Thinking outside the age care trap
Jul 18, 2022
Image: Wikimedia Commons
Too much of our thinking about aged care is based on outmoded assumptions. It is argued that ageing Baby Boomers will cost the economy dearly, when in fact it is the policy taken that has caused a crisis. Change is essential, for today's Millennials, facing a century-long life, will be an even larger aged cohort. There are many variations on the story but at the core is a fundamental problem. We have achieved the remarkable medical feat of prolonging life by two or three decades but have done practically nothing to restructure a 100-year life.
Millennials and Baby Boomers are of a different breed and as the latest Census reveals already the millennials outnumber the Baby Boomers. Future policies and programs for the aged will have to adapt to these new demographics, their different values, and lifestyles. Early retirement will not allow for an income sufficient to cover a longer lifespan, independent living will depend on having a partner or family willing to care for the other and shifting accommodation types is already often too costly or impractical.
Germaine Greer has discovered old age and dislikes her options. Having no partner or children of her own and finding living 'independently' difficult, she put herself into aged care for ten months. She found there, as have many others, mostly women 'inmates', poorly paid staff, food others complained about but which she ate. They played games like Word Bingo which she won all the time so was told to shut up. She was taken on outings in a bus to what looked to her like the same places. Plenty of the 'inmates' complained, people were depressed, but she thinks that's normal at that age. She has opted to go live with her brother in a big communal family which 'isn't easy' for her as she likes peace and quiet, but they are turning an old part of the house into a studio where she expects to live as 'a reclusive'.
This is the old age dilemma, put bluntly, matter-of-factly, and openly.
Where to live when we age is a question that hovers over us when we approach 60-70. Surveys show that 'independent living' is the preferred option, but that depends on having a home to live in, having a partner or other family carer to help, and enough savings income to survive those extra years. Some choose to go early to retirement villages, segregated from the larger community, where they have chatty neighbours, badgering Court captains, 'communal' activities and not a young person in sight. Its suits some but others hate it, and find they are trapped financially. It's not easy to come and go.
The worst option is to have nowhere to go, but to an aged care 'home' - for many, a place where you are neglected, abused, and left to die a very lonely and unpleasant death. The Royal Commission, at the time of Covid, exposed the disgraceful end to life our old age policy approach has brought to many, along with the exploitation of patients, staff, and families.
A complete rethink is needed about work, careers, housing, lifestyle, relationships, parenting, and lifelong support across the ages. Expanding aged care homes, care packages and retirement villages have tried to 'solve' the issue by segregating older people into a new 'tribe' of oldies, while the current vogue of identity politics further undermines the need for all of us to live with mutual community-wide lifelong support. Western capitalist society has lost its sense of reciprocity, breaking up into fragmented groups with self-interests, rather than common interests.
In some cultures, respect for the old is a core value, with intergenerational family support the expected form of care. Singapore even mandates larger apartments and lower rent for younger couples who take in their ageing parents. In Sweden, local municipalities are largely responsible for providing home help to keep older people living 'independently', plus they offer preventive services such as physical exercise and home visiting to delay the need for full-time care. But in a society where later partnering, divorce, the assertion of individual rights to be 'free' and exploring life's options, with intergenerational hostility fostered by the media (those 'selfish baby-boomers!'), the model, is mostly, by default, government-provided aged care.
We know that current aged care programs are costly, and that cost will increase inevitably as life expectancy increases. Professionally trained carers are in short supply and very poorly paid. Older people's needs vary enormously, with some people able to cope with living alone, independent save for some paid assistance with household chores, others needing help with shopping, cooking, transport, even showering and taking medications.
Unlike the Boomers, the Millennials will live even longer. They are less likely to own their own home. Their working careers, as we define them now, will mean their superannuation savings will be insufficient to cover the cost of living in their extended later years. For those unable to break into the housing market, income inequality will increase. Women will be left behind on all fronts.
On the other hand, more of the Millennials will be computer-savvy, will have experienced intermittent work, and will know they will need to stay working longer to save money, and perhaps never 'retire' in the way current generations have been encouraged to do.
Retirement has become an obsolete term; an arbitrary retirement/pension eligibility age not only pushes still-productive people out of the workforce, it also colours our thinking about ageing. Age discrimination in the workplace has become an issue, as at 60-65, more and more people want a phased move out of the workforce. Both government policy and business practice will have to change; economically and socially it makes sense. Workers will need bespoke retraining and job redesign.
The message should not be just that the economy needs more people to stay employed and paying taxes longer, but that healthy ageing is correlated with meaningful activity and social contacts. That recognition will lead to a more productive society and a more positive outlook for longevity.
An ageing population also challenges many assumptions about citizenship and responsibility. Individuals do have a responsibility to care for themselves; but with two-thirds of Australians either obese or overweight, self-care seems not to be widespread. As the body ages, inevitable breakdowns occur in bodily functions - arthritis affects movement and pain becomes part of everyday life. Diseases such as cancer, diabetes and cardiac problems affect many in their 70s-80s, with the onset of dementia and Alzheimer's a common concern.
We should know what to do to help stave off the effects of bodily ageing. Daily exercise, lifting weights, avoiding obesity and diabetes by eating a sensible diet, removing obstacles likely to result in a 'fall', remaining engaged in socially useful, productive work (either paid or volunteer), and maintaining social friendships and contacts are all proven correlates of healthy ageing.
But exhortations to live more healthily will not be enough. We need society, governments at all levels, to support healthy individual behaviours. Well-designed media campaigns about diet and exercise; towns and cities designed to be age-friendly, with accessible parks, walking tracks and resting points, plus public transport systems to facilitate local shopping and community engagement. Prevention also means local councils make sure footpaths are free of obstacles, pothole traps, with well-paved walking tracks and frequent rest benches in public places.
Redesigning a 100-year life span demands public policy that encourages intergenerational contact, a mix of ages in housing estates, accessible public transport with subsidies for older people using taxis, buses, and trains. Shopping centres need to serve local communities with coffee shops, fruit and vegetable shops, pharmacies, and bakeries within easy walking distance; there must be a simpler way to order supplies online.
To avoid ageism in the workplace and expectations of early retirement we need to value the skills and experience of older people; provide tax incentives for older people living alone in big houses to share housing in exchange for support from younger adults; encourage schools to draw on the skills of older people in the learning process; insist that property developers include housing suitable for active older people, not tiny holes in inaccessible high-rise buildings. All these measures would help engage the old and foster a culture of integration and mutual respect.
The way forward is to fund programs of 'prevention' and support, planning for age-friendly, integrated communities, catering for the different needs of all age groups.
Patricia Edgar is an educator. She was the architect of the Australian Children's Television Standards, the founder of the Australian Children's Television Foundation and the World Summit on Media for Children Foundation.
Dr Don Edgar, OAM, is a sociologist, an Ambassador for NARI (National Ageing Research Institute) and Foundation Director of the Australian Institute of Family Studies.