What do care systems look like around the world?
With improved medical care and scientific funding, the global population is aging rapidly. It is important for elderly people to be well looked after in their later life to keep them happy and comfortable. Care systems differ on a country-by-country basis, with some more reliant on state care than others. Acorn Stairlifts, stockists of straight stairlifts investigates:
In the UK
The most common route for elders to take into care is staggered. This eases the elderly population into accepting care. When individuals are beginning to struggle, perhaps with making meals or getting washed, they can access help from home. This is in the form of specially trained carers who visit those in need at their own homes to provide necessary care.
There are now many homes and flats that have been specially designed for the older generation. These often have a community room where residents can socialise and a warden that is present during the day. The homes are specially designed for those who are less able, with non-slip floors and apparatus to help with getting up from the toilet and in and out of the shower.
When an elderly person needs more care than this, they usually go to a full-time care home. None of the services are free, although some people aged over 65 get help towards the costs and others use their savings. At the moment, people with assets of more than £23,250 have to pay for the full cost of their care (this includes the value of their home).
The system varies across countries in the UK. For example, in Northern Ireland, care in the home is free for people over the age of 75. For over 65s in Scotland, personal care is free if they are assessed as needing help for tasks like washing, dressing and preparing meals.
In the US
The healthcare system in the US is mostly private through people paying for care insurance. There is also a programme called Medicaid that assists with medical costs for those with limited resources — covering nursing home care. This system pays for 61% of nursing-home residents’ care. Elderly care is a key consideration that must be made by many. In the US, 47% of men and 58% of women who are of or above retirement age will experience a need for long-term care in the future.
It's understandably common for seniors to be reluctant to leave their homes. In fact, when surveyed, almost 90% of seniors said that they want to stay in their homes as they age. Care insurance often can assist with this as it pays for home help such as washing and cooking support. Even when elderly people begin to require day-to-day assistance such as getting dressed, only 4% said that they would prefer to move into a relatives’ home over staying in their own surroundings. Despite this low figure, 75% of adult children think about their parents’ abilities to live independently and presumably consider their future options. These children contribute between $7,000 and $14,000 per year to care for an ageing parent.
Seniors do have the option of round the clock care in a nursing home too. 11.2% of women over the age of 85 lived in a nursing home in 2014 and this figure stood at 6.1% for men of the same age group.
In Canada, the number of over 65s (16.9%) is now higher than the number of under 15s (16.3%)! This makes elderly care an important priority for Canadians. When looking at health expenditure as a whole, Canada has invested more funds into drugs rather than hospitals and physicians over the past 30 years and this could count towards their aging population.
Unlike in the US, the health care system in Canada is largely funded through taxing. The capital of Canada, Ottawa promised to spend $6 billion over the next decade in order to address their aging population and help with home-care programmes.
There is a lot of pressure on nurses to provide care in Canada. In fact, the demand for these workers is predicted to rise from just under 64,000 full-time jobs to 142,000 by 2035. Perhaps these stretched resources are the reason why more Canadians are taking on the role of caregiver and offering informal care for their own parents. In fact, 30% of workers with older parents take 450 hours per year of time off work — putting a strain on their own careers and on employers.
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The care system in Italy differs quire drastically to the systems elsewhere. The care of elders is said to be the responsibility of a person’s family and therefore care homes are not as popular as in other countries (less than 2% of the senior population use care home services). In fact, Italian institutions often only intervene if the person has no family to care of them.
It's traditionally left to the women of the household to care for older family members. However, they are now taking up employment and their time is spent working instead — creating a greater reliance on public care facilities. The mentality of family care was evident in 2004 when the majority of Italians thought that it would be beneficial if adult children looked after their older parents when they became reliant. It is likely that this mentality has continued many years later.
Unlike in the UK and US, there is not much of a staggered system. This means that elderly people who are fairly fit live in regular homes that have not been adjusted for needs of the older generation. However, in the 1990s, a greater focus was given to elderly people and their specific needs. This saw the introduction of a new framework which includes home care, day centres and nursing homes and now, over 5% of older Italians use home care services.
Similar to in Canada, the elderly care system is largely public funded. There is also a large amount of informal care that is offered by family members of elderly residents. The general aim amongst Belgians is to keep the older generation in their own homes, comfortably, for as long as possible.
In Belgium, there is a scheme of ‘service flats’ too. This is where elderly people can live within their own space but have access to useful facilities such as home help and cooked meals if they need it. There is also the option of day care and short stay centres and this provides families with some respite from care.
There is also an interesting initiative called ‘kangaroo housing’. This has been around for 30 years and involves older people living together with immigrant families in the same house on separate floors. The immigrant family help the elderly person out if they are ever in need. One project was launched in a Belgian district called Molenbeek where 60% of the population are immigrants and 25% are retired. It can benefit both parties in terms of improving their sense of belonging in the community and overall well-being.
Recent statistics have shown that there will be more than 23 million citizens in Germany over the age of 65 by 2035.
One of the schemes in place in Germany involves their intake of refugees. Between 2015 and 2016, 1.2 million asylum seekers entered Germany, most aged between 18 and 34 years old. A training scheme is in place where refugees are being taught how to care for the elderly. This addresses their aging population and the immigrants who are looking for work.
Another initiative involves cohabiting. When surveyed, 82% of Germans said that they did not want to grow old in a nursing home. Grants that were introduced in January 2013 allow the elderly to live in a community apartment with one another, cohabiting and socialising when they want to. This decreases their likelihood of becoming lonely without placing them in a full-time care home.
There are also places that have many generations under one roof. These multigeneration houses are made up of a kindergarten, a social centre for the elderly and somewhere for young families to drop in for socialising or support. Pensioners can volunteer to read to the children and interact with them through singing and games.
From unique schemes such as kangaroo housing in Belgium to the reliance on private healthcare in the US, it’s easy to see that care systems do differ around the world. And what does the future hold for our older generations? Innovative concepts such as elderly friendly supermarkets and villages are popping up in some places, as countries continue to reach out to older people and try to improve their quality of life.
Long haul Covid, the brain and digital therapies
It is estimated that around 10% of people who get Covid-19 develop long haul Covid, a debilitating condition that can last many months and cause breathlessness, exhaustion and pain.
Research is underway to find out who is more likely to get it and how to treat it. Here neuroplasticity expert and owner of Harley Street Solutions in London Ashok Gupta tells us how the condition affects the brain.
What is long Covid exactly?
Long Covid is when patients who have experienced Covid-19 go on to have continuing symptoms for weeks and months afterwards. These symptoms can include breathlessness, exhaustion, brain fog, gastric issues, pain, and post-exertional malaise. It is estimated that around 10% of Covid-19 infections may result in developing long haul symptoms, and in the USA, this may be affecting over 3 million people.
How does it affect the brain?
Here at our clinic, we hypothesise that it is due to a malfunction in the unconscious brain, creating a conditioned response that keeps the body in a hyper-aroused state of defensiveness. At the core of this hypothesis is the idea that we are here because our nervous system and immune system have evolved to survive. We are survival machines!
When we encounter something such as Covid-19, the brain perceives it as life threatening, and rightly so. And in the era of the pandemic, with more stress, anxiety and social isolation, our immunity may be compromised, and therefore it may take longer for the immune system to fight off the virus and recover.
If the brain makes the decision that this is potentially life threatening and we get to the stage where we’re overcoming the virus, a legacy is left in the brain; it keeps over-responding to anything that reminds us of the virus. Even if we’ve fought off the virus, the brain will react in a precautionary way to stimuli reminiscent of the virus.
The brain may get stuck in that overprotective response, and keeps stimulating our nervous system and our immune system, just in case the virus may still be present.
What symptoms does this cause?
These signals cause a cascade of symptoms including breathlessness, extreme fatigue, brain fog, loss of taste or smell, headaches, and many others. And these are caused by our own immunes system.
In the case of long-haul Covid, symptoms in the body get detected by a hypersensitive brain which thinks we’re still in danger. The brain then chronically stimulates the immune and nervous systems, and then we have a continuation of a chronic set of symptoms.
This isn’t unique to long-haul Covid. Many patients develop chronic fatigue syndrome, sometimes known as “ME”, for example, after the flu, a stomach bug, or respiratory illness. Covid-19 may be a severe trigger of a form of chronic fatigue syndrome or ME.
How does long-haul Covid affect mental health?
Anxiety is a very common symptom in long haulers. It can be frightening to wonder about what may be happening in your body, and what the prognosis is going to be for one’s long term health. Reaching out for support for mental health is crucial for long-haulers.
How does neuroplasticity treatment work for long-haul COVID patients?
We have been working with patients for two decades with a brain retraining programme using neuroplasticity or “limbic retraining.”
We believe that through neural rewiring, the brain can be “persuaded” that we are no longer in danger and to come back to homeostasis. But to be very clear, we are not saying it is psychological in any way, but we believe there are novel ways of accessing the unconscious brain.
We recently worked successfully with a 56-year-old male with long-haul Covid, who prior to contracting Covid-19 in March of 2020 was running half-marathons and cycling, but afterwards he struggled to get off the sofa for months. Within 3 months he’s now back to 100% and running half marathons again.
At our clinic, we train the patient to be able to recognise those subtle unconscious danger signals on the periphery of consciousness. This, coupled with supportive techniques and the natural hallmarks of good health such as sleep and diet help prepare the patient to respond to perceived threats that might trigger the response.
The natural state of our brain is to default to protection. The brain prioritises survival and passing on our genes to the next generation, over any other impulse. It cares more about that than you feeling healthy and well. Protective responses are evolutionary, and are the right thing for the brain to do – it’s survival.
What digital therapies or apps are proving effective at treating long-haul Covid?
It seems that long haul patients are availing themselves of many online therapies and services, including meditation apps and wellness websites. We have an online neuroplasticity “brain retraining” video course called the “Gupta Program” which hosts 15 interactive videos and many audio exercises. This is proving very popular with long haul patients, and we are currently conducting a trial to test the effectiveness of this therapy.
What is the danger of leaving long-haul Covid untreated?
The longer it goes untreated, we hypothesise that it may become more entrenched in the brain, and become chronic in the longer term. Therefore we advise all patients to get help and advice as soon as possible.