As the UK's life expectancy rate increases, so does the expectation of a well-funded and dignified long-term care service. Johanna Gornitzki investigates.
On 24 October last year, The Independent published a letter from a 75-year-old woman expressing anger that so little was being done to help her and her husband, and other people in the same situation, prepare for the future.
"Some realistic and practical help in growing old gracefully would surely be of benefit not only to the ageing millions but to the country in the long run," she pleaded. "We do our best. We eat sensibly and watch our weight, we take omega3 and glucosamine every day at our own expense, and walk when we can, despite our aching joints."
Unfortunately, she may be right in worrying about her future as it does not look like it will get any easier. Changing demographics mean that the number of elderly people living in Britain will rapidly increase over the next 50 years. With lifestyles improving and medical advances making it possible to treat most illnesses, it is no longer uncommon for people to live well into their 80s. According to Laing & Buisson's Care of Elderly People survey, published in 2007, the number of the UK population aged over 85 is forecasted to more than triple from 1.28 million in 2007 to 5 million in 2071 - increasing from 2.1% to 7.1% of the total population. And while this segment will see the major increase, the 75 to 84 and 65 to 74 age groups will also experience growth, increasing from 5.6% to 9.6% and from 8.4% to 10.6% respectively over the next 64 years. In total, 27.3% of the total UK population will be older than 65 in 2071 - that is more than one in four people.
So what will this mean for society as a whole? Recent media reports have suggested the UK may be facing an ageing timebomb, but is there any truth in that? 'Yes' but 'no' seems to be the general consensus among commentators.
Ageing concerns
Gordon Lishman, director general for Age Concern England, is concerned that people may forget the many opportunities that living longer could create and argues that problems will only arise if the change in demographics is ignored. "This change will have profound effects, but if we plan for it properly it doesn't have to be a 'timebomb'. Living longer creates opportunities for individuals and society. Any threats are a product of our failure to plan properly for the consequences of a change that we have seen coming for decades."
In order to plan ahead, it is necessary to establish how much more care is likely to be needed. This is one of the key questions The Wanless Social Care Review: Securing Good Care for Older People, published in 2006, tried to address. According to the report, trends in diseases and conditions can be used to estimate future numbers of people with social care needs. However, while it concluded that the UK population's health is likely to improve due to effective new treatments, technology and reductions in various 'lifestyle' conditions, it nevertheless forecasted a 54% increase in the number of older people with a high level of need.
This high level of need is closely linked to age; leaving many long-term care experts concerned that the group of people aged 85 and over is increasing at such speed. Because rates of disability and dependence escalate so rapidly with increasing old age, any long-term increase in population ageing will have a large impact on the demand for care services, as Lishman explains: "The primary driver for the increase in care needs will be the very significant increase in those living into their 80s and beyond."
Proportional representation
But while it is clear that the total number of people potentially in need of care will be higher, the question is how much more care will be needed? There are two schools of thought here. Some experts believe future advances in medical technology could reduce the demand for long-term care, arguing that, as scientists discover new ways of treating various illnesses, there will be nothing left to die from apart from old age. "In the 21st century, for the first time we will see human beings running out of things to die from," reveals Dr Karol Sikora, medical director at CancerPartnersUK.
He adds that what technology is trying to do is shorten the period of ill health at the end of someone's life in order to achieve a compression of morbidity. "The hope is that people will die cheaply," he says.
However, there is also a conflicting and pessimistic theory that suggests the overall effect of medical technology will continue to extend the expectation of life without reducing the number of years suffering of ill health.
Changes in demographics could also impact on the number of people willing or able to care for elderly relatives, which, in turn, would affect how many elderly people would have to rely on the State for their care. The disintegration of the nuclear family, people moving abroad and more women choosing to work are but a few things that could affect the amount of informal care provided. The latest Laing & Buisson report estimated that the potential cost of replacing such informal care - should friends and relatives stop offering it - would amount to around £21bn a year (although another survey states that it could be as much as £57bn a year). Luckily, several reports, including one from The Joseph Rowntree Foundation, assert that, while demographics may change, there is little evidence it will have a wider effect on family support for old people. That said, the Laing & Buisson report warned that even small changes in the willingness of people to provide unpaid care would substantially increase the need for formal care. "There is no doubt that relatives are the unpaid bedrock of care in Britain, and that, if relatives were to withdraw from providing informal care, over a period of time it would have massive and expanding effects on the shape and cost of long-term care in the future," it stated.
People have tried hard to solve the problem with the lack of carers and Dr Sikora reveals that there has even been a suggestion that robots could do the job. "Can you get a robot to do the caring? It all sounds like science fiction but people are being serious."
This problem aside, expectations among older people are also changing and new generations are likely to be more demanding when it comes to choice and quality. The so-called baby boomers that are soon to reach retirement age are, for example, likely to expect higher standards.
So what needs to be done?
At present, just over half of all care costs in England are paid for by the State - either through local authorities or the NHS - and are concentrated on those who have the fewest resources and only provided through means-testing. There are also two social security benefits that provide funds that can be spent on social care - Attendance Allowance and Disability Living Allowance - and they are the only sources of non means-tested funding for older people with disabilities. The means-testing system has come under a lot of criticism for being too complex and for penalising savers as well as using a 'postcode lottery' for domiciliary charges, causing The Joseph Rowntree Foundation to describe the UK's current long-term funding model as "unfair, not clear and unlikely to be sustainable in the future". The organisation argues that, without changes, older people will increasingly have to pay more from their own pockets.
Luckily, it seems like the Government has heard the pleas and, in October last year, Chancellor Alistair Darling announced that it will be launching a Green Paper on how to tackle the issue of how long-term care is funded.
Lishman thinks the move has come in the nick of time. "We need a significant cash injection immediately to keep the current system hobbling on followed by fundamental reform," he says, adding that, "older people are desperately concerned about losing their independence and being seen to be a burden".
Agreeing with Lishman, a spokesperson for Help the Aged, says she hopes the Green Paper will remove the means-testing system. One of the proposals currently on the table is for the Government to launch a State-backed insurance scheme that would work in a similar way to National Insurance, she says, but adds that the Government has refused to be drawn on anything yet.
Whatever is revealed in the Government's Green Paper, the hope remains that it will give more reassurance than the current system to those desperately in need of care. As Lishman concludes: "It is often hard to offer much hope when the current system is so thoroughly broken." n
