Home care services for the aging population

Hasnat M Alamgir | Saturday, 6 August 2022

Bangladesh needs to find and develop suitable models to provide care for its growing aging population. Old homes have been built here but complete residential isolation of the older parents and living with strangers have not been well liked by their family members because of the prevailing social, cultural, and religious norms of the country. Bangladeshi people in general value socialisation with friends and enjoy the company of family members more. Alternate care delivery models need to be explored that will meet the care needs and will also be accepted by the care recipients and their offspring. The rising older population is intensifying this need and the country is simply not prepared to offer suitable options on how to deal with their needs.
In 2019, about 13 million people in Bangladesh were 60 and above which was about 8 per cent of its total population and it is predicted that in 2025, about 37 million people in Bangladesh will be 60 and above making them 21.0per cent of its total population. Life expectancy for Bangladeshi males will be 78 years in 2050 (an increase by about 7.6 years from 2019) and for women, it will be 81 years (an increase by about 7.3 years from 2019). The old-age dependency ratio (65+ people to 15-64 people) will grow to 23.5 from 7.7 during that time. The fact that almost one-fifth of the country's population will be over 60 in near future should raise alarms for all stakeholders including the health care providers, health professionals, policymakers, social welfare system, NGOs, and public health experts to work on proposing ways to take care of this vulnerable demographic segment and meeting their healthcare needs.
Adult daycare is an option where older adults spend time with similar age groups during the day. Providing care at home (home care) is another realistic option as recent research shows that most people like to live and age in their own homes. The home care services model provides essential health and personal care supportive services that enable people to live in their homes. This may be a preferred approach over receiving care in a nursing home (commonly referred to as an old home in Bangladesh) or other institutional settings.
The demand for home care (HC) is increasing across the world because the supply of traditional home-based caregivers (female family members), women between 15 and 64 years, are in school or engaged in the formal paid labor force. As an example, in the USA, 67 per cent of women between 15-64 are now working outside whereas 52 per cent of women globally are working outside. This caregiver gap is growing widespread worldwide including in Bangladesh and has interestingly highlighted the often invisible, ignored, or undervalued care work that women have always done since the dawn of human history.
Home care workers are known for several occupational titles; for example, home health aide, certified nursing assistant, hospice aide, personal care aide, personal care attendant, and homemaker. The term "Home care aide" usually refers to the full range of all these occupations. While there is also considerable overlap with respect to tasks, there are also differences in job tasks, usually related to the degree of medical support they can provide. Home care aides may be employed by a business called an agency or hired directly by the care recipients or their families. Home care recipients are called patients, clients, or consumers; for brevity, "client" refers to all home care recipients. HC aides usually assist clients in their home with "Activities of Daily Living (ADL)" including Walking, getting around the home or outside, feeding, dressing and grooming, toileting, bathing, and transferring. They also assist with "Instrumental Activities of Daily Living (IADL)" including managing transportation, shopping and meal preparation, housecleaning and home maintenance, managing communication, and managing medications.
The convergence of several social, economic, and technological changes is creating the urgent need for more home care services. The great majority of those who will need these services are people over 65 years and others with illnesses or disabilities. According to one report, nearly 17 million Americans living in the community require assistance completing self-care and other daily tasks for their physical, cognitive, developmental, and/or behavioural conditions, and 70 per cent of 65+ adults in the USA will need paying long-term support services at some time before they die. People are living longer with complex and a variety of health issues- for example, 80per cent of Americans over 65 have one or more chronic health conditions.
Social, demographic, and economic changes are driving the delivery of care into the home across the world. The majority of Americans report that they would like to receive care at home; health professionals, clinicians, government payers, and private insurers are recognising the medical and economic advantages of keeping clients at home. Another report states that Americans now prefer to die at home. In fact, more Americans died at home than in hospitals, nursing homes, or any other facility in 2016.
This Covid-19 pandemic highlighted again the importance of home-based care as an alternative to facility-based care: elders were at high risk of severe Covid-19 infection, and nursing homes reported high infection and fatality rates.
The pandemic made it clear that a healthy and safe workforce is needed to provide healthy and safe care to millions of people in their homes when possible.
Some issues or questions that Bangladesh needs to consider or ponder about how to deliver care for its aging, chronically ill population or people with disability are: (1) Can home care service be a suitable care delivery model?; (2) Who will pay for these services?; (3) How to develop a workforce with training and skills in delivering home care?; (4) how can accounting for aide and client safety together improve HC services overall?; And (5) how can this model be made popular among the care recipients and family caregivers?

Dr. Hasnat M Alamgir is Professor and Chair of Public Health at IUBAT-International University of Business Agriculture and Technology, Uttara, Dhaka.
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