Ten proposals for ageing well in long-lived societies

The steady and unstoppable growth of ageing people imposes new challenges to be faced as a society and as individuals. Aspects such as the consideration of ageing in public policies, the review of the meaning of vital changes such as retirement, as well as the organisation and planning of care, are key issues to which we should respond.

The following are some proposals in this regard.

To advance in the construction of a society that incorporates in its policies and action plans the challenge posed by the longevity revolution, promoting an image adjusted to the reality of the ageing process.

There is ample scientific evidence about the existence of negative stereotypes associated with age, as well as their relationship with discriminatory attitudes and abusive behaviour. The COVID-19 syndemic has been a clear example of this situation; older people have been infantilised and overprotected, especially in situations of dependency, while at the same time they have been treated in a way that could be improved, to say the least. Recently, organisations such as the WHO and the United Nations have launched a global call to promote and make visible initiatives that incorporate age from a perspective of social and individual transformation, which has resulted in the formulation of the Decade of Healthy Ageing (2021-2030), a concerted and collaborative global action aimed at improving the lives of older people, their families and the communities in which they live.

Promote the anticipation and prevention of unwanted situations by facilitating timely decisions on how we want to grow old.

It is necessary to ensure that prevention becomes a responsibility of society as a whole, led by the public authorities in a cross-cutting and multidimensional approach. If health care is currently an unquestionable priority, which has achieved advances that were unimaginable only a few decades ago, issues related to transition and planning for life after retirement, the housing situation, economic decisions or legal advice should be incorporated as preventive interventions in guidance and advice programmes in which local administration, the world of associations and voluntary action can play a decisive role. Early decision-making benefits all citizens.

When the elderly need support and care

Planning long-term care (LTC) from an ecosystemic, collaborative and community-based conceptual framework.

The desire of older people to remain at home and in their immediate environment, even when they need care, is well known. These wishes increase with increasing age. In order to meet this aspiration, it is necessary to develop a model of services and support of proximity, balanced, complementary, territorialised and, if possible, in perimeters accessible to people with reduced mobility. Urban planning initiatives known as superblocks or "15-minute cities" favour daily life, with easy access to all the necessary services both on foot and by local transport.

In short, the generation of "kind" or "friendly" environments (WHO) that address the multidimensionality of sectors that have an impact on ageing well generates well-being both in old age and throughout the life course.

Valuing family care by supporting and protecting caregivers.

Throughout the world, the needs generated by situations of dependency are mostly covered by families. In Spain, this tradition is particularly strong, although in turn, the provision of care takes on dimensions that have a negative impact on carers, most of whom are women, whose daily lives make it almost impossible to reconcile family life and work. The significant increase in the life expectancy of people in situations of dependency, as well as the complexity and intensity of the care required, means that services (temporary accommodation, day centres, home care) must be increased, as well as the essential support in situations of emotional overload or bereavement and training for the complex tasks involved in this type of care. All of this in a working environment that favours work-life balance.

Promoting ageing "at home" among people in need of care.

Ensuring permanence in the home requires an in-depth reformulation of the current model of home services. A system designed several decades ago to deal with the tasks of cleaning and fitting out the homes of elderly people, many of whom had major problems of habitability, and which is currently focused mainly on the care - often complex - of people with high degrees of dependency. The provision of this type of care requires a strong boost both in terms of its hourly intensity and in the recognition of the diversity of care required, which must be managed from professional profiles that assume its integral coordination: family, domestic worker, proximity services, voluntary action, nursing or other services of a therapeutic nature.

The integration of care through coordination from different sources is identified as the only way to make it possible to remain in the close environment.

And if not at home, "just like at home". Move towards an offer of accommodation of diverse typologies with homely designs.

The complexity of some situations of dependency makes the availability of residential accommodation essential when people are unable or unwilling to continue living at home. However, despite the evolution and professionalisation of residential models, their "institutional" weight generates an undesirable way of life for people in this last stage of our life itinerary. Depersonalisation, homogenisation in the face of unique life histories and other characteristics are negatively associated with today's residential homes. The accumulated experience, both in different studies and in other countries that have transformed institutional models into others adjusted to people's needs and preferences, offers abundant evidence of the benefits of this process of change. Environmental transformations in the current centres, such as modulation in small group living units, generation of homely and personalised living spaces, as well as a profound revision in the model of care and treatment, and in their organisational culture, are generating excellent results in the well-being of the people who live in these homes.

Advancing the professionalisation and social value of care.

Throughout the world, and especially in Spain, the care sector is characterised by precariousness, which is reflected in a strong feminisation, especially in the world of migration. Poor training and low salaries complete a professional profile whose social value is very low. The lessons learned from COVID-19 call for a review of these professional profiles, leading to a clear dignification of care, both for the people who provide it and for those who receive it. In addition to the consequent increase in their funding, it is necessary to identify competences, skills and also attitudes that build solid and attractive professional profiles for men and women in the labour market.

The National Training Strategy in the field of care proposed in the Spain 2050 Report is a highly interesting way to achieve an improvement in the education, training and accreditation of professionals in this field.

Improving the quality of care through people-centred approaches.

The "cultural change" required by the current model of CLD provision requires a shift in its conceptual focus towards an ethical approach centred on people, their needs, desires and preferences, making services and the tasks they entail available to support the identity, uniqueness and life project of each of these people. This framework, together with the knowledge available in relation to the design of meaningful and appropriate environments for people, should lay the foundations for a new guiding model for the quality of CLD that facilitates the identification of its components and criteria, and its subsequent evaluation.

In this sense, the creation of a National Agency for Quality in Care, a body that already exists in other countries, could provide an impetus for progress in these aspects in the different territories.

Integrate the health and social care of CLDs through the coordination of their systems.

The increase in situations of dependency observed in recent decades, generated in part by major achievements in life expectancy and in the treatment of chronic and degenerative diseases, is evidence of a growing need for health care in the field of the provision of CLD. This issue has been debated for decades with mixed results in Spain and Europe. Once again, the pandemic has revealed multiple shortcomings in the health response in social resources. Different disciplinary cultures and unequal access models hinder progress in proposals for integrating care from the two sectors. However, within the framework of the proposals made above, which are very focused on close and domestic environments, it is possible to facilitate normalised health care through our system structured in geographical areas of primary care (suitably reinforced) and hospital care. In short, we need to articulate a model in which the health system guarantees the right to health care for dependent persons wherever they live.

Tackle the necessary revision of the Law for the Promotion of Autonomy and Protection of Dependency Situations.

While recognising the importance of having a law that generates a subjective right to respond to the care needs of citizens, there are many shortcomings in its development, undoubtedly derived from its coincidence with economic and health crises of unforeseen proportions. In short, a review of this regulation is needed in different dimensions: speeding up the processes of assessment and recognition of the degree of dependency, general improvement in its management and distribution of powers, readjustment of its catalogue of benefits and services, etc.

There is consensus on the need to provide this law with sufficient funding to make its objectives a reality, which are centred on the protection of autonom and the generation of well-being among its potential beneficiaries: dependent persons, family members who assume their care and professionals who aspire to live and care for them with dignity.

Making progress in all of the above allows us to be more optimistic about the future. It is not a struggle of "others", of those who already have grey hair or are beginning to treasure a sea of wrinkles on their faces. It is a challenge that challenges all of us who aspire to enjoy a dignified, full and meaningful old age. As citizens, let us make our own the commitment to build a new social narrative that promotes the development of policies and actions aimed at being able to age well in long-lived societies. For those who were, for those who are and for those who will be older people (if they are lucky enough). May the train of life not stop at the station called "old age".