Long-term care

In France an entire village has been converted into a long term care facility for its elders. Walkways have been fixed with railings and ramps, a senior centre has been established to provide company and activities and a meals on wheels service provides nutritionally balanced food. The model focuses on long term care of the elderly while allowing them to remain in their homes and concentrates on helping them be independent for as long as possible. This is a fabulous model that Sri Lanka with its rapidly ageing population can learn from. 

By 2030 the World Bank estimates that one in every five Sri Lankans will be over the age of 60. The over 80 age category will have more women than men since the average life expectancy of men is 72 but for women it’s 79. But it’s not all bad news. 

Another World Bank national survey on ageing conducted in 2006 found that 40% of older persons live with their spouse and children; 37% only with their children; 10% only with their spouse; and 6% live alone. Those living alone or with only their spouse are more vulnerable and more likely to need help. Less than 1% of older persons in Sri Lanka are estimated to live in residential nursing homes.

While the current cohort of older persons has benefitted from the progressive health, education and social welfare policies during their lives, many have little or no income and depend financially on their children. Currently, most long term care is provided at home by family members. 

This situation is gradually changing as a result of smaller families, greater involvement of women in the workforce, greater migration rates and changing expectations. Family caregivers need support. Home nursing care services, with availability of day care, rehabilitation and respite care services, can greatly assist families to continue to care for older family members at home. The most vulnerable older persons, who may be living alone or with only their spouse, and destitute older persons, need to be identified and prioritised for long term care services. 

Most Sri Lankan older persons and their families are reluctant to accept residential care, but the need for residential care is increasing and there will need to be greater investment in day care and residential care. This needs to be accompanied by regulation and close monitoring to prevent abuses.

Community based organisations, Shramadana societies, faith based groups and women’s groups can also play important roles in long term care. Inter-generational activities can ensure that there is ‘someone for everyone’ by pairing young people with older people, with mutual benefits. Development NGOs can be encouraged to mainstream ageing in their work in the same way they mainstream gender.

In planning long term care services it is important to have a gender perspective. There are older women than older men, and they have a higher prevalence of disability, especially in the oldest age groups. Older women today were not engaged in formal sector employment when they were younger and so are more likely to have an inadequate income. It is usually women who provide care for older family members.

The private sector also has a role to play and there is scope for the development of small and medium sized business to provide home-based long term care services for those who can afford it. But the central idea of all this is to ensure that older people can remain at home and be looked after well.