Family, Community and State in Ageing Societies
23–25 October 2018, Tehran, I.R. Iran
Parallel session snapshots (day 2)
Round 1: Older people and their changing families
Income-1: What trends in family transfers and personal income in old age will we see with population ageing?
Family is generally expected to provide financial support to older people, especially older women, and studies show that family continues to be a main source of income for older people in lower and middle income countries of Asia. But in many high income countries where nuclear families dominate, older people increasingly rely instead on income they control personally – from state transfers, pensions, assets including home ownership, retirement savings, and wages from labour beyond retirement age. Based on recent trends, what balance in family and personal income should we expect in the future, and what is the implication of these trends for policy? How do the situation and challenges vary by gender, especially as women often have limited or no access to pension income?
Care-1: How will trends in family care for older people change in the future?
Asian populations are ageing, and many older people, the majority women, will need care and support at some point in life. Yet households are become smaller and more dispersed, particularly with migration of younger people, leaving fewer people at home to provide personal assistance. We celebrate expanded life expectancy and improved health prospects, which can delay the need for long term care and allow greater independence in old age. Yet when required, care is becoming more complex and specialised – in many cases beyond the capacity of untrained family members. Family members especially females have traditionally been the main providers. With demographic change, to what extent will the situation and past patterns of family care change? What are the main drivers of those changes?
Inclusion-1: What triggers exclusion and isolation in old age and how may these grow in the future?
Social inclusion is strengthened or compromised by a wide range of factors including public services and accessible environments and workplaces. But the first social circle for many older people is the family. In the past, many social connections by an older person took place within the household or else were facilitated by the family. In large, multi-generation households, the older person routinely socialized with family members, or within the community together with family, although patterns varied by gender. For older persons with functional limitations, the family also provided mobility support. With family arrangements changing and migration of younger adults, the concept of family as social hub may be evolving rapidly. To what extent is family still important in a discussion of social inclusion? Will social isolation expand in the future as household structures change, and what factors including perceptions of ageism could contribute to exclusion?
Round 2: The role of communities
Income-2: How can community organisations facilitate work in later life in ageing?
Many older people stop working at a certain age, and beyond that point their families may provide for their material needs. But with changes in household structures resulting from demographic change, and increased longevity, work in old age is increasingly feasible and sometimes important for older women and men. For those who want to continue working, community-based organisations (CBOs) can provide credit, training, technical support and encouragement for older women and men to improve or expand their livelihoods, while linking them to government services. Such older people’s associations and other CBOs can tap into the potential of people in later life to continue contributing and remain independent. But in many countries, such CBOs have struggled to expand in number or beyond a narrow range of social functions. How can such interventions reach scale and be sustainable, and what is the role of governments to promote their expansion?
Care-2: What are the future drivers of expanding community-based care – civil society, market, government?
In light of demographic and social change, the need for creative and responsive long term care services is clear, and to move from an institutional model to home and community based care models. But the assumed driver of expansion at community levels is not always clear. What do we mean by “community” – the spontaneous actions of community members (usually women) or CSOs, or local services funded and driven by the government or private providers? How significant is the role of community volunteers in the provision of community-based care? In light of clinical, ADL and psycho-social services, what are the various roles and interactions as well as the relative strengths of the main providers – civil society, the private sector and government? What does international experience teach us about successful attempts to expand coverage and better integrate community-based care services? How does the impact of these interventions vary by gender?
Inclusion-2: How can age-friendly communities prevent social isolation in later life?
Family is an important channel for enabling social inclusion and preventing isolation, though these relationships may be different for older women and older men. With demographic change bringing smaller and more dispersed families, the practical and personal assistance family members provide older people may decline. At the same time, independence in older age is an increasing expectation among older people themselves. Expanding functionality and managing disability can support greater autonomy in old age. WHO highlights eight key domains of an age-friendly community: the built environment, transport, housing, social participation, respect and social inclusion, civic participation and employment, communication, and community support and health services. How can age-friendly communities (both urban and rural) facilitate that independence and compensate for the anticipated decline in personal assistance from family?
Round 3: The role of government
Income-3: How can ageing societies reach universal pensions coverage and reduce overreliance on other sources of income in old age?
Old-age pensions are a key intervention for ensuring income security. However, expanding coverage has been a major challenge, and now populations of older people are rising rapidly. A focus on contributory pensions has limited the expansion of coverage in low and middle income countries, where the labour force is predominantly in the informal sector and workers usually earn low and irregular incomes. This is especially true for women, who are disproportionately likely to be uncovered by pensions and dependent on others for income. There are various alternative approaches, including universal social pensions which have been introduced in a number of Asian countries in recent years. What are the options for expanding pension coverage and adequacy in contexts of informality and low incomes? How does their potential impact vary by gender?
Care-3: What are the most effective ways for government to support when long term care is provided informally?
Governments talk about “supporting families”, but what does that really mean in practice? Most older people in low and middle income countries have their long term care needs met informally, usually by females in the household. But this care and support may be inadequate and put profound stress on families, especially with care needs becoming more complex. This strain can also lead to violence, abuse and neglect. Which interventions can reduce the strain on families or promote the functional independence and autonomy of the older individual? Examples of interventions include allowances, training, respite care, tax credits, special leave arrangements or flexible work arrangements. Which approaches are really effective, and what are the characteristics of successful delivery? Does the provision of alternatives weaken family care (i.e. substitution) or complement it? What are the dynamics by gender?
Inclusion-3: What are the most effective ways for government to reduce loneliness in later life as populations age?
Many countries with advanced ageing populations – including Japan, South Korea and some European countries – have experienced worrying trends towards loneliness, depression and social isolation among older people. Isolation may lead to additional risks of violence, abuse or neglect. Isolation often occurs among older persons or couples who live alone or who lack close family ties, and those ties may come under additional pressure because of demographic change. With advancing age, many women and men lose connection with their friendship networks and find it difficult to initiate new friendships. If ageing in place is no longer an option, migration to a new social or cultural context may intensify feelings of isolation. What can government do practically, through policies or services, to prevent and address loneliness among older people? How might interventions vary by gender?