By Zuleyka Zevallos, PhD

CNN reports that in response to the neglect of elderly family members, the Chinese government amended The “Law of Protection of Rights and Interests of the Aged” in December. The new legislation addressed cases of neglect of elderly parents, such as one reported case where an elderly family member was kept in a pigsty. This is an interesting case that I will explore in comparison to the management of aged care in various societies, including China, Sweden, Japan, the UK and Australia.

The population in some of the world’s most economically advanced nations are increasingly skewed towards an older distribution. This presents social policy problems for governments, communities, the healthcare system and social welfare. Aged care was once the domain of families, but harking back to family care is not necessarily a viable solution. Aging populations require specialist knowledge from various fields in medicine, social work and the social sciences in order to plan for the future. This includes new knowledge about health, sustainable environmental planning, social research and new community infrastructures.

Today I want to explore the question: As our workforces are increasingly older, whose job is it to look after the elderly?

Government Responses in China

China’s social norms about family have changed rapidly. Chinese cultures still emphasise family honour and the special status and obligations towards elderly family members (“filial piety”). Nevertheless, what this means today with respect to aged care is a topic of social contention.

Family norms have changed as a result of the one child policy, meaning there are less siblings who can share the load of care. It is also an outcome of economic expansion, as more people are expected to pursue careers demanding long hours.

This is an important social policy case study. Even under the best of intentions, state intervention into family life does not always benefit all groups. Instead of expanding its social welfare system to support families, the Chinese government will prosecute people for neglect. This may not be wise, given the pressure that some families already experience in keeping up with excessive work demands and financial constraints. Wealthy families are better positioned to outsource care for elderly members, while those who already struggle are likely to be penalised under this model.

Furthermore, as many younger people have moved away from their families’ remote villages in order to pursue an education and to find work, the new law will effectively force them back home where there may not be the same opportunities.

Looking Beyond Family Obligation in Sweden and Japan

The issue of elderly care is a big concern around the world, with some of the strongest economies and most technologically advanced nations having to figure out how to care for their aging workforce. In Sweden, one of the most progressive social welfare systems in the world, public spending on aged care has been decreasing. People who can afford to fund private care for family members are the lucky few.

A larger proportion of aged care is being managed by families: 60% of families cared for aged family members in 1994 and 70% did so in 2000. While this might seem ideal, so that elderly people are not shuffled into clinics, this does not necessarily mean better care. Elderly people who are sick and frail require specialised care that families may not be able to provide.

In Japan, medical researcher H. Arai notes that the proportion of elderly has increased from less than 6% of the population in 1960 to 23% in 2010. This  presents many social welfare challenges to support the social participation of the eldery, to help them cope with isolation and increase their social esteem.

Moreover, experts from several fields (medicine, social work, environmental planning and so on) need to work together to start training more professionals to research and better support the health and wellbeing of an aging population given changing social conditions, diet, exercise and technological needs. This multi-disciplinary approach to aged care is known as gerontology.

Eligibility & Access to Aged Care Funding in the UK

In the UK, there have been many controversies over the Care and Support Act. Professor of Applied Science Bob Hudson points out the fact that apart from the issue of how much money should be spent on aged care and where that funding should come from, the biggest barrier to aged care is eligibility. In its present form, the legislation will disqualify many people from affordable social welfare and healthcare. Hudson writes:

“Ultimately the real issue is about priorities. Do we, as a society, want to find the resources to invest in securing better care and support for people who are sick and frail? If so then resources can be found. But until this happens we will continue to have a fire-fight over people with the highest need while allowing others to fester behind closed doors.”

What this tells us is that government policies that look only to solve aged care needs in terms of economics are neglecting the social and health responsibilities towards its citizens. Without taking on board social science findings, policies will continue to exclude and neglect an increasing number of people. This will only exacerbate future problems. What we do today will put societies in a better position to cope with aging populations.

Changing Needs of the Elderly in Australia

In Australia, research shows that elderly people would prefer to be cared for in their own homes rather than being taken into hospital or to some other facility. Siggins Miller’s 2003 report argues that hospital and community programs should look to balance out the wishes and health needs of elderly people, by supporting transitional care to enable people to return home where they are physically and medically safe to do so.

Sub-groups within society have other special needs. For example sociologist Loretta Baldassar notes that migrants from non-English-speaking backgrounds have different obligations to their families in Australia as well as elderly members overseas. This shows that cultural considerations are important considerations when governments enact new family policies.

How Sociology can Improve Aged Care Policy Delivery

Sociologists break down the various elements of health care in order to improve social policies. Generally, this encompasses economic, legal and political, and emotional needs, which should be addressed within a holistic policy framework.

• Economic: this includes financial and other resources needed to maintain a minimum level of healthcare. This might encompass having access to networks that will determine the best available care for individuals in particular locations.
• Legal & Political: This includes social policies that must take into consideration socio-economic factors of care for different groups at the individual, community, state and federal levels.
• Emotional: This includes the psychological and personal wellbeing of people who require health care.

In all cases, a robust health care policy takes into consideration local resources and the needs of people who require care, as well as their caregivers. In the case of aged care, as I have discussed, placing greater demand on families does not adequately match the welfare system that we live in today.

Social science brings other care requirements to light, such as inequalities in providing care. Sociologists Michael Fine and Caroline Glendinning show that aged care has additional “burdens” that change over the life cycle. For example, research shows that women provide the greatest “hands on” care in families for children and throughout middle age. Amongst elderly couples, however, research from the UK shows that there are similar rates of men and women providing care for their spouse from the age of 65 years. In Australia, a slightly higher proportion of elderly men care for their wives. This creates further health complications. For example, elderly people experience higher levels of stress when they look an elderly spouse who suffers from dementia.

The researchers argue that the public healthcare model for aged care should be built upon the idea of interdependence. When one family member takes care of another, this creates other health issues that need social policy intervention.

Fine and Glendinning argue that carers are in a vulnerable position. Carers require additional services and support in addition to the needs of elderly people receiving care. The physical demands of aged care as well as other work (housework and tending to other duties), economic needs and emotional care are a drain on individuals and their families. Means-testing financial and other assistance can add to the pressures on families when policy measures are based on narrow ideas about what aged care actually entails on a day to day basis. There is much invisible work that families invest into aged care. This has other ripple effects, such as the ability to continue working, studying and participating in a well rounded community life.

Social policy makers would be in a better position to prepare for the future of our aging population when addressing these complex sociological lessons on aged care.