Heavy Burden of Elder Care Falls on Families; Where Is the Government?

The secretary of Iran's National Council for the Elderly, stressing the need to revise the care system, said Iranian families require greater support in caring for older people.

Sefir Arjan - Community Group: With the increase in the elderly population and the change in the family structure in Iran, the issue of caring for the elderly has become one of the important social issues. An issue that, in addition to the living conditions of the elderly, also affects the economic status, employment and mental health of family members.

Majid Fuladiyan, head of the secretariat of the National Elderly Council of the country, in a conversation with Mehr reporter, pointed out the pressure of care on families, explained the necessity of developing the infrastructure for the care of the elderly, supporting caring families and creating diverse patterns of residence and care. According to him, the goal of policy in this area should not be to replace the government instead of the family, but a system should be created so that the family is not left alone in the responsibility of caring for the elderly.

You can read the details of this conversation below:

What problems do families who take care of a child and the elderly at the same time face?

Fuladiyan: In sociology, we have a concept called "sandwich generation". It means a generation that is responsible for the care and upbringing of its children on the one hand, and on the other hand, it has to take care of its own elderly parents. This situation has become more important in our society, because on the one hand life expectancy has increased and on the other hand families have become smaller.

For example, imagine a couple who both work, have a child in school, and at the same time, one of their parents needs daily care due to illness or limited mobility. This family must balance work, raising children, living expenses and caring for the elderly. It is natural that this situation creates a lot of financial, psychological and time pressure.

The more important thing is that this pressure is not distributed equally in families. Usually, a large part of the caregiving responsibility falls on the women of the family, especially daughters and daughters-in-law. Sometimes a woman has to reduce her working hours or even quit her job to take care of elderly parents. Therefore, the problem is not only fatigue or mental pressure; Caregiving can affect the caregiver's employment, income, family relationships, and economic future.

I think we need to make an important change in our view. Caring for the elderly should not mean wearing down family members. The family needs support; From caregiving training to home care services, day care, respite care services and insurance and financial support.

If we do not support the family, the quality of life of the elderly may be damaged, as well as the health and well-being of the family members.

Does Iran have enough infrastructure for the increasing elderly population in the coming years?

Fuladiyan: I think the short answer is no, we are not ready enough yet. Of course, this does not mean that there is no infrastructure. We have a health system, support networks, rehabilitation centers and significant family and social capacities, but the problem is that these infrastructures are mainly formed for the demographic structure of today and the past, not a society in which more than 30% of the population will be elderly.

Now, more than 12% of the country's population is 60 years old and older, and estimates show that by 1430, this share can exceed 30%. That means we don't have much time to prepare.

The issue is not just increasing the number of hospital beds or nursing homes. We have to think about the set of infrastructures of life in old age; From housing and transportation and the adaptation of cities to the long-term care system, home health services, care insurance, assistive technologies, and even the infrastructure of social communication and participation of the elderly.

There is another important point. We will not only face more elderly people in the future; We will face elderly people who have a different family structure. The number of children has decreased, families have become smaller, some of the children have migrated, and the number of elderly people who live alone may increase. Therefore, we cannot assume that the same traditional family care system that existed in the past will continue with the same capacity in the future.

One of our priorities in the secretariat of the National Council of the Elderly is to turn the issue of aging from a merely supportive issue into a major issue in the country's planning. We need interdisciplinary planning; This means that the Ministry of Health, Ministry of Welfare, municipalities, housing sector, insurances and other institutions should prepare themselves for this change from today.

The real crisis is not that our people are living longer; The crisis occurs when the social and economic structures of the country are not prepared for this change.

To what extent is the responsibility of caring for the elderly on the family and to what extent on the government?

Fuladiyan: In my opinion, basically, we should not see this issue in the form of a percentage division, for example, say that 70% of the responsibility lies with the family and 30% with the government. The more important issue is what kind of responsibility is given to each one.

The family plays a very important role in the life of the elderly; Especially in maintaining emotional relationships, sense of belonging, social support and daily companionship. But we should not conclude from this role that all professional, financial and caring responsibilities should be on the shoulders of the family.

Suppose an elderly person needs continuous care due to illness or functional limitations. Is it reasonable to expect her son or daughter to quit their job and take on full caregiving responsibilities without specialized training? I think this expectation is neither fair nor sustainable in the long run.

The government must provide the care infrastructure; That is, to develop the caregiver training system, service standards, care insurance and financing, service quality monitoring, and support for caregiver families. Of course, this does not mean that the government should be the provider of all services. The private sector, NGOs and charities can also play an important role, but the responsibility for regulation, ensuring fair access and monitoring the quality of services rests with the government.

In the secretariat, we have followed the issue of professional training of elderly caregivers and organization of caregiver dispatch centers with exactly the same view. The goal is that families can use standard, reliable and professional services.

I believe that the family should remain the center of affection and emotional support for the elderly, but it should not become the sole provider of care. Especially in a society where families have become smaller and the number of potential caregivers for the elderly is decreasing.

Is it more appropriate to care for the elderly at home or in the care centers for the elderly and what factors play a role in this choice?

Fuladiyan: I think we should first correct a common perception. We usually pose this question in the form of a dual; Either the elderly stay at home or be transferred to a care center. While in advanced aged care systems, there are various options between the two.

The important principle is that the elderly should be able to remain in the familiar living environment and in the society as far as possible and willing. This is the same approach that is referred to as "aging at home".

For many seniors, staying at home means maintaining independence, connections with neighbors, memories, social relationships, and a sense of belonging. So if we can provide home care services, nursing, rehabilitation and daily supports, living at home will be a better choice in many cases.

But we should not turn this into an absolute rule either. Sometimes the elderly need specialized and round-the-clock care that the family cannot provide. Sometimes the housing conditions are not suitable, the elderly are alone or even prefer to live in a residential complex that has more services, security and social connection.

Therefore, choosing a place to live should be based on the real needs of the elderly, their independence and functional ability, family conditions, the quality of available services, and most importantly, the wishes and satisfaction of the elderly.

Another important point is that we should not think of all accommodation centers as the same. There is a big difference between a 24-hour care facility for highly dependent seniors and a senior-friendly residential complex where people live independently.

For this reason, we at the secretariat are looking for the development of various patterns of residence and care for the elderly; From home care and daily services to residences and residential complexes tailored to the needs of the elderly.

In my opinion, the future of the elderly policy should not be based on leading the elderly to a single model of life. We must create more options so that the elderly can choose according to their own conditions and preferences.

Finally, the main issue is not where the elderly lives; The issue is whether there is security, independence, respect, social connection and quality of life in that environment or not. A house where the elderly are alone

unattended and at risk, not necessarily better than a quality residential facility; Just as it is not the right decision to transfer an independent elderly person who likes to live at home to a care facility just because they are getting older.