Broken care system
“Aged care system fails to meet the needs of its older, vulnerable, citizens. It does not deliver uniformly safe and quality care, is unkind and uncaring towards older people and, in too many instances, it neglects them.”
So stated the interim report of the Royal Aged Care Commission in October 2019. In short, the aged care system in Australia is unable to deal with the level of demand for home care services.
The inability to meet the needs of older population is clearly shown in the number of community-dwelling older people not receiving the care they need. As many as 65% – or 129,000 people – of those who have been assessed to be entitled for a home care package do not receive the services at the approved level. Of these, 75,000 are not offered any home care at all and 53,000 are offered a package that doesn’t meet their needs in the first place.
The major quality and safety deficiencies of aged care listed in the Royal Commission report are truly shocking
The major quality and safety deficiencies of aged care listed in the Royal Commission report are truly shocking. They include inadequate care of wounds, sometimes leading to septicemia or even death; poor continence management, no help with using toilet or rationing continence pads, leaving persons sitting or lying in urine or faeces; and dreadful food, nutrition and hydration, just to name a few.
We cannot bear to think of this happening to our parents, aunts and uncles or even ourselves. As human beings, we are able to feel the fear of being abandoned without sufficient help for essential basic needs. As stated in the report, the scale and seriousness of failing to meet the care needs of older people in Australia is a shocking tale of neglect.
Care poverty – A global social malady
Australia is not the only country where the systematic and large-scale deficiencies of care systems to cover the care needs of the older population have surfaced. In the past decade, researchers in the UK, the US, Canada, Spain, China and several other nations have observed a high level of unmet care needs.
In Finland, our new study shows that 17% of people aged 75+ who have ‘Activities of Daily Living’ (ADL) needs, do not receive adequate support. These refer to personal care needs and key life tasks that people need to manage in order to live at home and be independent, such as walking, feeding, dressing, bathing and toileting.
Among people with ‘Instrumental Activities for Daily Living (IADL) needs, the level of unmet needs is even higher at 26%. These refer to things such as managing one’s finances, housecleaning, and meal preparation.
As such, it is clear that unmet long-term care needs are a global social malady.
In our study, we introduce a new concept for inadequate care: care poverty. We argue that ‘unnmet needs’, the term that has traditionally been used to describe the issue in gerontology, does not capture the inequality dimension, and consequently the seriousness of the problem.
Everyone has the right to affordable long-term care services of good quality, in particular home-care and community-based services. If and when this does not come true, society deprives its members their right to old age with dignity
Uncovered care needs mean deprivation of basic human needs. What’s more, they are a violation of several human rights treaties. The 2017 European Pillar of Social Rights says it clearly: ”Everyone has the right to affordable long-term care services of good quality, in particular home-care and community-based services.” If – and unfortunately often, when – this does not come true, society deprives its members their right to old age with dignity and quality of life.
This marks a failure of care policy and, more generally, a failure of the welfare state. And this policy failure brings about inequalities between those who receive adequate care and those who don’t.
Furthermore, there is a high risk that this inequality in care is connected to, and deepens other economic and social inequalities between different population groups. Low-income families, ethnic minorities, people with disabilities and unemployed persons are some of the groups that are under specific risk of care poverty. In addition, while the lack of adequate care has multiple and serious consequences for health and well-being for the older people directly affected, family carers and others who provide the care are obviously significantly impacted too.
It is obvious that unmet care needs are fundamentally a social policy issue. Care policies either reproduce or diminish inequalities between people. Deprivation of care is a social issue as serious as deprivation of basic material necessities. Both are connected to policy systems and social equality.
Eradication of care poverty should become the number one priority of care systems
On the other hand, poverty research with its long traditions and developed conceptual and methodological frameworks might offer insights and lessons for research on inadequate care. For all these reasons, we suggests that the lack of adequate support should referred to as care poverty.
Eradication of care poverty should become the number one priority of care systems everywhere in the world: care service provisions that meet the needs of the whole aging population both in quantity and quality have to be built. This is possible but requires effective and determined policies – and their creation requires political will. The question is, do we have what it takes?
This article is based on the authors’ recently published research: Kröger T, Puthenparambil JM & Van Aerschot, L (2019) Care poverty: unmet care needs in a Nordic welfare state, International Journal of Care and Caring. Access the journal article here.