Globally, many politicians neglect long-term care (LTC ) needs of older persons and assign a very low priority to public support provided through social protection – despite the dramatic ageing of the world’s population (PNUD et al., 2014) and the growing number of older persons with physical or mental incapacities in need of LTC. However, currently, very few countries provide such protection or are planning related reforms to offer public support for LTC. Also in the recent discussions around the post 2015 agenda and the Sustainable Development Goals (SDGs), LTC has not been considered as an issue to be addressed with high priority.
One of the reasons the need for LTC is disregarded relates to the perceived availability of “free” care provided primarily by female family members. Stereotypes that female family members can and should take over the full burden of providing LTC are widespread and exist in countries of all regions, developed and developing. However, these viewpoints ignore that LTC requires by far more than compassion for relatives:
LTC requires professional and skilled workers to provide quality services, as well as coverage of the related expenditure.
It also requires funds that empower and enable persons in need of LTC, for example to develop enabling living environments.
Family care involves significant costs due to foregone income of caregivers and associated risks of impoverishment due to a lack of social protection during times of care, for example in case of sickness, accident or old age.
Politicians should also be aware that the number of potential family care givers will shrink due to demographic ageing, growing female labour market participation and the impact of reversing early retirement policies. Thus, while the role of families in providing informal care will remain important, such approaches are not sufficient in the context of demographic ageing and might involve in the longer term higher costs in the form of lost income and productivity than if comprehensive public support was provided through social protection schemes and systems.
The neglect of making public LTC solutions available can also be interpreted in the context of discrimination and negative attitudes towards older persons: Ageism is a global phenomenon that is sometimes even laid down in regulations and legislation, for example higher costs or unfavourable conditions of certain insurance policies for older persons or being refused for specific medical services due to age (Naish, 2012).
Negative myths about older persons can even be found in text books for health and LTC workers that often ignore the potential of health and functional capacity improvements of older persons and under-report positive developments that can be achieved by providing adequate quality LTC services including prevention for older persons.
The situation is aggravated by the fact, that the training and skills development of formal LTC workers is often at very low levels compared to e.g. health workers (Colombo et al., 2011). Thereby the dependency and functional incapacities of older persons are likely to increase and a self-fulfilling prophecy occurs. In the worst cases, ageism results in abuse and violence against older persons in need of LTC, both in institutions and when receiving home-based care. Reasons often relate to a lack of adequate training and skills and result from perceived excessive demands (OHCHR, 2014). It is estimated that in Europe alone at least 4 million older persons experience such abuses every year (WHO Euro, 2011).
Finally, in many countries a cultural aversion to LTC exists, as it is understood as institutional care only while ignoring other forms of care, such as home-based services. In these countries, it is regarded as dishonorable if family members do not take care of older relatives. In Algeria, for example, a study among 115 people (the majority younger than 35 years) revealed that none of the respondents supported the idea of sending their parents to a care institution (Paranque & Perret, 2013).
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