An age-old crisis? Now is the time for action

In October 2020, the Royal Commission into Aged Care Quality and Safety published its report into ‘Aged care and COVID-19’,¹ setting out some of the devastating effects the pandemic has had on the sector. The quality of care for older people all over the globe has been thrust into the spotlight by the COVID-19 pandemic, with deaths in care homes one of the major tragedies of the crisis. Governments in many countries have been accused of neglecting those living in care homes, or wanting to keep them hidden from view. The failure to protect care home residents and staff at the outset, the consequent high death rates and the ongoing effects of restricted visiting rights have at least made the issue visible. Vital questions are rightly being asked about how we want to care for the growing number of older people now and in the future.

These questions are long overdue. Almost every country in the world is experiencing a rapid demographic shift, as people live for longer and birth patterns change. These longer lives are a huge achievement due to improvements in living standards, public health measures and advances in medical care. They are something to be celebrated, but they also require radical change in policy that so far has failed to materialise. The catastrophe we have seen in care homes in recent months is the tragic consequence of policymakers kicking the issue of an ageing population into the long grass for too long.

Here in the UK, this policy paralysis has created a crisis in the long-term care system in spite of successive governments’ pledges to reform it. Cuts to local authority budgets combined with an increase in demand has meant that in many places, only those with the highest level of need are eligible for support. The result is that much of the responsibility for providing care falls on the shoulders of unpaid family carers, many of whom are forced to juggle caring with their careers. The system is also heavily means-tested so many people must meet the costs themselves, including from the value of their home, until their assets are exhausted. It’s clearly an unsustainable system in urgent need of reform to ensure that people get the care and support they need to live as full a life as possible.²

But we also need to radically rethink our approach to later life more generally. Ageing is not just something that happens at the end of life. Our homes, our work, the places where we live and our behaviours are all crucial to staying well for as long as possible and enjoying a good later life. This means action by national and local government, by the private sector and public services, by voluntary and community organisations and individuals. If we take the following actions, we can enable more people to live longer, healthier and happier lives:

1. ensure new homes are built to higher accessibility standards and existing homes are made safe and adapted to meet our changing needs as we age;

2. support people to remain in work for longer, particularly those with health conditions and caring responsibilities, and provide training and support for older workers to return to work if they are made redundant;

3. create communities which encourage people to remain active, and where people of all ages can meet one another and contribute to the community; and

4. take actions to make it easier to stop smoking, reduce alcohol consumption, eat healthily, and exercise more.

This year we have seen the consequences of failing to adequately respond to a pandemic. We don’t have to wait for a crisis before addressing the age shift in the population. If we take action today, we can create a better future – an age of ageing better in which everyone can enjoy later life.³

The author declares no competing interests.