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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 Services
  • 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 purchasableB

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 employment
  • 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 which read:

"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 my duties.

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, Japan.

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 Health Authorities.
  • 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 strategic directions.

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 aging society.

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:

(1) Quality

  • 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.

(2) Sustainability

  • 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.

(3) Accountability

  • 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 social policies.

Click here for Mr. Furuichi's presentation materials in PDF.


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