Boomers Say No to Nursing Homes, Yes to HomeCare
Healthy Aging: Change Long Term Care Paradigm, Build Communities
Oct 8, 2009
Working Americans are concerned about the logistics of providing care for older relatives, the reliability of long term care insurance, and the prospect of paying tens of thousands of dollars out of pocket for home care or nursing home care. Those were findings of a survey called "National Research on Caregiving and Faith-Based Volunteerism," produced by the Robert Wood Johnson Foundation, Harris Interactive and Johns Hopkins University at the end of 2003. Since then the eldercare picture hasn't gotten any rosier. Boomers are concerned for their own aging process, and for their elderly parents, too. And many feel that staying active and connected to others is a key element in healthy aging. Policy makers are actively looking for new ideas for long term care. And some individuals are considering major reorganization of their personal life, for instance by exploring senior co-housing.
Eldercare in Denmark
There’s almost no such concern among baby boomers in certain other nations, where the caregiving crisis was anticipated decades ago.
For instance, Sine J., a 36-year-old Danish government employee working in the Dane Age Association says she needn’t worry about providing hands-on eldercare for her parents as they age. Although she lives in Copenhagen and they live in Aarhus, 50 kilometers away, she’s confident that government-funded programs will provide medical care and even once-monthly housecleaning services for her parents should they need assistance. Home-based services become available on an as-needed basis when Danes turn age 60. “It’s one-stop shopping, and it all happens through the government,” Sine says.
Elderly Danish Citizens Prefer Living at Home With Community-Based Care
An Oxford University's 2006 publication by George W. Leeson, called "Attitudes to Aging and Old Age: The Danish Longitudinal Future Study" explores the impact of different models of care for older people. Based on a large-scale study of generations born in the 1920s, 1930s, 1940s and 1950s, the report says that the vast majority of Danes 50 years of age and older expect (not just want, but expect) as they age to stay in the same home where they currently reside. The desire to do so is such a decisive generational characteristic that Danish sociologists call these citizens “staying-put generations.”
Acknowledged today as enjoying one of the world’s most comprehensive homecare systems, Denmark’s older citizens can remain in their own homes as long as possible, even as their health and ability to function declines. In so doing, they remain active, engaged with others, and as independent as possible. (Nursing homes do exist, but are used much less commonly than in the U.S.) There’s a price to be paid for living in this psychological comfort zone, of course. Danish taxes are among the highest in the world, rising to 60 percent for those in the highest paid class. Sine, who has been in the workforce for 15 years, pays close to half of her salary to taxes to support social programs, though only one is eldercare.
Will Denmark’s home-based services survive the demographic onslaught of the aging boomers? Nobody is sure. “We will have a lack of hands,” Sine predicts, referring to a shortage of home care workers. There are already efforts to recruit new home care workers among women returning to the workforce after taking time off to raise families. Another uncertainty hangs over whether today’s middle-aged citizens will be healthier or sicker in their old age. She ruminates. “The big question is what will happen in 20-30 years. Are people going to get really old and then die of a heart attack? Or get some illness like heart disease, and remain sick for a long time, and need a lot of care?”
Eldercare, which in the United States is a pressing issue for insurance companies, corporate human resource executives and most poignantly for individuals, is a problem the Danes successfully addressed almost 30 years ago. The Danish government-run program of homecare services, called hjemmeplejen, was instituted in the 1970s as an antidote to public dissatisfaction with nursing homes and institutions for disabled older people. Could the US long term care policy follow a similar path? It's challenging, but time to address the issue is now.
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