The Organisation for Economic Co-operation and Development (OECD) recently published a study on the cost of long-term care (LTC-Care provided at home) and poverty among older adults. It highlighted the increasing rates of expenditure from public services as well as people’s own finances for the cost of such long-term care provided at home. In some instances, it was noted that individuals in OECD countries could be paying more than half of their total monthly income for the cost of care at home. Despite a number of initiatives by respective governments to provide more equitable access to care, poverty remains high across this demographic. With a significant increase in the population of over-65’s projected globally over the next 30 years, it is difficult to see how the situation will improve.
The UK context
In Scotland, we have a rather innovative approach to funding of long-term care in the sense that it is free (for personal and nursing care only). Additionally, Scotland also has free prescription services, with most medications being prescribed to those over the age of 50. However, even with these very progressive approaches, this does not necessarily equate to a reduction in poverty levels for older adults in Scotland. Absolute poverty in older adults has seen the same fluctuations in Scotland as it has in England and Wales since the introduction of free personal care in 2002 and the introduction of free prescriptions in 2011. Furthermore, although relative poverty in older adults in Scotland is at a lower level than in England and Wales, the percentage difference remains quite marginal.
Additionally, some OECD nations with means-tested charges for LTC, actually have lower levels of poverty in over-65’s when compared to Scotland (Finland, Norway etc.). Moreover, the cost of free personal care alone is now nearing £900 million for the Scottish government. Though I would remain optimistic about its continuation, its expansion to other countries, and certainly see its benefit to individuals, there are other areas to consider to prevent poverty among this demographic.
Poverty and poorer health outcomes
As the report highlights, attention should be given to enabling individuals to live well in later life. This, as opposed to trying to address the problem of poverty in older age adults given the inevitable increasing demand on public finances through the coming years. Income poverty levels continue to fluctuate throughout the OECD, with sharp increases for a number of countries since the pandemic. Significant research has focused on the links between poverty and poor health, specifically chronic and enduring illness which requires the implementation of long-term hospital-based or community care services. Income poverty, however, is unevenly spread between different groups and demographics in society. In the UK, black and ethnic minority groups tend to be amongst the poorest in terms of income, which correlates with poorer health outcomes for this demographic in adult and later life.
Income poverty, however, is only one aspect which has significant detrimental impacts on overall health and wellbeing. The World Health Organisation’s publication on social determinants of poor health indicate several areas outside of income poverty which can have notably detrimental impacts on physical and mental health. Areas such as safe and adequate housing, education and food security all play key roles in how our lives are shaped by governmental economic and social policies. In addition to this, how and when we can access medical and social care can play major parts in how we are able to continue functioning at any stage in our lives.
Early and effective interventions
For governments to deal with the increasing demand on social care costs in later life, there needs to be a concerted effort to address those structural inequalities which lead us to needing that care as we grow older. That is why early and effective interventions are crucial, particularly in the field of health and social care, to address concerns before they reach crisis point.
Furthermore, there needs to be greater emphasis on multi-disciplinary working within primary care settings. Holistic and comprehensive networks are required in order to identify and tackle medical issues in the context of an individual and social landscape and that should be the focus of a well-balanced and well-funded primary care system. When we consider the impact of lengthy hospital admissions or pressures on beds for example, it seems somewhat absurd to think of how much of an imbalance this strikes with preventative measures in the community.
An added factor in implementing proper multi-disciplinary teams, however, is staffing levels. Although there are increases in numbers of staff working in health and social care globally, general practitioner levels are quite low in comparison to specialists. Physiotherapist numbers are on a downturn and numbers of nurses have seen a very marginal increase over the past 10 years, coming nowhere close to the rise in population during that time. To address this issue, there needs to be a multi-faceted approach to drawing people back into, and keeping them in, the professions which are required so desperately. Long working hours, increasing demand, low pay and poor working conditions are rife across health and social care services, with little change being made to address those areas.
Cost and trust in healthcare services
In addition to structural barriers to intervention, individual perspectives and socio-economic factors also play their part. Cancer screening, for example, is largely free across most OECD countries, but patient uptake remains fairly low in spite of this (p.108). Certainly, ensuing cost in countries where subsequent treatment is not free is a significant factor, with individuals from lower-economic standing delaying or failing to engage with treatment being a common issue.
However, there is also a real concern in a number of countries about trust in healthcare services, with a noted drop in such perceptions in 12 of 22 OECD countries surveyed since the pandemic. Waiting times also play a part in individual trust in healthcare services, with some people reportedly waiting for over a year for basic knee surgery in some countries such as Chile, Poland and Estonia for example. For countries with more rural areas and lack of outreach services, travel can be a crucial issue for most people when seeking the support of medical care, particularly individuals with lower income. Lack of access to medical services then increases the risk of poorer health outcomes in later life.
Giving us the needs to live well in later life
Poverty in later life will continue to remain a pressing concern for most governments globally. However, we can see that there are multiple factors which create the need for care in later life. Focus should be placed heavily on our ability to live well at all stages of the life course, and much work is needed to address the inequalities which severely impact the way in which our lives, our health and our environment are shaped. To address that, we need to see the increasing role of governments to build and maintain appropriate health and social care systems which meet the needs of their growing aging populations and allow us to have the confidence and trust of our public services to enable us to live better for longer.
More in health.
