Health Care, Long-term Care
As noted earlier, one of the causes of the aging population of western Europe is increased longevity: more people than ever before are experiencing a long and often healthy life. To place the sometimes alarming discussions about the financial consequences of population aging in perspective, it should be emphasized that many elderly people do not need more care than other adults. Although there is some variation among countries, relatively low percentages (around 5 percent) of people aged sixty to sixty-nine regard themselves as needing considerable care. Several inconclusive reports suggest, however, that over one-third of people age eighty and over will suffer from a longstanding illness or disability, but this means that the majority of these people do not regard themselves as disabled to any major extent. In this sense, aging in western Europe is not a grim prospect.
Nevertheless, for those responsible for policy decisions regarding care, the numbers remain daunting. The main problem appears to be that many of the existing ways to organize and supply care are not adequate to provide for the very different needs of aging people. Costs of care may be unnecessarily high because there is a lack of residential long-term care, efficient rehabilitation programs, or differentiated care in the community. A major problem of health care and long-term care for the aging population is limited flexibility; the solution to this problem is in the restructuring and recoordination of the relevant services.
The process of population aging in western Europe occurs alongside important changes in lifestyle, primary relationships, and employment. This change, often referred to as ‘‘late modernity’’ or ‘‘postmodernity,’’ has profound consequences for the supply of informal care for the aged because it affects the situation of female family members who have long served as the primary informal caregivers. Long-term caregiving remains the domain of women, although this is more true in the southern countries than in those of northern Europe. According to the Eurobarometer Survey, in the EU as a whole adult children (mainly daughters) were responsible for caring for older people in 40 percent of all cases. The ways in which this takes place differs considerably: in the southern countries more than one-third of these children were living in the same house as those for whom they provided care, whereas this occurred only seldomly in the Netherlands (2 percent) or in Denmark (4 percent).
The consequences of a postmodern aging society are manifold. As women leave the traditional patterns of family life, they are less available for caregiving or related tasks. These tasks will therefore be redistributed and renegotiated, and it remains an open question whether men will be able and willing to provide the same level of care to the elderly population. Moreover, as mobility increases, family members may live too far apart to provide such care. Finally, the changes in primary relations that have been going on for some decades will also affect the social situation of the aged population of the future. More older adults will live alone, will not have children, or may have a less intimate relationship with their children because of divorce, relocation, and so on.
Consequently, public and private forms of care will need to be restructured and developed in such a way that addresses such changes.
Eurostat Labour Force Survey. Luxembourg: Eurostat, 1994.
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WALKER, A. Age and Attitudes—Main Results from a Eurobarometer Survey. Brussels: CEC, 1993.
WALKER, A., and MALTBY, T. Ageing Europe. Buckingham, U.K.: Open University Press, 1997.