An ageing population is not just a problem for the financing of retirement pensions; it constitutes a major challenge in terms of elderly care. Fewer and fewer care-givers have to care for a growing number of dependent elderly.
Our society is thus facing a twofold challenge. Political compromise is necessary, for state and private retirement plans alike, to ensure that benefits and contributions are in tune with the retirement age. Securing nursing and care for the elderly is more complex, however, and demands, in addition to political decisions, training programmes for professional staff and the development of new care-taking models and infrastructure. All this requires vision, initiative and, most of all, a long lead time warns Jérôme Cosandey of Avenir Suisse, a Swiss think tank.
The 80+ age group is growing the fastest
Care for the elderly is doubly impacted: there are fewer and fewer professional and volunteer care-givers to cope with growing numbers of dependent elderly. In Switzerland, the 80+ age group is the age group with the strongest growth. In 20 years’ time, the size of the population over 80 will have increased by 77% compared with a meagre 12% for the rest of the population.
According to the Federal Office for Statistics, by 2060, there will be 1.15mn people aged 80 or over. Of those, about 60,000 – the population of a town like Biel or Lugano – will be 100 or older.
Care for the elderly: huge challenges
Avenir Suisse believes that elderly care in Switzerland faces five major challenges. First, a profound change in patient profile. Thanks to medical progress, more patients survive heart attacks and cancer. Artificial limbs allow people to remain independent longer. As a result, they go to nursing homes later, with more chronic and complex ailments (e.g. Alzheimer’s). The radically changing needs of elderly patients are imposing increasing demands on doctors and nursing staff.
More professionals needed
Second, we need a greater number of professional care-givers to look after growing numbers of intensive-care patients. The ageing of the Swiss population is against us here. Where there are 12 earners for each 80-year old today, the ratio will be halved in the next twenty years. Failing intensive training programmes, immigration and efficiency enhancements, elderly care will face a huge shortage of staff.
More infrastructure means higher costs
Third, there is not enough infrastructure to care for all the elderly. According to Senesuisse, the Swiss association of nursing homes, Switzerland needs 30,000 more beds between now and 2030. To make up for this shortfall, each canton would have to build one 60-bed nursing home a year, for a total investment of CHF 60bn.
Fewer volunteers
Fourth, we can expect a relative decrease in the number of volunteer helpers; so far, relatives and neighbours have contributed to keeping down or delaying the number of nursing home admissions. Today, volunteers contribute about 100mn hours of elderly care per year. Volunteer care is generally provided by spouses, sons and daughters – mainly daughters – and young pensioners. Here too, the ageing of the population will significantly reduce the number of potential helpers; from 2.3 young pensioners for every 80+ year-old today, to 1.3 helpers in 2030.
Financing elderly care uncertain in the medium-term
Fifth, these changes involve significant cost. Obsan, the Swiss health observatory, estimates the additional cost at 18bn in 2030; in other words, twice as much as in 2007.
This cost has to be financed privately through health insurance premiums and, increasingly, by public funding, i.e. taxation. Only very few people can afford to pay nursing home fees of CHF 50,000 to 140,000 per year. That is why about half of the 80+ age group will depend on supplemental benefits from the cantons and municipalities. Unless counteraction is taken, Cosandey warns that the financing of elderly care is uncertain in the medium term.