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The Changing Nature of Aged Care - 1


Sweet little old ladies no more. These are some of Australia's Knitting Nannas, quietly protesting against fracking and more gas fields. They are on the front lines of the Climate War 

This Photo by Kate Ausburn is licensed under CC BY-ND


The World Health Organisation (WHO) tells us that globally there will be approximately 2 billion people over 60 by 2050, more than double the number in 2017 and far fewer people to support them. There are many reasons for this including smaller families, much longer periods spent in education, young people moving from rural areas into cities for education and work, more family breakups, different family structures, more single parents, cultural changes away from extended families and traditional practices, and people living longer due to medical advances. Now governments and others involved in the age care sector are scrambling to meet the rising demand. 

Changing Times

In many Asian countries such as South Korea and Vietnam the Confucian virtue of filial piety ensured that the elderly were respected and taken care of.  This duty officially fell upon the oldest son, but was most likely carried out by his wife. This has become more difficult to enforce in recent times as children move away or both parents work outside the home.

In China there were even fewer children as a result of the one child policy which ran from the 1970s to 2015, leaving even fewer young people to take care of the old. It has now made it mandatory that adult children must not only support ageing parents financially but visit them as well. Some 1,000 Chinese children have already been sued under such laws. In Singapore adult children can be punished with six months in gaol for failing to pay an allowance to their parents.

I was surprised to learn that many other countries including India, France, The Ukraine and Puerto Rico also have such laws on their books. I was even more surprised that Canada and some 29 US states had them too, even if rarely enforced

 The switch to in – home care

Helping people to stay in their own homes rather than in institutions is considerably less costly and not just in monetary terms. Pandemic death rates were far higher in Aged Care settings than amongst those who remained at home. Keeping people in institutions also tends to result in earlier physical and cognitive decline, more hospitalisations and even premature death. Losing lose contact with their friends and community and resulting loneliness and social isolation have been shown to be major factors. Many older people who are able to remain independent also do a great deal of society’s paid and unpaid work, including taking care of others, minding the children of working parents, coaching sport, driving others to appointments, delivering meals on wheels and oh yes, saving the planet!


Scotland has been rethinking its aged care sector since 2012. At the time 60% of its £5 billion aged care bill was being spent on institutions and hospitals.

Now very few older people are going into such facilities. Instead they are being supported to stay at home and remain independent for longer. Their homes are being modified with aids such as handrails and ramps, health and well -being are promoted and individual needs and desires are taken into account. Consultation with the older person is an important part of the program, rather than others making decisions for them. It's all about giving older people autonomy and dignity. Their carers are also supported and should they eventually need to enter an aged care home, the person can choose where they would like to go. 

Co -Housing

With more and more older people neither wanting to live alone nor end their days in a care home, co -housing is gaining traction. Pioneered in countries such as Denmark, Germany and the Netherlands, it is especially favoured by single women and those who have lost their partners through death or divorce, since it provides the option to interact with others or retain one’s privacy. 

The New Care Homes

When a care home does become necessary because of failing health, these are also being designed to be smaller and more home- like than conventional facilities, with opportunity for both individual and communal activity. To allow for more inter -generational contact and connection to community and services, they often include street – facing cafes, shops, medical services and pharmacies, as well as discreet modifications for those with reduced mobility, hearing or vision and those living with dementia.

 The Age -Friendly City

Others are considering change on a grander scale. Some 1000 cities in 40 countries have signed on to the World Health Organisation’s Age -Friendly Cities program. See the map here.


What makes a city Age- friendly?

 In practical terms, age-friendly environments are free from physical and social barriers and supported by policies, systems, services, products and technologies that:

     ● promote health and build and maintain physical and mental capacity across the life course; and
     ● enable people, even when experiencing capacity loss, to continue to do the things they value.

Age-friendly practices help build older peoples abilities to:

     ● meet their basic needs;
     ● learn, grow and make decisions;
     ● be mobile;
     ● build and maintain relationships; and
     ● contribute.

In doing so, age-friendly practices:

     ● recognise the wide range of capacities and resources among older people;
     ● anticipate and respond flexibly to ageing-related needs and preferences;
     ● respect older people's decisions and lifestyle choices;
     ● reduce inequities;
     ● protect those who are most vulnerable; and
     ● promote older people's inclusion in and contribute to all areas of community life.

 - WHO Age- friendly practices 


The World Health Organisation’s  "Age -friendly Environments in Europe” is an excellent resource for planners, national, state and city authorities, community groups, businesses and most importantly, elderly people themselves, to assess their own cities and to work out what their priorities should be. While these will vary from place to place, key concerns are listed below. I will only touch on them briefly here and then offer some practical examples in the next post.You can also read more here


1.       Outdoor Environment This involves looking at things like how “walkable” local streets are, whether there are pedestrian paths which will accommodate wheelchairs and mobility aids, whether there are resting places at convenient distances, safe cross walks, kerb cuts, accessible washrooms, clear signage and so on.

2.       Transport and mobility are about ensuring that the elderly have access to services and remain connected to their communities. This includes having adequate and affordable public transport, having bus stops within 500 metres of homes and facilities such as libraries and chemists which elderly people are likely to use. It asks questions such as whether buses have easy access or steps and whether there is adequate priority parking.    

3.       Housing, Building and Planning. Apart from ensuring that homes are affordable, practical and close to services, this is also about ensuring that public spaces and buildings are fully accessible to those with mobility, vision or hearing difficulties, that there is ground floor access, that aisles and doors are wide enough for wheelchairs and scooters and that there are automatic doors.

4.       Social Participation  - What activities and facilities are available for physical, cultural, social and learning opportunities?

5.       Inclusion and Non discrimination – Countering Ageism, incorporating inter -generational activities and making sure that people can participate regardless of physical or mental constraints.

6.       Civic Engagement and or employment opportunities

7.       Safety – This is about reducing crime against the elderly, including protection from fraud and abuse and also road safety.

8.       Communication and Information – How is information conveyed and how effective is it? In Australia for example, many older people do not have internet access or lack the necessary skills to navigate the many age -related websites.

9.       Community and Health Services

To be continued...For a glimpse of what's happening in some of these cities and how these principles are being put into practice, watch out for the next post.