A reliable and updated infrastructure keeps communities safe, productive and happy. That’s why it’s important to keep aging roads, bridges, power systems, sewers, water mains and the like robust and responsive to society’s changing needs. When any part of an infrastructure stops working well, the disruption to people’s lives – not to mention the environment and economy — can be catastrophic. A crumbling, unstable infrastructure makes for a scary and uncertain future.
The human population is also aging, and there are cracks in the systems designed to support it. These cracks are warnings signs about an impending crisis on the horizon if we don’t start fixing them now.
Hawaii’s life expectancy — currently at 80.7 years — is the highest in the nation. One-fifth of our population is considered older adults. This age category, typically defined as people 65 years and over, will continue to grow until the year 2030 when the last of the Baby Boom generation enters older adulthood.
As the population ages, however, the availability of paid and unpaid caregivers is decreasing. Families are getting smaller. U.S. Census data show that childlessness is more prevalent among people in the 55 to 64 age cohort compared to older age categories. When these older adults on the younger end of the age spectrum get older — a time when they typically need more help with their daily activities — there will be fewer family members around to step up as unpaid caregivers. The exodus of the young is understandable in Hawaii because the high cost of living is pushing them to the continent in search of good jobs and affordable homes.
Additional eldercare services and supports will need to come from providers other than family members, such as government agencies, community-based organizations and private businesses.
The problem is that the service demands on the health care workforce is already strained at all levels, including on direct care workers like nursing assistants and personal care aides who play an important role in home health, long-term care and acute care settings. These frontline workers are the backbone of the long-term care system in Hawaii and — if properly trained — are often the first to notice emerging health problems in the early stages before they escalate into full-blown crises. The work they do is demanding and often goes unrecognized, and the rewards are inconsistent.
Employers face stiff competition for these workers from within the health care sector and from other job sectors such as retail and hospitality.
What we are facing, if we continue on this trajectory, is insufficient eldercare at a time when it will be needed most. While there are many older adults who can independently age in place at home, those who can no longer do so safely will rely on the state’s eldercare infrastructure for services and supports. Generally speaking, older residents tend to be the heaviest users of health care services due to chronic health problems that rise with age.
What’s needed is an investment in the eldercare infrastructure that includes coordinated research, planning and implementation of myriad solutions over the short-, medium- and long-term. Everyone interested in helping older people age with dignity should be involved in this process.
One way to move forward is identify what’s already working well — and there are people and programs doing excellent work on behalf of older adults — and to support them however we can.
But more needs to be done, involving government, academia, private businesses, community- based organizations and civil society (such as volunteers) working together to build a more resilient eldercare infrastructure.
The COVID-19 pandemic was disastrous for older adults in particular, but it did bring key stakeholders in the community together to work alongside conventional service providers to provide food, shelter, access to health care, friendly visits and other assistance to isolated older adults. The pandemic also taught us about the potential for using technology to address gaps in care and supportive services, as well as the importance of involving all sectors to help build age-friendly communities.
We now know that our lives can change almost overnight. Another pandemic, a personal health crisis, emotional turmoil as a result of loss — these are all real possibilities. Planning entails preparing legal, financial and health directives, as well as identifying one’s own dependable strengths for resilience during life’s most challenging times. These may require the services of a trusted professional.
Building a resilient eldercare infrastructure is both a personal and a social project, one that can take many years to complete, but a strong and enduring infrastructure is designed to keep people from falling through the cracks due to insufficient support. It requires an “all hands on deck” approach and is well worth the investment.
Kevin Y. Kawamoto, LSW, Ph.D., is a gerontological social work educator; Christy Nishita, Ph.D., is director of the University of Hawaii-Manoa Center on Aging, and co-coordinator of the Kupuna Collective (www.hiphi.org/kupuna).
