Bye bye, say bye bye
Bye bye
Whether caring for parents, grandparents or partners as they age...
...how best to help the elderly...
...and those with dementia...
...is a question that affects everyone
If I hug her she pushes me away...
...because I’m a stranger, you know
Around the world people are living longer...
...but many governments spend very little...
...on long-term care for the elderly
And covid-19 has brought things to crisis point
More deaths in care homes than in hospitals
The care assistants have moved in so they can keep the virus out
One in four residents here now dead
The pandemic has sort of highlighted everything...
...that is wrong with institutional care
Across the rich world, around half of covid-19 deaths...
...have been in care homes
Despite the fact just under 1% of people live in them
But the pandemic also offers a unique opportunity to rethink care
And the devastation caused by covid-19...
...could be a tipping-point in how societies treat their old people
What do you find challenging?
It’s not remembering things isn't it?
No
It’s not following conversations
I think like forgetfulness you see...
...I forget things so...
...oh here and there
The challenges of caring for people...
...as they age will affect everyone
No because you didn’t have that on properly
No it hasn’t started properly yet has it
If not now, then soon
There’s something wrong
The share of people over 80...
...is expected to double in the next 30 years
And at the same time, there will be fewer people...
...of working age to look after the elderly...
...especially in the rich world
Take Spain
For every ten working-age people...
...in the country today...
...there are currently three people over retirement age
By 2050 there will be eight
Close to a one-to-one ratio
We are tipping into sort of being 65-plus societies
There is a simple question of...
...who is going to look after these people in a dignified way
The cost of care is a major factor in these decisions
In America alone, almost half of those who reach the age of 65...
...will need some form of paid care
And as these costs are highest in rich countries...
...one solution could be to outsource care internationally
This is Baan Kamlangchay in northern Thailand
It’s home to 14 residents from Germany and Switzerland
Maya is the youngest resident, at 60
She was diagnosed with dementia ten years ago
I said to her, you know, I promise you Maya...
...I will do always the best, you don’t have to worry
I promise you that
The care system in much of Europe...
...means it is often family members...
...who take on the burden of care
And Maya came to Thailand when her husband Walter...
...could no longer look after her
I realised if I carry on with this I will die before Maya
I will, I will be flat in a few months
And the children told me also you better do something now...
...because you cannot do both, work and taking care of your wife
All the residents here have dementia...
...and across the world it’s thought between third and half...
...of those 85 or older have the condition
There is no cure, and the global cost of dementia by 2030...
...will be a staggering $2trn every year
Residents with dementia here...
...have three carers each...
...providing around-the-clock care...
...for a fraction of the equivalent cost in Switzerland
But not everyone approves of sending loved ones...
...to the other side of the world
Well I got a letter, from a school friend of my wife
She told me I'm a big idiot disposing my wife in Thailand and I'm stingy
It’s the best thing we could have done
There is a shortage of staff like everywhere in Europe in these care homes
Nobody has time to really look after her
She deserves better than just put in the corner and look at the wall
The centre was founded by Swiss entrepreneur...
...Martin Woodtli, after his own mother was diagnosed...
...with dementia
Are you hungry?
A bit, a little bit
Ok then let’s go
It is one of several care centres in northern Thailand...
...that market their services to Europeans
Here in our village, what we try to do...
...we try to make the atmosphere like just normal life in a village
I would wish that it would be possible...
...much more going back to the family...
...much more going back to the community system...
...and solve the problem in that way
What are you doing? Are you buying chocolate?
Yeah
But few communities in the West...
...can provide this type of one-on-one care
And personalised nursing like this...
...is only available to the very richest people
So some care providers are looking for other ways...
...to keep people at home and in their communities for longer
Thousands of miles away, in southern England...
Your turn
...Afzal and his wife Zohra are part of a pilot scheme...
...to help dementia sufferers live longer and healthier lives at home
Your turn
I think he would only be ready to go into a care home...
...if he was so bad, he wouldn’t even know he was in a care home
And I hope it never comes. Yes
In much of the rich world...
...a significant portion of long-term care is provided in care homes
But the practice of caring for people in large institutions as they age...
...has been called into question by the pandemic...
...which left many care-home residents cut off from family...
...and at increased risk of disease
Across the the rich world, around half of all covid-19 deaths...
...occurred in care homes...
...and in Canada and Australia the estimated figure is closer to 80%
We have institutionalised care...
...but both covid, as well as just the fact...
...that life is much longer than we ever thought it would be...
...mean that experts are starting to question...
...whether that is really the best way to deliver care
Many experts now believe around half of the care provided...
...in care homes could be done at home
Technology can help
Afzal has dementia, and there are sensors fitted around his home...
...to track his movements
The data gathered by the sensors...
...are fed back to a remote-monitoring team
Along with medical readings like Afzal’s blood pressure and temperature
I’ve never seen that red light before
Retry
What’s happening?
It means there is somebody watching all the time
That’s very reassuring
The monitoring team would then know that the patient...
...is eating, is drinking, is looking after themselves...
...or the carer’s looking after them
When I do some cooking or something...
...I leave the fire on
So this is very helpful
The support of the remote-monitoring team...
...helps relieve some of the pressures on unpaid carers like Zohra...
...and save money for overstretched health systems
Looks like it’s come up to about 90 then dropped down again
Looks like they repeated it and it came back as normal
Real-time data from Afzal’s home is collected here...
...and if they notice changes to temperature or blood pressure...
...that might indicate infection they’re able to intervene early...
...and prevent costly hospital admissions
One in four hospital beds are currently being occupied...
...with people with dementia...
...and because the current service can’t cope with the increasing number...
...and the resources that requires, we need to bring a new model of working
So with this model...
...with three or four monitors we are able to monitor 500 people
Something that is impossible to do in a normal outpatient appointment
But while technology like this can reduce the ratio of carers to patients...
...it can’t fully tackle the fundamental problem...
...there simply are not enough people to look after the elderly
There are shortages of carers everywhere
Why might that be?
Well, a number of reasons...
...one, we don’t look after carers very well at all
So pay is one of the most obvious things
In Britain social carers tend to be paid less...
...than people who work in supermarkets
The demand on people who work on it...
...the stress levels, the injury levels, etc...
...are just very, very high
If you add those two things up, you might think...
...well, there are easier ways to make your money
In Germany a third of care workers leave their job after a year
And in most rich countries a care-home worker is paid 36% less...
...than someone doing a similar job in a hospital
Changing the way the elderly are cared for will require...
...profound political and structural upheaval
But it’s just possible the pandemic could provide the necessary momentum
It’s never going win you an election...
...and so politicians will pass the potato...
...on and on and on and on and on...
...and maybe covid will be that moment
Maybe covid will be that moment where you just can’t ignore it any longer
I certainly hope so
I’m Sacha Nauta, public policy editor at The Economist
This film was inspired by a piece that I wrote...
...about how covid-19 was highlighting the flaws of elderly care
To read it please click on this link
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