Paying for ourselves as we get older: rethinking resource allocation

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Issue 3: The supply of care

A third issue concerns not financial resources paying for material support, but the human resources – most often unpaid, although in other cases professionalised – that are used to care for people not able fully to care for themselves. Will we in future have an adequate supply of such care to meet demand?

Both the supply of and the demand for care are susceptible to demographic changes. Most obviously, there are two groups who are more likely than others to need a relatively intensive form of care: the very young and the very old. All children under 16 can be expected to require some form of care. For older people it is harder to generalise, but after the age of about 75 the chances of needing some form of care starts to increase sharply with age.
A first question is therefore what will happen to the number of people in these age-groups. Figure 4 shows that in the past 35 years the total number over 75 and under 16 has in fact declined as a percentage of the population, as falling numbers of young people have not been matched by the growth in the elderly population. In the next 35 years on the other hand the picture is very different. The child population will decline more slowly while the over-75 population will rise more rapidly, and the total will return to around the 1971 level by 2041. Most importantly, whereas in 1971 there were five times as many under-16s as over-75s, by 2041 there will be similar numbers in each category.

In this context, we can think in the long term not so much of an increased burden of care but of a massive shift from young to old. A major problem for our society of mainly nuclear families is that mechanisms for caring for the elderly are in certain ways more problematic than mechanisms for caring for children. Most obviously, unpaid care within families is most straightforward when people live in the same household. Childcare is also easier to plan than elder care, because of the relative predictability of an individual’s needs. And when it comes to professional care, the major institution of school, which has recently been extended downwards to cater for more children under five, takes up a considerable part of the burden.
On the other hand, there may also be parallels between strategies for dealing with demographic change in care for older and younger people. In the past 30 years, a big difficulty in resourcing the care of children has been the growth in lone parenthood. In lone parent families, it is not possible to follow the traditional support model, of one partner working full-time helping to support a carer who is either not working or working part-time. Recent policies have helped address that resource shortfall by improving professional childcare opportunities and also by improving financial support for lone parents on low incomes. In particular, the present tax credits system is extremely favourable to lone parents working part-time: those who work 16 hours a week on relatively low wages get especially large supplements to their earnings, as well as a 70% subsidy to childcare costs. This greatly helps lone parents to combine caring responsibilities with economic activity, and potentially creates a more efficient supply response to childcare demand by allowing some people (many of whom are parents themselves) to care for more children as childminders than they would only as parents.
Are there way of replicating this with elder care? An interesting parallel to the situation of lone parents under competing pressure to earn and to care is that of working women in their 50s, many of whom have parents requiring care, combined in many cases with other caring responsibilities including for children and grandchildren (see Figure 5). There are various ways in which public policy might approach the caring roles of this age group. One may be to give greater financial and other kinds of support to those who combine caring with paid work. But the pressure on people in their 50s to earn at the same time as the number of older people is growing, is bound to create a supply-side squeeze on unpaid care, compounding emerging shortages in the supply of paid carers. Another approach might therefore be to give new incentives and recognition to carers in a slightly older age-group – people in their 60s, many of whom have left paid work but are still relatively fit. Many of these people at present help out in various voluntary capacities, but there may be scope for engaging them in more formal roles, which do not entail paid employment. Just as an army of childminders who are not career professionals helps enhance the supply of care for children, so we may need to develop new intermediate cadres of carers for the elderly.

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