Caring for the aged

Providing medical, social and psychological assistance for those who the aging process has rendered unable to care for themselves.

Prior to the 20th century, care for the aged was largely the responsibility of the family. Before the industrial revolution the aged were not considered a separate class needing special care. During the 19th century the processes of industrialization of agriculture and manufacturing, increased mobility of families and urbanization resulted in the disruption of social institutions. The family has become a one or two generation social unit instead of a 3 or 4 generation unit with unmarried adult relatives doing household work. Social, economic, and medical advances have extended life expectancy of people, thus aggravating the problem.

Initially social legislation was based on the belief that poverty and unemployment are voluntary. This resulted in often harsh or punitive action with minimal medical care and little social and intellectual stimulation. Elders were institutionalized in almshouses, poorhouses and sometimes public hospitals. By the last half of the 19th century specialized institutions for orphans, feeble-minded and the sick were admitting the aged and conditions began to improve.

The two conventional solutions to care for the aged are either (1) to go bankrupt trying to keep promises made to the elderly during their working time, because the elderly percentage of the population is systematically increasing over time or (2) to cut back the support to match the available funds. Since 1995, the Sawayaka Health Foundation in Japan has successfully implemented a third solution. It consists of complementing whatever services are provided by the national health insurance with a network of service providers paid in Hureai Kippu which means "caring relationship tickets". The unit is the hour of service and different tariffs apply to different types of services and times. The credits can be used by the owner for their own health support or that of an ageing relative in another part of the country. More than 300 systems are currently operational in Japan. The Chinese government is implementing a similar process since 2001.