”, the session was held in Bangkok on Jan 28, 2020.
Around the time the number of Janpan’s ageing population had doubled between 1970s and 1990s, there were many senior people in Japan who were left without sufficient care and ended up staying in a hospital for a long time, said Shintaro Nakamura, a senior advisor on social security of JICA.
While their families weren’t really ready to take care of those elderly people, the medium- and small-sized hospitals desperate to fill their vacant beds simply admitted them, he said.
But these hospitals weren’t really ideal places for the elderly care due to their lack of staff specifically trained for delivering care to the elderly people, he said.
 “The elderly needs more than basic day-to-day care. They also need an active social life and more. When they get lost, they need someone to find them,” he said.
By 2000, Japan adopted a paradigm shift in the elderly care by introducing long-term care insurance, which is a shift from tax-based financing to insurance-based financing, he said.
The long-term care insurance had attracted more private service providers to enter the elderly care sector, he said.
The long-term care insurance covers a wide range of services, which are home-based and community-based practice including daycare service, outpatient rehabilitation and short-term stays in a nursing care facility, he said.
Other than the community-based care givers, the informal care givers such as local volunteers and other people in the same communities including shopkeepers and local police are also important to Japan’s community-based integrated care for the elderly, he said.
Thailand has a very strong support from communities, concerning its about 1 million health volunteers and tens of thousands of elderly volunteers nationwide, he said.
With the elderly people accounting for 20% of the entire population, Thailand is now in the middle stage of the ageing society, the second out of three stages, said Dr Sakarn Bunnag, director of Thailand’s Geriatric Institute.
In the next ten years Thailand is expected to reach the super-aged society when the population will make up of 30% of elderly people, he said.
Thailand has been learning from Japan’s experience in developing an effective system for caring for the elderly people, he said.
In the beginning, the elderly care work in Thailand was focused mainly on acute care, he said, adding that now the country has begun to see the importance of and is moving toward the development of a national system of long-term care of the elderly in communities.
All the same, Sri Lanka now focuses on promoting communities’ roles in the national system for elderly care, said Dr Shiromi Maduwage, a community physician serving as a consultant to Youth, Elders and Disability Unit of Sri Lanka’s Ministry of Health and Indigenous Medicine.
Aside from establishing elderly committees at the provincial, district, divisional and village levels to lead the work of promoting communities’ roles in the country’s elderly care system, Sri Lanka is also promoting active and healthy ageing in communities, she said.
About 60% of Mexico’s elderly people are severely impaired physically due to a lack of proper care, which has stemmed from families’ lacking of basic knowledge about care of the dependent family members, said Dr Luise Miguel Gutierrez Robledo, director-general of Mexico’s Instituto Nacional de Geriatria.
The country still lacks also competency in long-term care of the elderly, he said.
Old adults in Chile have the highest rate of suicide, about 13.6 per 100,000 population, compared to the 10 per 100,000 per pulation in general population, said Gladys Gonzales, manager of Social Services Department.
The department is under Chile’s Ministry of Social Development and Family’s National Service for Elderly.
Loneliness and a lack of social support are believed to be main factors resulting in this higher suicide rate among the old people in Chile, she said.
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