Up to the 1950s less than 5% of the population was over 65 and only a few lived longer than their seventies. The number of old people around the world began to surge in the second half of the 20th century and is growing mainly as a result of increases in the delivery and standards of health care. In first-world countries life expectancy and old age population have increased consistently over the last decades.
Traditionally, aged care has been the responsibility of family members and was provided within the extended family home. Increasingly in modern societies, aged care is now being provided by state-run or charitable institutions. The reasons for this change include:
- decreasing family size,
- the greater life expectancy of elderly people,
- the geographical dispersion of families,
- the changing nature of aged related ailments, and
- the tendency for women to be educated and work outside the home.
Aged care is about providing for the social and personal requirements of senior citizens who need some assistance with daily activities and health care. The aged care initiatives in most developed countries is a response in recognition of the special needs and requirements that are unique to senior citizens who want to age with dignity. The term aged care covers services which include assisted living, adult day care, long term care, nursing homes, hospice care, and home care.
Australiaâ€™s aged care system aims to ensure that all older people receive support and quality care when they need it. In Australia there are around 2 million participants in the aged care system, of which roughly 10% are in residential aged care. Residential aged care facilities are places where older people who can no longer live independently can live and receive full time care and support. Reasons for moving into residential aged care can include illness, disability, bereavement, an emergency, the needs of their carer, family or friends, or because it is no longer possible for the person to manage at home without help.
One of the consequences of the growing proportion of old people in society has been pressure on the social security systems in first world countries. The average lifeÂ expectancy of a 65 year old in the 1930s was around 5 years for most first world countries. Today it would be about 20 years. This increase in longevity is accompanied by a growing demand for health care and related services. Growing life expectancies and older populations have brought into question the model under which social security systems were designed. Given the increasing numbers of people over aged 65 and the increased life expectancy they enjoy, many governments are faced with increasing fiscal pressures. This is magnified by the fact that the elderly consume the most health expenditures out of any other age group.
As a result most developed countries are resorting to a â€œuser paysâ€ aged care system as far as is possible. For example, in the USA 67% of the one million or so residents in assisted living facilities pay for care out of their own funds. The rest get help from family and friends and from state agencies. Medicare does not pay unless skilled-nursing care is needed and given in certified skilled nursing facilities or by a skilled nursing agency in the home. Similarly, in Canada the government may partly subsidize the cost of some public facilities. Residents pay for their care on a sliding scale, which is based on annual income. For example, seniors living in British Columbiaâ€™s government subsidized â€œLong Term Careâ€ pay 80% of their after tax income unless their After Tax Income is less than $16,500. The UK scenario is based on a similar â€œuser paysâ€ basis. Whilst the National Health Service provides medical care for the elderly free at the point of use, the government does not automatically provide social care. Social care is only funded by public authorities when a person has exhausted their private resources, for example, by selling their home.
In Australia the types of fees and charges payable are heavily regulated by the Government. In addition the Australian Government provides substantial aged care funding for residential aged care and a range of community care services, including care in the home. However seniors may also be asked to pay some of the fees and charges to their residential aged care home if they can afford it.