How we can transform services to help more people grow old at home

By Jessica Chamba, Associate Partner – Ernst & Young Consulting – Health & Social Services Deputy Leader – Global Human Services

It’s no secret that we are facing an eldercare crisis. As a society we have reached a pivotal moment with two powerful forces coming together at the same time, driving a need to revolutionize the way we care for the elderly.

Firstly, we have a growing ageing population and, alongside this, more and more people are choosing to stay at home for their remaining years. This demographic and behavioral shift is forcing organizations to rethink the current system.

Certainly our institutions and eldercare organizations are facing unprecedented demand. The “baby boom generation” ⏤ the post-war babies ⏤ who are now reaching their 70s and 80s and starting to face mobility and autonomy issues will increasingly need help in the coming years.

According to the World Health Organization, the global population of people aged 60 years and older will more than double, from 900 million in 2015 to about two billion in 2050, putting huge pressure on health and aged care systems.

It’s not simply a case of people getting older, but also the quantity of people against a backdrop of budget cuts and constraints in the field of social care.

These two forces are driving transformation and governments will need to make changes to ensure that their health and social systems are able to incorporate this demographic shift.

For now though this aging population raises two big challenges for social services and eldercare organizations. The first major question is, how do we transform the way in which we deliver these services? The next is what do we do with the current institutions as a result of this transformation?

How to transform the current way in which we deliver these services

 As I mentioned above, over the past 30 years there has been a demographic shift and now the majority of elderly people wish to grow old in their own homes rather than move to a care home. One US survey found that 77% of adults aged 50 and over want to remain in their homes long term – a number that has been consistent for more than a decade. An IFOP study revealed that the number in France is even higher, with 85% of the French population wishing to remain at home. This trend is partly attributed to cost but it also reflects people’s desire to have greater independence and autonomy.

To undergo this paradigm shift toward deinstitutionalization of people in long-term care, I believe we need to improve the support services offered at home. This requires putting the people who care for the elderly at the very center of this equation.

While many care-givers choose to go into this profession for altruistic reasons, because they have a desire to help others, often they are poorly paid, work antisocial hours, with limited support and training.

What to do with the current institutions

There is a tendency to think that creating more institutions is the answer to the immediate crisis, but I believe we need an evolution of the current system, a deinstitutionalization of long-term care for the elderly.

Yes, we still need institutes for people who are incapable of looking after themselves, but we potentially need less of them and could organize the system a bit differently.

I think one solution would be to create two types of institutes; one close to hospitals, which would effectively be an extension of hospital geriatric services that would be able to provide 24/7 care for those whose needs are too great to be able to live independently.

At the moment emergency services and geriatric wards are full of people who are not able or well enough to go home so we need institutes that are able to offer a higher level of care and nursing to relieve pressure on hospitals.

The other type of institute would offer a link between the service at home and an institution which would allow people to maintain their independence and carrying on living at home while still having access to all the services that institutes provide, such as transport, social activities and home assistance via digital technology (e.g., tele assistance and tele medicine).

Essentially we are talking about community-based long-term care, which would enable older generations to maintain as much autonomy as possible and still be an integral part of society. For them, staying at home is not just about cost, it is about personal choice and independence.

To facilitate this, governments and public sector organizations need to create a people-centric model of delivering eldercare services.

How to shape the future of eldercare

Here are what I consider the main four focus areas for governments and public institutions as they look to reshape the future of eldercare.

 Put people’s homes at the centre of our strategy – what is needed is institutional reform. I think we need to be ambitious with our new strategy. From the outset, we need to put people’s homes at the center of this transformation and find ways to help people live out their days at home. This means prioritizing the provision of support care at home and helping them to transform and adapt their homes – whether that’s by fitting a stairlift, ramps for wheelchair access, or programs to prevent falls, all of which will avoid people ending up in hospital long term.

Transferring activities and support services from institutes to home-based services – by facilitating interventions at home thanks to the development of new partnerships between institutions and home-based services, with a focus on new technology (including connected medical devices, home automation, etc.).

 Address the workforce challenges – we need carers to feel rewarded financially and recognized for the job they do through continuous learning and support. We ought to look at how these jobs are structured and the role IT can play to help alleviate some of the more negative aspects of the job. In Australia, the Department of Social Services has funded the Boosting the Local Care Workforce Program (BLCW Program) to expand workforces and meet increasing demands for high-quality care.

Financial support – we need to reform the financial model of long-term care services to adapt it to more flexible, tailor-made support services. France is already making headway in this area by prioritizing housing adaptation. To demonstrate its commitment to this, the government is implementing a new aid program, “Ma Prime Adapt,” which will allow the elderly to adapt their homes so they are able to live independently for as long as possible.

There is no doubt that a transformation is underway but not necessarily in a coordinated fashion or at the pace or scale required to meet the current demands of this baby-boom generation. Undoubtedly at the heart of it should be people centricity and creating a care system that actually supports the needs and wishes of the elderly.

Now is the time to make a real commitment – a global commitment – to transforming our housing. We are essentially talking about the idea of a social pact where all economic and social enterprises, plus governments, come together collectively to revolutionize the system and overcome this challenge.

I hope this has given you hope for what the future could look like, and the type of transformation required. I would love to hear your views, so please do get in touch.

The views reflected in this article are the views of the author and do not necessarily reflect the views of the global EY organization or its member firms. This article previously appeared on the author’s linkedin page.