Panel Discussions: Baby Boomer's Aging in the World Challenges and Policies; how to cope with it
- The Hon. Josefina G. Carbonell,
Assistant Secretary for Aging, US Department of Health and Human
- Mr. Andrew Stuart,
First Assistant Secretary, Ageing and Aged Care Division, Department
of Health and Ageing
- Mr. Tom Mill, Executive
Director, Alberta Health and Wellness (He represented as a Special
Designated Representative for the Hon. Dave Hancock, Minister
of Health and Wellness and Government House Leader of the government
of Alberta, Canada)
- Mr. Kenichi Furuichi,
Director, Promotion Division, Bureau of Welfare for the Elderly,
Japan Ministry of Health, Labor and Welfare
- Mr. Nobuaki Koide, Managing Director in charge
of Editorial Affairs, Chunichi News Paper in Nagoya who acted
as the Moderator for the session.
The afternoon session at the symposium was designed not only to introduce
the policies and programs of the countries that the delegates represented
but also to discuss how each nation has been coping with the issues
of the newly emerging aging society due to the entry of Baby Boomers.
Mr. Koide as the Moderator of the session invited at first Assistant
Secretary for Aging, Hon. Josefina G. Carbonell to make her opening
remarks. Her remarks are cited as follows:
Assistant Secretary, Josefina
G. Carbonell emphasized that the issue of aging is no
longer the issue of coping with the elderly and the government
of the United States has taken the various initiative, one of
the recent initiatives taken is what is termed as " President's
New Freedom Initiative, designed to tear down the barriers that
prevent people with disabilities of all ages from being active
and involved in their communities." She also referred to a number
of the recent moves being made by both Bush Administration and
US. Congress which includes An Executive Order- Community-based
Alternatives for Individuals with Disability, Federal Agencies
--Real Choice System Change and Congressional Action--Deficit
Reduction Act (for the details of this initiatives, Mr. Edwin
Walker enumerates on his presentation). She also introduced how
the government of the United States is viewing the issue of newly
emerging aging society from the global point of view as exemplified
in the remarks made by Secretary of State, Condoleeza Rice during
the recent US Department of State's Summit on Global Aging. As
Assistant Secretary has quoted the remarks of Secretary of State
Condoleeza, it stated that " The impact of global aging is enormous
and complex, and we stand to benefit from sharing our common
solutions to our common problems. In today's interdependent would,
how one nation address a challenge like this has international
implications. We must do a lot to more integrate the issues of
aging into our international discussions and our foreign policy."
From this remarks made by Secretary of State, Condoleeza, the
government of the United States is taking positive and constructive
measures to address the issues of aging in global perspective.
Assistant Secretary, Josefina G. Carbonell cited about the significant
steps taken at the World Assembly on Aging held in Madrid in Spain
5 years ago and stated that an implementation plan for developing " A
Society for All Ages" and the continuing review of the progress
of this implementation plan, which will be enhance the awareness
of international collaboration and cooperation on the issues of
aging among the nations in the world.
She talked about the reforms of Medicare and Medicaid undertaken
under the leadership of Bush Administration which benefited the
elderly that are being made available such as prescription of drugs
for the elderly. The strengthening of OAA initiatives under the
leadership of Bush Administration has brought about the opportunity
of advancing changes in the state and local level designed to integrate
health and human services system. She talked about the easier access
to information by the elderly , their families and disabilities
as to what kind of services are available for them to meet their
needs by establishing "one stop-shop" programs. She emphasized
the strategies that are deployed to give consumers more control
over the service from the public programs, designed the consumers
to have more of their options of what they would like to receive
the services which are really needed for them. She has also touched
on the strategies which will enable the elderly and disabilities
to take an advantage of the efficacy of low-cost programs that
help the elderly to manage their health better. She stress that
these programs are proven scientifically to ensure the efficacy
of the programs.
Commenting on the preparatory awareness and attitudes on the
part of individuals while they are still young for their long-term
care services needs. The government is expanding information networks
to provide the valuable information which would help those to aware
of the importance of information on long-term care services by
establishing the National Clearinghouse for Long Term Care Information.
Because of difference of the system between Japan and the United
States, the long-term care insurance system which Japan has implemented
in the form of mandatory, she pointed out however that in the United
States is now endeavoring to encourage states governments to offer
an incentive known as "Partnership for Long-Term Care", designed
to provide the system whereby the use of private long-term care
insurance by offering state public health insurance as a form of
re-insurance, which will enable the private coverage more affordable
and make it more purchasableB
In concluding her key note remarks, Assistant Secretary Josephina
G. Carbonell pointed out that under the Bush Administration, the
long-term care modernization reforms being implemented in the Older
Americans Act, Medicare and Medicaid, hold great promises for improving
the quality of life for Older Americans.
The writer is very much impressed how the value of the grass-roots
movements are playing the key role in shaping the policies of the
United States in the field of aging and the service programs for
the elderly. The White House Conference On Aging is a typical demonstration
of how it is important to listen to the voice of people in order
to shape the policies of government into tangible and appropriate
programs for those who are looking for.
Click here for Assistant
Secretary Carbonell's presentation materials in PDF. The Japanese
translation of the presentation is also available here.
Mr. Andrew Stuart, First Assistant
Secretary, Ageing and Aged Care Division, Department of Health and
Ageing, the Government of Australia. Mr. Andrew Stuart delivered
his opening remarks under the title of " Ageing and Aged Care in
Australia". He cited at first about the Australian Government Ageing
and Aged Care programs and objectives, which stated in a very concise
and simple way. He stated that "it is support healthy ageing for
older Australians and quality, cost effective care for frail older
people and to provide support for cares." He predicts that population
growth of "Older Old" (80+) will double over the next 20 years. The
demographics of Australia predicted was introduced (For the details,
see his power point presentation). The reasons given for this growth
was due to the increase of the population of the older Australian
and that decline of birth rates has contributed; 3.5 births per female
in 1960 and it is now 1.7 births per female.
The strategic approach to aging in Australia is cited:
- Support positive attitudes to ageing
- Break down barriers to continuing workforce population
- Encourage financial security
- Assist people to stay in their homes
- Provide high quality care for frail older Australians
Commenting on how Australian government has been funding for the care
services, He stated that 1.000.000 people received some form of aged care
supported by Australian government and spent $7.1 million for it. He cited
about the two type of care services are provided, one being at institutional
facilities and other type is at homes. He introduces the core of care services
being provided in Australia, encouraging the elderly to stay at their homes
with the support of the communities, programs of which includes:
- Treasury, Employment, Health and Welfare Departments undertaking initiatives
- Public and private pensions funded from taxation and private sources
- Mature Age Employment and Workforce Strategies to support continuing
- Welfare Reform to address employment needs of income support recipients
- Support and recognition older people for their ongoing contribution
to the community
Mr. Stuart elaborates on the matte of how the aged are in place and type
for aged care in Australia. He provided the valuable information on (1)
Australia Government budget, Ageing and Aged Care, 2006-2007, (2) Estimated
Australian Government subsidized aged care receipients, 2005-2006, (3)
Growth in community care, (4) Community Care Expenditure, (5) Support for
careers, and (6) Community Care Packages. From these policies being implemented
by Australian government, it is obviously interested to know how and who
are paying for these programs derived from the policies that the government
has acted on.
According to Mr. Stuart, Australian Government is constantly checking
on the standard and rules that providers of care services are complying
to these regulative policies. Mr. Stuart listed the following points which
are designed to ensure "Quality framework" for the various services to
be in order:
- Accreditation of Residential Aged Care Homes
- Monitoring, including spot checks
- User Rights
- Building Certification
- Police Checks
- Compulsory Reporting of Abuse
The foregoing measure are said to ensure the quality framework. He also
referred to the changes taking place among users concerning residential
cares. In concluding the remarks, he stated that the number of the aged
70 and over is expected to double in the next 20 years. He stated that
there are (3) core points of challenges that Australia must cope with in
the newly emerging aging society, which is (1) Financial Sustainability,
(2) Workforces and (3) Technology.
During the discussion session, some of questions were raised concerning
the way how Australia is going to cope with fiscal matters due to relative
less populate nation together with the decline of birth rate, a question
of influx of people from Asian nations as immigrant into Australia which
may created the issues of how amalgamation of different ethnic group can
be smoothly in place. It is also raised the recent government policies
to curtail its immigration policies which may have negative impact on the
increase of population in Australia to improve and sustain the system to
provide care services from fiscal point of view. This type of the nature
of problems are not limited to Australia alone and Japan has already seen
the trend of the change in demographic situation, which is now one of the
most pressing issue how to improve the population of the supporting generation
to establish a kind of equilibrium of those who support the elderly and
those who are being cared. Mr. Stuart stated that the government of Australia
is being faced with this dilemma of how to develop the re-defined visions
and policies to meet the needs of the newly emerging aging society.
Click here for Mr. Stuart's presentation
materials in PDF.
Mr. Tom Mill, Executive Director, Alberta
Health and Wellness (A Specially designated representative for the Hon. Dave
Hancock, Minister of Health and Wellness and Government House Leader).
Mr. Mill opened his remark by introducing the message from his Minister
"Thank you and good afternoon. I would like to extend my thanks for inviting
me to your International Symposium. Though it is a great honor to be invited,
I regret that my schedule does not permit me to attend this event. As I
recently began my new role as the Minister of Health and Wellness in addition
to Government House Leader, I am obligated to remain in Alberta to fulfill
Your conference theme this year- "Baby Boomer's Entry into the aging
society; is so applicable and timely. Similar to the other countries that
are represented today, the aging population is an area of increasing concern
in our Province. I look forward to share the Alberta experience with you
and look forward to hearing from Alberta's delegates, Mr. Mill Tom and
Mrs.Vivien Lai regarding the discussions that takes place today."
Mr. Tom Mill focused his presentation mainly on the following points:
- Canada and the Province of Alberta
- Priorities & Mandates
- Evolution of Alberta's Continuing Care System
- Planning for the Future
- Future Direction
Before centering on the core of his presentation, he briefly explained
about Alberta which referred to the population of Alberta (33 million),
size of Alberta (661,185 square kilometers or 255.303 square miles. It
is 1.7 times the size of Japan. Alberta's population is around 10% of Canada's
population which is equivalent to the population of the city of Yokohama,
He cited about the government's top five priorities which are pledged
to promote under the newly form government under the leadership of a new
Premier and Cabinet. The five priorities are:
- Govern with integrity and transparency
- Manage growth pressures
- Improve Albertans' quality of life
- Build a stronger Alberta
- Provide safe and secure communities
He pointed out that these priorities are about addressing challenges
today and building for the future. Commenting on the government's fundamental
political philosophy and vision are to govern with integrity and transparency
tops the priority list because the way we do things is just as important
as what we do. He quoted the statement made by Premier Stelmack who says; " we
do not own the right to govern, we earn it." He also stated that transparency
is the key to be a Democratic government, performing its responsibilities
for the Albertans.
By using his power point presentational materials, he cited about the
following agendas that the government of Alberta has focused its priorities
on the issues of aging society.
- Implementing health care productivity reforms and long term sustainability
initiatives in consultation with health care professionals and Regional
- Implementing a comprehensive workforce strategy to secure and retain
the health professionals needed over the next 10 years.
- Implementing a new pharmaceutical strategy to improve the management
of government drug expenditures to ensure Albertans have access to sustainable
government drug coverage and
- Strengthening public health services that promote wellness and injury
and disease prevention and provide preparedness for public health emergencies.
Mr. Mill has cited the role that the Minister of seniors and Community
Supports have been charged with the following responsibilities:
- Establishing a Demographic Planning Commission to provide analysis
and proposals to prepare for the needs of an aging population and ensure
facilities and supports are available to seniors.
- Bringing forward an updated plan to expand long term care and improve
standards of care.
Commending on "Evolution of Continuing Care, Mr. Mill, the government
of Alberta has been implementing a number of important programs to ensure
that continuing care or long-term health care services including the programs
for disabled since the late 1970'. He said that the roots of the feature
of the current continuing care system has stemmed from the Report termed
as " Mirosh Report" which was submitted to the government for the implementation
of such programs in 1989. This policy and programs included the development
of the following:
- Implementing a single point of entry to the continuing care system
and ensuring appropriate use of services;
- Expansion of community-based services through planned growth and support
independence of clients.
- Develop and implement a funding scheme based on an annual, standardized,
classification and case-mix system for long-term care facilities.
Mr. Mill stated that the government embarked on a comprehensive review
of the long-term care system took place involving extensive consultation
with stakeholders and analytical work., which was initiated by a Member
of the Alberta Legislative Assembly with the support from the Ministry
of Health and Wellness. This led to the acceptance of the recommendations
of this Committee by the government, which was placed in the form of 9
The core of the recommendations included:
- Healthy Thy Aging;
Promote "healthy aging" as a priority goal for Alberta to ensure that Albertans
are healthy and independent as they age
- Continuing Care Services;
Modifying and enhance continuing care services to respond to the aging population
with the goal of supporting Albertans to "age in place" in the community.
- Home Care and Community Care;
Expand home care and community care services to meet the increased needs
of Albertans in the communalities
- Re-Generation of Long Term Care Centres;
Re-generate long term care centres to meet the needs of .residents with high
and complex health needs.
Citing on the progress of these policies and programs being implemented
are still being monitored to see if the further improvements that may require
to meet the issues of newly emerging aging society. In efforts to improve
and enhance these policies and programs, Mr. Mill commented that the Auditor
General of Alberta conducted an audit of Alberta's continuing care as a
part of a larger audit of Seniors care. The results of this audit led to
the creation of an MLA led task force on continuing care services standards.
He told that the feedback from these consultations fed into a new set of
continuing car standards for the province which are set to be in place
by the end of this month(April,2007).
In his final phase of the remarks, Mr. Tom Mill touched on the subject
of how the government is going to be planning for the future. In spite
of the enormous efforts injected both financially and resources for the
enhancement of the on-going policies and programs already in place, he
admitted that it will require the further continuing efforts to deploy
more extensive and effective measures to meet the issues of the newly emerging
He predicts that the growth of population of Alberta's seniors will be
inescapable for the next two decades. Based on the projection that the
government see, the total senior population(65+) will increase by nearly
50% by 2016 and by over 120% by 2026. The bulk of this growth will be made
up of seniors aged 65 to 74. He has cited that the population aged 85 and
over is projected to double over the next tow decades. He emphatically
stated that while this group is growing at slower rate compared to younger
seniors, they are heavy users of the health system. He estimates that the
average health expenditure of the 90 and over cohort is nearly 3 times
that of the 80 to 84 cohort, 10 times that of the age of 65 to 69 population,
and 25 times that of the 50 to 54 population.
Mr. Tom Mill stated that his Minister has developed a projection and
planning tool to support the province and the government's partners to
understand the implications of the aging population. He elaborated that
the model takes into account; clinical severity, demographic changes and
proportion of clients that can be shifted from facility to community based
care to project capacity, financial and human resources requirements needed
that are needed. This shift of facility to home-based care may need for
more comprehensive researches and may require political decision. He illustrated
how this shifts may have some impacts on the fiscal policy of the government
as well unless the concerted efforts of all parties involved must carefully
look into the furor projection.
Mr. Tom Mill did refer to the question of how it will have impacts may
have on aging population. His Ministry has done extensive work on modeling
the full impact of the aging population on all sectors of the health system.
He stated that "Health Benefit Design Options project explored different
options for funding the health care system and was heavily influenced by
the Japanese Long-Term Care Insurance System. He stated that the relationship
Dr. Teruhisa Mokno, CEO of Sun Life Social & Welfare Organization and
Mr.Yusuke Kataoka, Acting Chairman & Executive Director, US Foundation
for International Economic Policy has been very constructive in sharing
ideas and some in-depth insight into the pros and cons of the system as
it is in place in Japan.
In the concluding part of his remarks, Mr. Tom Mill dealt with the matter
of Future Direction. The approach to doing so is focused on the following:
- Improving both quality of care and quality of life.
- Better understanding of end-of-life issues and how families and caregivers
can be supported.
- New Continuing Care Standards.
- Implementing Inter-RAI and quality indicators.
- Ensuring value for money.
- Ensuring that continuing care clients are appropriately placed.
- New funding models that taking that are sensitive to the resource
requirements of the population and do not create perverse incentives.
- Responding to the needs and concerns of Albertans.
- Monitoring and reporting
- Transparency of processes; uniform care planning process; Inter=RAI,
quality indicators, public reporting.
Mr. Tom Mill concluded his remarks by citing the following:
- The Alberta government has taken action in a number of areas to improve
the continuing care system in the province.
- The government has also taken a number of steps, including increasing
funding and releasing new continuing care standards, that will help address
the challenges described above.
- The government Ôs strategy for dealing with the aging population will
be discussed in further detail during symposium presentation (For the
details, the materials and information provided below).
- There is still work to be done to ensure that our continuing care
system will be ready to accommodate the Baby Boomers when they enter
the system, but the province is well positioned to address this new generation
of older people.
It is very interested to note that the Province of Alberta is known to
be the province which are one of the most active economic and business
activities are prevailing that is benefiting due to mainly the abundance
of natural resources(sand oil and its related industries) and one of the
less populated provinces in Canada and that the fiscal policy of the government
is relatively stable compared to other provinces, it is, however, that
the government has taken steps to make it sure that the system of dealing
with the newly emerging aging society to ensure that the system it has
placed should be viable and sustainable without being affected by the fiscal
and economic condition of the province.
Click here for Mr. Mill's presentation
materials in PDF.
Mr. Kenichi Furuichi, Director, Promotion
Division, Health and Welfare Bureau for the Elderly,Japan Ministry of Health,
Labor and Welfare
Mr. Kenichi Furuichi has opened his remarks under the title of "Aging
of Baby Boomers Generation- Issues and Policies of Japan".
He cited about the current situation of Japan on life expectancy and
noted that average life expectancy for male was 78.3 and female at 85.2
in the year 2002., which means that both men and female are rated as No.
1 in terms of their life expectancy. It was 72.3 for male and 77.7 for
female in the year 2002 which was for "healthy life expectancy". Commenting
on the comparison of the rate of progression of the aging among Japan,
the United States, Canada and Australia, he shown on his power point presentation
materials provided at the session, it will take 24 years, 73 years, 65
years and 72 years respectively in terms of the older people who are 65
years old and over to double.
Mr. Furuichi moved on to focus on the outline of Japan's Long-term Care
Insurance System. He cited about the reasons for the increase of the elderly
requiring long-term care services which is due to; (1) increase in the
number of the elderly requiring long-term care and (2) lengthened and seriousness
of long-term care. He has cited some shift being developing in terms of
how family members of the elderly are providing care services for their
elder peoples. He attributed it to the change in the traditional way of
life of Japanese family which stems from the exodus of the younger generation
from the co-habitation way of life with their parents and the younger generations
are also getting older to provide the task of being caregivers. This has
led to establish the Social Support System for Long-term Care.
Mr. Furuichi cited about the image of the Aged Society in 2015 and also
how the revision of Long-term Care Insurance System which was enacted in
2005 will change the policies and programs of Japan's Long-term Care Insurance
System for the elderly. Speaking on the entry of Baby Boomers generation
into the family of the aging society, he enumerated projections on the
increase of the elderly with dementia (see power point) which will be expected
to be the number of 2.5 millions in 2015 from the number of 1.5 millions
in the year 2002. He stated that the number of households consisting of
an elderly people living alone will reach at 5.7 millions in the year 2015.
According to projections, the number of the elderly households will increase
to nearly 17 millions by the year 2015 including nearly 5.7 millions(approximately
33%) households consisting of an elderly people living alone. He predicts
that there will also be the enormous degree of increase in urban areas
such as Tokyo and other major large metropolitan cities.
On the subject of the future prospects of the population aged 65 or older,
he cited that so-called Baby Boomers generation will be at the age of 65
in 2015 and in the following 10 years, they will be the old-older with
the higher ratio of those requiring care services. He stated that this
projection has necessitated " Long-term Care Model to make its shift to " Long-term
Care + Prevention" model (For the further details of his remarks on this
point, please refer to his presentation material provided below). He has
also cited about increase of the elderly with dementia. He said that the
Ministry of Health, Labor and Welfare has developed an appropriate model
for the implementation under the revised long-term care service insurance
system as revised in the year 2005.
He provide the model which pertains to "living with Family" Model to " Living
with Family + Living Alone" Model (see power point). He pointed out that "society
will be aging rapidly especially in the urban area which will create the
situation whereby houses for the elderly will be a big problem."
He focused on the view points for the System Revision of Japan's Long-term
Care Insurance System. He cited about the reasons why such revisions had
to be nenacted:
- Shift to Long-term care + Prevention Model.
- Shift to Physical + Dementia care model.
- Shift to Living with the family + Living alone model.
For the details of how it is structured as far as the revised model designed
to emphasize prevention-oriented model system is illustrated in the power
point materials. Under the revised system, the policies and programs of
establishing so-called " Community Care System" has been implemented to
focus on(1) idea of Community Care System and (2) Role of Comprehensive
Support Center. The another reform took place is the programs of encouraging "Small-scale
Multi-functional in-home care which is designed to help users who can continue
to live at home by having main users to a care center and also providing
a combination services of "home-visit" and "short-stay" at any times; according
to the situation and requests from the elderly requiring care services.
Mr. Furuichi discussed about the challenge with which Japan has to face
in the future. He cited about the necessity of having the in-depth analysis
of the fiscal condition of the government to sustain this system as the
viable system. He talked about the increase of expenses of long-term car
services by enumerating on the record of how the increase of expenses has
been rising since the year 2000 till the year 2007. He also cited about
the case of the insurance premium for category 1 insured (National average),
which increased from \ 2,911. (FY 2000-FY 2002)--\ 3,293. (FY 2003- FY
2005)-\ 4,090. (FY 2006-2008).
Speaking of Aging of Baby Boomers Generation(born in 1947-1949), he used
the illustrative chart from which one can see how the population of Baby
Boomers are going to be look like (For the details of this chart, please
refer to his presentation materials provided below). In his concluding
remark, Mr.Furuichi cited that Japan' Long-term Care Insurance System has
now been shifted from it original policies and programs as a result of
the revision made in the year 2005. The policies are changed toward the "more
community-based and preventive care services from the nature of the conventional
Click here for Mr. Furuichi's
presentation materials in PDF.
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