Hasnat M Alamgir |
Published:
September 09, 2022 20:37:29
As life expectancy increases in Bangladesh, there are also concerns about how to organize and provide personal and health services to them. Rapid urbanization, living in high-rise buildings, greater participation of both spouses in the formal sector workforce, the disintegration of joint families, and loneliness (as most adult children work full time or move abroad) complicate the options and availability of care. Policy and structural deficiencies make the situation worse, as the country’s policy makers have yet to study and understand the enormous needs that the aging population will create over the coming decades and they have little or no insight into ways to meet these needs.
Older people and people with disabilities need long-term care (LTC) services. LTC involves a variety of services intended to meet an individual’s health or personal care needs, usually for an extended period of time. These services help people to live independently and as safely as possible when they are unable to carry out daily activities on their own. LTC is provided in various locations by a diverse group of caregivers, depending on the needs of the individual. Historically, most LTC is provided in the home by family members, relatives and friends and by domestic helpers in Bangladesh. However, it can also be provided in an institution such as an old people’s home (commonly called old houses in Bangladesh) or in the community, for example, in adult day care centers that have yet to establish and operate in Bangladesh.
The LTC service provides assistance with daily activities – commonly referred to as ‘Activities of Daily Living’. LTC also includes services such as arranging cooked meal delivery, attending adult daycare, and accessing transportation services. These services may be provided free of charge or at a cost depending on the options and availability of existing insurance company benefits, premium payment system or affordability, or government provided or subsidized systems. when the government of Bangladesh decides to develop and offer suitable models and means to help the elderly and disabled people.
People often need long-term care when they are not old but are developing a serious and persistent health problem or disability. Thus, the need for SLD may arise suddenly, for example after suffering a stroke, heart attack or injury. More often, however, the need for LTC develops gradually, as people age and become more frail or their ongoing illness or disability worsens over time. A disability is a condition of the body or mind that prevents the individual from doing certain activities. Disabilities can affect a person’s vision, movement, thinking, memory, learning, communication, hearing, mental health and social relationships.
It is not easy to imagine how much or what type of LTC an individual might need. Several risk factors have been identified that increase the need for LTC: 1) as people age, the need increases, 2) women are more at risk than men because they often live longer, 3) single people, including widows and widowers, need outpatient care. providers, 4) poor diet and lack of exercise increase a person’s vulnerability, 5) health and family history also affect risk.
Some of these identified risk factors are already common or will be more so among Bangladeshis as they will live longer, women almost always marry men who are several years older than them, which means they will be widowed more long, and people in general, especially city dwellers, have bad eating habits and hardly any opportunities for physical exercise. The divorce or separation rate is on the rise, more and more elderly people are living alone for a better life, education and wages, and many young people are leaving the country. All these elements suggest that LTC will be a great social necessity in Bangladesh.
Bangladesh needs to explore possible ways to meet the growing need for long-term care and an alternative to long-term care in old houses is to organize home-based care. Home-based LTC includes health, personal and support services and these help people stay at home independently for as long as possible. Most long-term care is still provided in homes in Bangladesh. These home services involve personal care, such as assistance with bathing, dressing, taking medication, and supervision. Family members, spouses, friends and unpaid neighbors provide most of this type of care in Bangladeshi society. Home-based LTC services may also be provided by paid caregivers, including informal caregivers, and health professionals such as nurses, home health aides, therapists and housewives, who are hired by home care agencies in other countries. These services include home health care, meal services, friendly visitor/companion services and emergency response systems. Bangladesh has yet to develop, test and offer home health care agencies. Entrepreneurs in Bangladesh can come up with business models.
However, gradually, the support of family and friends may no longer be enough. People may need to move to a full residential facility, commonly referred to as old houses, which provides some of these necessary services. Most old houses in Bangladesh only provide housing and housekeeping, but a few also provide personal care and medical services. Institutions in Bangladesh do not yet offer special programs for people with Alzheimer’s and dementia. Rehabilitation services, including physiotherapy, occupational therapy and speech therapy, are also not available in most current old Bangladeshi-style houses.
The rapid growth in the size of the aging population in Bangladesh over the next few decades will require tremendous effort from everyone to carefully consider their LTC needs and find ways to meet them.
Dr. Hasnat M Alamgir is Professor and Chair of Public Health at IUBAT (International University of Business Agriculture and Technology), Dhaka. [email protected]
