Elder Care

The form of elder care provided varies greatly among countries and is changing rapidly. Even within the same country, regional differences exist with respect to the care for the elderly.

Traditionally elder care has been the responsibility of family members and was provided within the extended family home. Increasingly in modern societies, elder care is now being provided by state or charitable institutions. The reasons for this change include decreasing family size, the greater life expectancy of elderly people, the geographical dispersion of families, and the tendency for women to be educated and work outside the home. Although these changes have affected European and North American countries first, it is now increasingly affecting Asian countries also.

In most western countries, elder care facilities are freestanding. They may also be part of a continuing-care retirement community, seniors apartment complex, or wing of a nursing home. Ownership and operations of these facilities vary also. In the United States, most of the large multi-facility providers are publicly owned and managed as for-profit businesses. There are exceptions; the largest operator in the US is the Evangelical Lutheran Good Samaritan Society, a not-for-profit organization that manages 6,531 beds in 22 states, according to a 1995 study by the American Health Care Association.

Medical versus social care

A distinction is generally made between medical and social care, and the latter is much less likely to be covered by insurance or public funds. In the US, 86% of the one million or so residents in assisted living facilities pay for care out of their own funds. The rest get help from family and friends and from state agencies. Medicare does not pay unless skilled-nursing care is needed and given in certified skilled nursing facilities. Assisted living facilities usually do not meet Medicare's requirements. However, Medicare does pay for some skilled care if your relative meets the requirements for the Medicare home health benefit.

Thirty-two states pay for care in assisted living facilities through their Medicaid wavier programs. Similarly, in the United Kingdom the National Health Service provides medical care for the elderly, as for all, free at the point of use, but social care is only paid for by public authorities when a person has exhausted their private resources.

Elderly care emphasizes the social and personal requirements of senior citizens who need some assistance with daily activities and health care, but who desire and deserve to age with dignity. It is an important distinction, in that the design of housing, services, activities, employee training and such should be truly customer-centered.

However, elderly care is focused on satisfying the expectations of two tiers of customers: the resident customer and the purchasing customer, who are often not identical, since relatives or public authorities rather than the resident may be providing the cost of care. Where residents are confused or have communication difficulties, it may be very difficult for relatives or other concerned parties to be sure of the standard of care being given, and the possibility of elder abuse is a continuing source of concern.