Quality care

United National Party (UNP) presidential aspirant Sajith Premadasa went on record this week, outlining policies that he has pledged to implement should he come to power, which also concentrated on wider welfare support for the elderly.  

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 years compared to 79 for women. The data bears out the need Premadasa has said he will support. However, it is essential to understand the scope of the assistance needed, find a way to fund it, as the existing Government revenue cannot take on the additional costs involved, and establish a community-based system where the elderly can enjoy better end-of-life care than what they currently have access to.   

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. 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 more 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 also 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 businesses 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. Sri Lanka’s healthcare system will have to make a paradigm shift to match this change, as the quota of older people increase.