Creating long term care facilities for the elderly

Creating long term care facilities for the elderly

Elderly population (65+) in Bangladesh will reportedly make 16.30 per cent (31,413,697) of the total estimated population of 192,690,991 in 2051-- only in thirty years from its 2021 share of 5.33 per cent (8,865,237) out of the current total population of 166,303,494 (Source: United Nations, Department of Economic and Social Affairs, World Population Prospects 2019: https://population-pyramid.net/en/pp/bangladesh). Elderly population will account for one third of Bangladesh's population in 2100. This ageing of population will change the landscape of the current ways food, transportation, housing and healthcare are planned, developed and delivered.

The growing prevalence and burden of chronic diseases and health conditions and other associated morbid conditions will lead to functional impairment (disability) and limitations of daily living (dependency) and thereby the need of long term care (LTC) in Bangladesh will rise enormously over the approaching decades.

Given the rise of the size of the elderly, Bangladesh needs to reflect seriously about preparing, organising, packaging and delivering necessary social and health services for its ageing population while ensuring the quality of such services along with respecting the dignity and privacy of all the beneficiaries. When the care recipients will themselves pay for these services, they must get the maximum value from the service providers and when the government will provide these services free or subsidise them partially, it must create an accountable system including setting the standards of care so that tax money is not wasted and satisfaction of the senior citizen is assured.

LTC encompasses a multiplicity of services depending on the care recipients and their needs and is delivered to meet health or personal care needs. These services help people when they can no longer perform their daily activities because of an illness, disability or simply old age and let them live as independently as possible for as long as possible. It is provided by caregivers with different types of training, skill-sets and certification depending on a recipient's health condition, susceptibility and available family support. Even though it is not called as such, most LTC in Bangladesh has always been provided at home by unpaid family members and friends. It can also be provided at a facility such as an "old home" as is popularly called now in Bangladesh or in the community such as at "adult daycare centres" which do not exist nor offered in Bangladesh yet. But with rapid and continued growth of the old age population, the attention of the government, non-government policy makers in Bangladesh is finally drawn to think about planning and delivering LTC in a more structured and formal way.

The type of LTC most commonly used is personal care-assistance with everyday activities, also called "activities of daily living (ADL)" in formal literature and professional reports. These activities include dressing, grooming, bathing, using the toilet, eating, and moving around. Getting out of bed and sitting into a chair or on a mat is also a required service for a frail enough individual. LTC in other countries also includes services provided in the community such as delivering prepared or cooked meals and arranging for transportation services. These services may be provided free by a government in some countries with socialized healthcare delivery systems or for a fee in countries where private pay for services is customary.

In addition to older people, others in the society may also often need LTC when they have a serious, ongoing illness or develop a disability for example children with autism, people with a spinal cord or traumatic brain injury. The need for LTC can arise unpredictably, such as after a heart attack or stroke. More often, it develops progressively, as people get older and weaker with time or as an illness or disability worsens.

There have been research attempts to measure functional independence via different quick and easy ways to use tools; for example, one such tool uses a 0-7 scale to rank different ADLs based on the level of assistance required. Whereas instrumental activities of daily living (IADLs) measure  fundamental functioning as individuals live independently in a community, these include cleaning the house, cooking meals, shopping for groceries and supplies, managing money, moving within the community, taking medications and using the telephone and other forms of communication.

It is difficult to forecast how much or what type of LTC an individual may need. However, several characteristics have been identified to increase this need. LTC need generally increases as people get older and women need it more than men primarily because they have higher life expectancy. In Bangladesh, women almost always outlive their spouses as men marry women who are younger by several years. Single or divorced people are reported to need more care than married people. Poor diet and exercise habits can increase care needs as well as the health and family history. Research also suggests that persons with low income, who are very old, and who live alone need a higher amount of LTC services.

Home-based LTC includes health, personal, and support services to assist people living at home. These home-based services involve help with bathing, dressing, and taking medications. Unpaid family members, friends, and neighbours provide most of this type of care in Bangladesh. Home-based services can also be provided by paid caregivers and in other countries healthcare professionals such as nurses and therapists can be hired as and when needed. However, at some point, these supports may not be enough and people may require help full-time and must move to a residential facility. Group homes, continuing care retirement communities, assisted living facilities or nursing homes constitute residential care facilities where facility-based LTC can be arranged. Some have only housing and housekeeping whereas others also provide personal care and medical services. Special facilities offer care for Alzheimer's and other types of dementia. Physical, occupational, and speech therapy are also provided as rehabilitation services. Many residents in nursing homes live there long term because of their ongoing physical or mental conditions.

Bangladesh must address the needs and services of its fast growing elderly population; national level stakeholder engagement and planning may help formulate appropriate policies and start offering programmes to meet the needs taking into consideration the unique socio-cultural context of the country.

Dr. Hasnat M Alamgir is a Professor of Public Health.

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