By Olof Björlin
Sweden, a country with a population of some 9 million people, is currently facing the same demographic situation or challenge as other European countries. The number of elderly people is predicted to increase steadily over the coming decades forcing us to contemplate the future from a different perspective. Many of these people will live much longer than predecessor generations and will remain in good health until late in life. The health problems they face will develop at a later stage and will be of a varied and often multiple nature. The particular challenge facing society is that these people will be in such great number.
The facts and figures speak for themselves. Although retirement age is currently set at 65 there is a legal right to remain in a job until the age of 67. For those who retire before the age of 65, whether by choice or for health reasons, pension entitlement is lower. At present, the elderly population includes over 1.3 million people born before 1937 and some 320,000 pensioners born after 1938. Of these, 370,000 are widows, with more than half of this latter group over the age of 79. Only 11 per cent of pensioners are younger than 65. This long retirement period poses a new challenge not only for the individuals concerned but also for society at large.
The increased length of retirement can give rise to personal problems. For many retirees it is, however, a source of richness. What is decisive in this regard and also of relevance to the question of equal opportunities for retired people is their economic situation. Are pensions adequate to live on? In many cases they are, although there are, of course, limits as to what is possible on an average pension with living costs rising annually and inadequate pension uprating. Real difficulties are faced by older widows who were not previously active in the labour market. Their pension averages only 8,600 euro per annum. Even with social welfare assistance many of them struggle to make ends meet. Their income is so low, they are often forced to go without.
The question of ageing – especially in terms of employment – has moved high up the European agenda. A change in attitude is required. In Sweden, as in many other European countries, people over 50 often face considerable problems in the labour market, especially if they lose their existing job. Finding a new job is very difficult. Many of us in campaigning organisations are working hard to convince employers to change their attitudes, to realise that a person over 50 is not old and that they have many years remaining in which to perform a valuable job, drawing on their extensive experience and training. Real discrimination exists in this field because employers consider people of that age not only to be incapable of hard work but also as lacking the ability to learn new skills. Unfortunately, it is not unusual for an employer to refuse older workers the training necessary for their existing job and for future career development. The absence of training consitutes a serious obstacle to equal opportunities. Lifelong learning is, in practice, rare.
The EU Directive on age discrimination in employment which most other EU Member States have already implemented has not yet been transposed into Swedish law and transposition in Sweden is unlikely before 2008. Campaigners are trying to convince the government to extend the scope of the anti-discrimination provisions on age to include access to goods, facilities and services as has already happened in some of the other Member States.
Retirement day can be a difficult moment for many. It appears to be easier for women than it is for men. Many men construct their identity through work and without it life may seem very empty. By way of contrast, women often have a network of female friends outside of work which helps them cope and for those with grandchildren this may also prove a welcome distraction. We must not lose sight of the fact, however, that many people are happy to retire, although some do look for a part-time job in order to help stimulate their physical and mental health. The experience of campaigners is that many retired people can and do positively benefit from the services offered by pensioner organisations.
In Sweden, five pensioner organisations exist. The largest has around 380,000 members and the next in size has around 240,000. The other three are smaller but are organised in more and less the same manner, operating at a national, regional and community level. Taking all of these organisations into account, it can be said that almost half of the retired population are members of pensioner organisations, indicating thus the strength of those organisations.
Campaigning at a national level
At the national level, pensioner organisations maintain contacts with government, members of parliament and other important policymaking bodies in order to be well informed on policy development and – most importantly – to express pensioner views. A special committee on pensioner issues with representatives from government and the five pensioner organisations meets around five times a year to discuss current policy issues. Representatives from pensioner organisations are invariably invited to participate in official reports and inquiries into pensioner matters. Pensioner organisations aim at this level to persuade the authorities to adopt policy solutions appropriate to the needs of older people, for example, adequate funding for long-term housing needs, special payments for dental treatment of people in long-term care, etc.
Pressure-group activities at a regional level
Regional authorities are responsible for hospitals and provision of medical and care services. At this level pensioner organisations work in close contact with those authorities in order to scrutinise developments. Pensioner organisations generally need to apply significant pressure on the regional authorities because those authorities have a tendency not to prioritise pensioner provision because of funding difficulties. Where, for example, national legislation requires regional authorities to take steps to improve provision for older people, close surveillance is needed in order to ensure that the legislative aim becomes a reality.
The authorities seem to forget or ignore many of the particular issues affecting older people. For example, their health needs often require the treatment of a specialist but there are very few geriatricians and currently there is little prospect that their number will be considerably increased. The authorities appear to think that general practitioner (GP) services are sufficient to meet the needs of the elderly. Increasingly, evidence suggests, however, that this approach is inadequate in the long run. GPs lack the specialist training for geriatrics and are in any event already too busy with other work.
Unfortunately, the mental health of the elderly is not seen as a priority. With increasing numbers of older people the number of those with dementia is also on the rise. Accordingly, the situation demands the development of better treatment methods and ideally a cure. Rehabilitation services also give cause for concern. When an elderly person falls and breaks a leg or an arm or has a stroke, rehabilitation is of particular importance. The services available to older people are, however, not as extensive as those offered to younger people, thus providing another example of the unequal opportunities facing the elderly.
In all regions groups with representatives from the regional authorities and from regional pensioner organisations meet four or five times per year, offering pensioners the possibility to exchange information and to express criticism and suggestions for improvement.
Community level issues
In almost every town there is at least one consultative group which includes representatives of the local authority and local pensioners organisations. In larger towns and cities there are usually several such groups which meet at least four or five times per year.
The activities of those groups are of considerable importance for the elderly because local authorities are responsible for many services for the elderly, for example, the provision of long term care and housing services. In addition, it must be recalled that many of the elderly – even if they are still in good health – have needs as elderly persons and, in addition, the right to be treated as an equal member of society. This means that older people can reasonably expect urban planning to take account of their needs, for example, in ensuring that local shops and amenities are within walking distance with adequate lighting and security thus preventing them becoming isolated in their own homes. Similarly, public transport – appropriately priced – must also be adapted to ensure that older people have the same access to mobility as younger people.
Whilst older people remain in good health and can take care of themselves the problems facing society are less significant but greater life expectancy means that older people are increasingly exposed to illness and require care in their final days and months of life. This fact presents society with a problem.
Until recently, local authorities offered a certain number of nursing home places where older people could live together enjoying each other’s company in the certain knowledge that a nurse or care assistant was on hand as necessary. Today, local authorities both lack the funding for nursing homes and also have adopted a new principle for care of the elderly. They believe – wrongly – that older people want to remain at home as long as possible and therefore many of the nursing homes have been closed. Instead of providing nursing home accommodation, local authorities send homecare assistants to the elderly to bring meals, provide assistance with personal hygiene and perform limited domestic tasks. In this manner, cost savings can be achieved. It is not, however, an appropriate solution in all cases.
Are older people satisfied with this situation? The answer to that question depends very much on who you are and where you live. In some municipalities service provision is very good but in many it is seriously lacking. One of the most criticised aspects of local authority provision concerns the meals supplied. In many cases the food is poor, deep-frozen and tasteless or has a flavour that is unrecognisable or unfamiliar to the older person and, above all, the older person invariably has to eat alone. As a result, the older person may not eat enough or sometimes may not eat at all, with the inevitable consequences for that person’s health thereby arising.
As previously indicated, local authorities are responsible for care of the elderly but the care they provide is inadequate. Notwithstanding that responsibility, in practice, it is relatives of older people, husbands, wives and children who perform much of the caring work. Exact figures do not exist, but it is believed that about 70 per cent of all care necessary for the elderly comes from relatives. It can only be imagined what would happen if relatives did not provide that care. The caring responsibility offer forces relatives into a difficult situation, far removed from the everyday life of others. That position is particularly challenging where the older person begins to suffer from dementia. Some local authorities provide assistance to relatives acting as carers but that help is generally insufficient.
The matters highlighted above provide only a flavour of the issues facing local consultative groups. For representatives of pensioner organisations to be effective in those groups, meeting politicians on an equal level, they need training in advocacy matters and to be well informed on pensioners’ rights.
It must be recalled, however, that there are also positive aspects to life as an older person. Pensioner organisations can make a significant contribution in that regard, offering many social activities – often the major reason for membership. In many local organisations there is a monthly social event, an opportunity to have coffee with friends and to enjoy musical or other entertainment. Other activities include museum and theatre visits, bridge and bowls competitions, and courses in IT and other matters. An important element for many are the study circles where members can discuss and learn about a variety of health issues.
Understandably, some members do not attend meetings or take part in social activities. In order to ensure that those members do not feel left out, however, there is a concept of ‘service amongst friends’, which means that another member will go to that person’s house to invite them to attend and if necessary accompany them to the meeting. Likewise, help can be provided in accompanying members when visiting the hospital, doctor or pharmacy or simply in providing conversation in their own home.
Despite these activities there remain many who are completely cut off from society, people living completely alone with no relatives and no human contact other than with the postman or nurse.
People over 50 who are unemployed have difficulties in re-entering the labour market. The year of equal opportunities in 2007 is unlikely to provide much assistance in that regard. Even those who have sufficient financial resources may endure considerable stress. Retired people in good health are in a better situation, however, with many possibilities to give meaning to their lives. Even though pensioner organisations do not have the same role in society as a trade union does they can do much for pensioners and fulfil a valuable social function.
On a final note, it must be observed that much remains to be done particularly with regard to health issues. Elderly patients are not treated in the same way as younger people who are sick. Often they have to wait longer for treatment with new medicines trialled only on younger patients. They do not always have the best medicines and access to rehabilitation is restricted as regards persons over the age of 65. The underlying issue is one of limited financial resources and as long as society prioritises younger people, the elderly will continue to lose out.
Olof Björlin is a graduate in Law. He acts as legal advisor to the Swedish Medical Association and the Swedish Association of Senior Citizens.