After decades of growth, life expectancy gains are now stalling in many OECD countries. The OECD has undertaken new work on healthy ageing to look at how we can support people to age more healthily, exploring how health systems are adapting to population ageing and how communities are supporting older people to live healthily and independently
Ageing and long-term care
As people get older, it becomes more likely that they will need help with day-to-day activities like cooking, cleaning, getting dressed and self-care. This type of support is known as long-term care (LTC). With rapid population ageing, countries need to rethink how systems can promote healthier ageing, improve the quality of care and find new ways to care for people at the end of their lives, while balancing the social adequacy of systems with financial sustainability.
Key messages
LTC needs are particularly high among vulnerable populations such as women and those on low incomes, and, while all OECD countries provide some degree of support for LTC, many might not be able to afford care. For the first time, new data on LTC systems provides insights into the affordability of LTC from the user’s perspective, looking at how much it costs to get help with LTC needs, available state support, and potential support needed from family and personal resources.
Due to the pressing challenge of an ageing population, the demand for LTC workers is set to outpace supply, requiring a sharp increase in LTC employment over the next decade. In order to meet demand, countries have taken a number of actions to attract and retain LTC workers, such as increasing carer wages, improving working conditions, and enhancing social recognition. In addition, the bulk of care is provided by family or informal carers who also need support in combining their work and caring responsibilities.
Context
Worker shortages in long term care
Ageing populations are expected to significantly boost the demand for long-term care services, yet the supply of care workers has been stagnating over the past decade. Poor working conditions, low salaries and a lack of recognition make recruiting and retaining LTC workers difficult. Education and training requirements are also generally low, which can negatively affect the quality of care.
A major part of care is provided by informal carers, such as family and close friends. Across 25 OECD countries, about one in eight people aged 50 and over provide informal care. Intense forms of providing care also negatively affect the mental health of informal carers and make it difficult to reconcile work with providing care.
Where do people receive end-of-life care?
Measuring the quality of end-of-life care is not straightforward, but exploring where people die and what type of care they receive in their last months of life are considered good indicators. End-of-life care can be delivered in a number of settings and most people would prefer to spend the last days of their lives at home. Yet, hospitals remain the most common place of death and end-of-life care spending is geared towards hospital settings.
It is important to realise that a decrease in the share of deaths in hospital does not necessarily mean better quality of end-of-life care. In fact, ensuring that adequate end-of-life care is available in all settings is essential to allow people to choose where they wish to be cared for at the end of their lives.
