Crisis in care – no ideal remedy

November 25, 2009

Demographic change has begun to materialise. Countries with rapidly ageing populations have to come up with customised solutions in order to avert a crisis in care. Technological innovations will be a key element of such solutions.

"Facts do not cease to exist because they are ignored." (Aldous Huxley, 1927)

One of the most profound structural problems confronting industrial countries is demographic change. The resulting shortage of labour and especially of skilled workers is reducing the competitiveness of industrial nations and is presenting social security systems in particular with daunting challenges. (Blinkert and Gräf 2009)

The situation is acute in Japan and many Western European countries. in Japan at present the ratio of pensioners (over-65 cohort) to members of the workforce is one to three. In 2020 this ratio is expected to increase to 1:2. Switzerland has to expect the ratio to deteriorate from 1:4 to nearly 1:3 by 2020. In Germany the ratio of pensioners to members of the workforce is already 1:3. In Germany, as in many other European countries, the full force of demographic change will not be felt until after 2020.

The impact on the care sector will be particularly pronounced. Societal ageing and in particular the fast-growing 80+ age group have led to a dramatic increase in the demand for care. The resulting demand overhang jeopardises the quality of life of people requiring care. In Japan and Switzerland, for example, the skill shortages are already so acute that the talk there is of a crisis in care.

Despite the promises made in advertisements there is no cure for ageing; but what are the options open to policymakers in tackling the problem? 1) Increase the supply of care staff by boosting immigration in particular, 2) Reduce the demand for care services or 3) Boost the productivity of the existing care staff?

1. The primary focus of attention at present is on increasing the supply of care staff. A selective migration policy is one important factor in reducing the skill shortage. In Switzerland the shortfall in care personnel is projected to reach at least 120,000 by 2030, while Japan is already contending with this problem. That is why the Japanese government has signed bilateral labour migration agreements for care personnel with the Philippines, for example. This is an astonishing step given Japan’s otherwise lukewarm support for migration strategies. In the long term, however, migration can only be one part of the solution, because worldwide there are already too many countries affected by demographic change. Tackling skill shortages at the expense of less developed countries is also a disturbing approach as these nations would have to provide the majority of care personnel. The competition between countries has intensified so much in the meantime that the World Health Organization (WHO) is pushing for a code of conduct and bilateral agreements to protect weaker countries.
2. The phenomenon of increasingly “healthy” ageing is an important damper on the demographically driven rise in demand for care services. We are not only getting older, we are also remaining healthy for longer, which means that the age from which care services are required is trending upwards. Technological innovations like tele-health, tele-care and ambient intelligence could foster the independence from care services and preventive measures could bring about a further increase in the healthy years of life. Furthermore, technological aids and prosthetics enable individuals to remain independent for longer in their own homes. These developments will enable inpatient care to be cut back in favour of outpatient care. Another important means of reducing demand is by boosting social capital, via mutual aid, for example. The combination of mutual aid and technology could for example lighten the load on caregivers and at the same time allay ethical concerns regarding the use of technology, such as it making users feel isolated.
3. Boosting the productivity of the existing skilled personnel is particularly dependent on technical equipment. Every activity that care staff can be relieved of frees up capacity. Productivity gains in this case are not, however, synonymous with a lower standard of care or even less face time. On the contrary many technological innovations have the potential to boost these quality criteria, for example by reducing time-consuming ancillary and administrative tasks.

Technophile Japan leads the way. There, robots are already being used that can lift and carry patients interactively and as the situation demands. They operate while the carer is present and therefore do not disrupt contact with the patient. Developments in the therapy for dementia sufferers go much further. The first robots for this application are in the form of cuddly toys that enable interactive communication via sensor technology. This application is not a substitute for personal care either, but it does perform time-consuming care tasks that cannot otherwise be performed due to the capacity limitations. This area undoubtedly requires a high degree of sensitivity.

How to weight the three options open to the politicians of the countries concerned is dependent both on the respective immigration and innovation potential as well as the decisions made by other countries that are competitors for skilled personnel and market share in the technology segment. Countries like Japan, with a heavily technophile population and a high per-capita income, will presumably choose strategies that rely more heavily on technology than countries with comparatively large migration potential. Certainly none of the approaches described above can be dismissed. As such, governments need to ensure early implementation of measures, not only in research and migration policy but also in the areas of communication and education. The efficacy of the solutions presented is conditional on their acceptability to the population. This acceptability can by no means be taken for granted as far as the use of foreign care staff and novel care technologies are concerned. The ground must be prepared in a timely fashion and an active communication policy is necessary.

See also: E-Health: New medical and nursing options help doctors, health insurers and patients

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