Conclusions and policy implications

Together, Finland, Japan, and Australia provide a powerful illustration for policy makers of the diverse range and mix of policies and programs that can emerge in countries that share a common goal for the support and care of older people but that have different cultural and political traditions. While the approaches and measures are unique to each country, several common elements can serve as models for both Canada and the Atlantic region.

Common Areas of Policy Reform Whole-of-government policy frameworks Employment of older workers Pension reform Alternatives to institutionalization and support for care in the community Comprehensive support systems for family caregivers Supportive housing Private-sector service providers (both commercial and not-for-profit) National standards for care

The first of these is the development of whole-of-government strategic frameworks at the national level for coordinating and gaining support for age-related reforms. All three countries felt the need to develop comprehensive age-related policy frameworks with principles, goals, and objectives that consider all of the determinants of active aging as well as economic prosperity. These frameworks involve all government departments, social partners, non-governmental organizations and the general public. While the frameworks vary in scope and structure, a main purpose has been to build the public understanding and consensus required to support the reforms - some of which would otherwise be unpopular. These frameworks have provided national leadership for action and a coherence in activities in different sectors and levels. They are believed to have helped sustain reform over a longer period of time than is typical in public policy. In Finland and Japan, strategic plans for population aging are also required at the state or municipal level. The Australian approach has involved the general public in a national debate to develop the framework.

Another common theme is the concern with labour issues such as mature-age unemployment, early retirement, and worker shortage. All three countries have begun experiencing the impact of population aging on the labour force. They have recognized the folly of incentives for early retirement and have made 180-degree policy shifts in this area. They have also instituted policies to promote rehabilitation, retraining, and lifelong learning to enable older people to remain in the work force at least until the age of 65. Both Japan and Finland have developed comprehensive policy frameworks to address work-force aging. In Atlantic Canada, as in Finland, we are more familiar with unemployment than worker shortage, and this issue may be hard to grasp. However, we have recently begun to see signs of worker shortages in professions such as nursing, teaching, and medicine in Atlantic Canada. Unemployment among older resource workers is at an all-time high in our region, and future employment prospects for those with limited literacy and training are discouraging.

Another strong theme is the priority that Finland, Japan, and Australia have placed on keeping older people out of institutions. Each has adopted a comprehensive range of measures to keep older people in the community. In Australia and Japan, the expression “long-term care” no longer refers to institutionalization because long-term care is now available both at home and in a range of facilities. A wide variety of supportive services have been rapidly created to encourage care at home. This profusion of in-home support and care services has led to the need for care coordination. In all three countries, a care coordinator is assigned to people who require several support services.

Also to facilitate care at home, the countries examined have all developed strong support systems for caregivers. These all include some form of payment, legal entitlement to respite services, and easy access to both advice and emotional support.

For older people who cannot remain at home, all three countries have emphasized the construction of a range of supportive housing such as hostels, cluster homes, service homes, and special nursing homes. These facilities all provide security and assistance but do not provide nursing care. In most cases, they are not staffed around the clock.

Another common element of these reforms is the reliance on the private sector for providing many of the supportive services for seniors. While services are purchased by the government, they are increasingly delivered by private-sector providers, including both for-profit and not-for-profit organizations.

Both the growing private-sector involvement and the decentralization of services to municipalities (in Japan and Finland) have led to concerns about inconsistencies and quality in all three countries, which are all now developing mechanisms such as national standards and accreditation programs to enhance quality and consistency.

Canada can also learn from the significant differences in the approaches used by each country. A strong theme across all Australian programs is public participation and access to information. The Australian government’s consultative approach to developing the National Strategy for an Ageing Australia, with five discussion papers available in 13 languages, is in sharp contrast to the top-down Japanese approach. The Australian government has made access to information a priority, with many free publications available in several languages, a number of toll-free information lines, and a variety of storefront information centres available across the country to keep seniors and their caregivers abreast of all available services and programs.

Japan’s very systematic approach to planning can also provide a model for policy makers in Atlantic Canada. With demographic projections of the number of older seniors who will be requiring care in our region in the next two decades, municipalities, health regions, and provinces can begin to set targets now for building the required infrastructure - the same way in which Japan did in its series of Gold Plans.

Policy makers in Atlantic Canada might well ask who will pay for these extensive reforms. Experiences in Finland, Japan, and Australia suggest that there is no one source of funding. Each country uses a combination of measures to pay for new programs and services. In Finland’s cradle-to-grave welfare system, most programs are still funded through general taxation, with employers bearing some responsibility to provide services to employees and their families. User fees have been introduced for many programs. The Australian system requires means testing for most services. For the first time in its history, Australia’s older population is relatively well-off financially, and users who can are expected to pay for services. The Japanese, who are highly averse to taxation, have a strong belief that people should be self-reliant. Even so, when the first Gold Plan was introduced in 1989, the Japanese government introduced a goods and services tax for the first time. While the two measures were not officially linked, there is a general belief that they are related. More recently, Japan’s new Long-Term Care Insurance Program requires employers, workers, and seniors to pay regular premiums to support the reforms. In addition, users are required to pay from 10% to 30% of the costs for most services. All three countries have taken measures to reduce the burden on national pension and unemployment-insurance programs. Clearly, none of these measures have been popular with the general public, but over time they have been accepted. Informed public discussion about alternatives for both reforms and their financing will provide an opportunity for all of us in Atlantic Canada to design the right mix of services and payment schemes to meet our own unique situation.

Population aging is a demographic phenomenon that is not going to disappear. It will only increase in our lifetime. Experiences in Finland, Japan, and Australia demonstrate that it takes more than a decade to develop a comprehensive and integrated infrastructure that will maintain prosperity and support an aging population. The unique blend of policies and programs in each of these countries has emerged from the complex interactions of their culture, traditions, and economic priorities. The emerging similarities between Finland, Japan, and Australia in their responses to the aging of their communities offer strong role models to policy makers in Atlantic Canada and to the country as a whole.

 

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