Fixing the broken system of elderly care - a new way of thinking about ageing is needed to come up with innovative solutions for the future

Elderly care home resident

The first person to reach the age of 135 has already been born

"The first person to reach the age of 135 has already been born, but it is wrong to think that we can take the life stories of our parents and grandparents as a blueprint for the way our own lives should unfold" according to Rudi Westendorp, an expert on geriatric medicine who has just written a book “Growing Older without Feeling Old”.

New developments in our understanding of the biological determinants of ageing and better healthcare are behind the growing life expectancy (80 now from 40 a century ago). But socially and culturally we have not kept pace with what this will mean in our ageing society of the future. What do longer life spans mean for the way we organise our societies? How can people best prepare themselves for living considerably longer?

These are all questions that society and government are asking themselves now.  In the UK the system for elderly care is broken and what it means to grow old looks bleak.  Our social care services and NHS simply cannot keep up with the growing demands of a growing older population. This is a key reason why the recent Innovate UK challenge focused on long term care asked for a “revolution” and not an “evolution” of the current model of care for our senior citizens.

Staff costs on average represent about 60% of the cost base for a residential care home and most care workers would qualify for the living wage

Yet the living wage shows there is not joined up thinking in Government.  The long term care sector is experiencing serious threats with the new living wage recently announced which will be potentially catastrophic for the elderly population most in need of long term care.   Government thinking needs to understand cause and effect better in addressing the huge crisis we have in looking after an ageing population. Why?  Because staff costs on average represent about 60% of the cost base for a care home and most care workers would qualify for the living wage meaning that care home operators will need to foot the bill (with 700,00 workers likely to be eligible this will cost care providers up to £2 billion alone) - at a time when funding has been cut by about 20% between 2010 and 2014 (source: Age UK) and local authorities have been reducing rather than increasing the fees paid for elderly care according to a recent Deloitte report.

Where will local councils find the extra £2 billion?

Where will local councils find the extra £2 billion?  Before Osborne’s announcement it was estimated that about 800,000 people need formal care but are not currently receiving it- but this care gap will only increase after the living wage sets in.  Maybe Osborne and others in Government are setting up a larger discussion about how we care for our older citizens.

Crucially, the tone of government is that we will need to take more personal responsibility for our “old age” ahead as the state just cannot do it on its own with the ticking time bomb looming of an increasingly older and ageing population.  Already Jeremy Hunt has been hinting that there will need to be more onus on families to care for elderly relatives with them moving into the family home rather than a care home- and recent “Nannies for grannies” headlines have been appearing in the press.

The elderly population will need to retire later to meet the growing demands of taking more personal responsibility.  This could be enabled by more flexible or part time working hours for the elder generation but this will require a change towards the role of older generations in society.

Massive disruption in thinking and joining up the dots is clearly needed to fix the system.

Massive disruption in thinking and joining up the dots is clearly needed to fix the system.  Leadership is required from government, business and a myriad of other stakeholders and a cross industry view is needed to explore the opportunities to completely redefine what people want from services as they go through their journey of ageing and how to pay for it.

There is a real danger of the generation retiring between 2025 and 2040 being underprepared for retirement, caused by inadequate savings and pensions pots being overly dominated by macroeconomic tinkering.  This is increasing the risk of a “sandwich generation” required to care for the generation above and below them simultaneously.

What this signals is the urgent need for a change in the public’s attitudes towards saving towards our personal pensions pots.  Undoubtedly contributions and enrolment rates need to rise. The level of the rate rise may need to be higher than initially suggested by the Government too. The future may see new pension products being introduced to combat the risks associated with Defined Contribution schemes and the expected closure of many Defined Benefit schemes. A hybrid of the two schemes may be a solution. Pension savings will also be expected to take into account costs of healthcare in future life and ultimately a pension pot may need to become the norm and viewed in a similar bracket to a bank account.

Smart technology in the home is expected to play a huge role to enable more people to live independently for longer in their own homes, reducing the burden on society and the state and improving their quality of life.

Clearly, the pension gap is a key issue requiring urgent solutions from business and government but there are growing opportunities presented by technology, especially the Big Data revolution and Internet of Things, that may also help to address many challenges of the growing ageing society.  The use of personal data will help to understand consumer behaviour and what products and services will help them on their journey of ageing, especially in terms of health and social care. Smart technology in the home is expected to play a huge role to enable more people to live independently for longer in their own homes, reducing the burden on society and the state and improving their quality of life.  Of course there are risks involved with the use of data and technology but consumers are already prepared to waive their right to privacy in return for rewards for example (just look at the success of Tesco Club Card!). 

Increasing consumer comfort with sharing data in return for benefits may drive business innovation in this area.   This is certainly expected in the healthcare space,  as highlighted ina recent report Lansons Health published in association with Opinium, “People Powered Health: Engaging Citizens in the Future of Health and Technological Innovation”.    Growing consumer engagement on the notion of personal responsibility for their own health and wellbeing will create the grassroots momentum for more autonomous care models, which will also help to reduce costs in the system with individuals staying in their homes for longer and with more community support being planned in the NHS 5 year plan.  Hospitals will no doubt look very different by 2030. The NHS vision of the future includes community hospitals at the centre of local populations.   Reliance on A&E will be eased through easier access to local GPs too and all this will reduce cost in the system (presently, 80 per cent of emergency admissions who stay for more than two weeks are patients aged over 65, and is  an incredible waste of precious NHS resources?).

A completely new “ageing” vocabulary and language is needed and we need turn the conversation towards enablement as people go on their journey of ageing.

The challenges to fix the broken system of elderly care are vast, but so are the opportunities to completely redefine thinking of what ageing means to society and the role of the state and business to support the growing ageing population.  Culturally, we need a new paradigm of thinking.  The baby boomers today don’t like to see themselves as “getting old” and certainly don’t look forward to going into a care home as part of their life plan in the current status quo.  A completely new “ageing” vocabulary and language is needed and we need turn the conversation towards enablement as people go on their journey of ageing. 

In parallel with this new language we need a new model for innovation in “ageing”, around notions of empowerment and enablement that is centred on what humans need as they grow older to live they lives they want.  This will require a multi-stakeholder and cross- sector approach from government, business and the social /charity communities.  As citizens first, and as leaders second, let’s start asking ourselves serious questions to understand the problems- and then the solutions to fix them- from a human perspective. 

 

Eric Kihlstrom, KareInn

Tina Woods, Lansons