In Bangladesh, older peoples' livelihood difficulties will be further aggravated as only a third of them (33.4 per cent) older than pensionable age receive a pension and current social safety schemes in the country are still in infancy and trial stage and do not cover most of the people yet with or without economic insecurity. The trend shows that over time, there will be fewer and fewer working-age adults to support their old-age parents and dependents as the old-age dependency ratio is forecasted to triple in the next few decades. Population aging in Bangladesh will seriously impact individuals, families, society, government, NGOs, healthcare system, social service providers, and private-sector organizations as they all need to find solutions to issues on housing, social security, retirement, health care, caregiving, and the affliction of disease and disability. The long term care (LTC) service delivery system is still in a nascent stage in Bangladesh with only sporadic and largely private individual-driven initiatives on developing small scale "old homes" here and there to serve only those older people who have no close family members alive, no one is willing or available to look after them or those who have no alternate means or support left for them. LTC involves a variety of services designed to cater to the needs of a person- both healthcare and personal care- to help people live as independently and safely as possible when they become dependent on others to perform their everyday activities.
LTC is provided in different places by different caregivers, depending on needs. Most LTC is provided at home by volunteer family members and other relatives. It can also be arranged in a facility such as a nursing home or in the community as adult daycare centers. In Bangladesh, it is predicted that the current level of interest and availability of family members and relatives will decline over time to provide care for their dependents and this will create enormous challenges for these individuals to continue receiving care and large scale initiatives are to be in place to meet their uninterrupted and mounting care needs. While a few nursing homes -popularly called "old homes" have been built in Bangladesh but adult daycare centers remain to be a foreign concept and have not gotten any traction yet from any quarter.
The most common among LTC services is personal care-help with routine activities including bathing, dressing, grooming, eating, using the toilet, and moving around. LTC also includes delivering prepared meals and access to an adult daycare where older people can spend the day under supervision in company with peers, friends, and neighbors of similar age brackets (like daycare centers for children which are now popular in Bangladesh). Special transportation services will be needed as conventional vehicles in Bangladesh have no accommodation arrangements for people with special needs or for the aged population.
The LTC need usually grows progressively, as people get older and weaker and their illness or disability deteriorates over time. Several factors predict the type and amount of LTC need: the risk almost always increases as people get older; women are at higher risk than men as they have higher life expectancy; single, widows and widowers are more likely than married people to need care; poor nutrition habits and lack of physical activity can escalate a person's risk; poor health and family history also are associated with the care need. Research also suggests that low-income, very old people and people living without a spouse need more LTC.
Bangladesh needs to have plans, policies, and programmes in place, develop a legal framework, and start developing the structure and human resources (care providers) for its growing older population. Human resource policy is to be developed to create a large pool of trained and skilled formal, full-time to part-time, informal caregivers, and ensure an adequate supply of healthcare professionals such as Geriatricians, gerontologists, dieticians, nutritionists, nurses, nursing assistants, home health workers, social workers, care aides, physical therapists, occupational therapists, speech and language therapists, and homemakers.
Dr Hasnat M Alamgir is a Professor of Public Health
hasnat.md.alamgir@gmail.com