In Bangladesh, we inherit a culture of respect to the ageing population and a strong sense of community sensitivity in our society. With the changes of time and socio-economic condition these customs are decaying. However, it is not lost completely. That's the ray of hope I would like to bank upon for discussion on the issue of care and services to Older People (OP).
Whenever the care and service issue for OP comes, immediately some people think of services through institutions like Old Home. Largely nurtured in the west this model apparently serves the purpose of caring the OPs as somebody excluded from the mainstream society, as if they have nothing to do more in this world, their ability is exhausted and the family and society have no or little obligation to them, thus completely denying their rights and strengths to live a worth life.
At the outset, therefore I would thus give emphasis on the image building on ageing towards enhancement of social recognition of the ability, wisdom, productivity and other possible contributions of older persons.
To me it is a shared responsibility in support of full-time care to the OPs through a combination of family and community care complemented by OP Center supported care where required. In this connection I would like to refer to the statement of Kofi Annan who adequately emphasized it during adoption of the Madrid International Plan of Action on Ageing and the Political Declaration at the Second World Assembly on Ageing (2002).
"Each and every one of us, young and old, has a role to play in promoting solidarity between generations, in combating discrimination against older people, and in building a future of security, opportunity and dignity for people of all ages."
The Madrid Declaration, which marks a turning point in how the world addresses the key challenge of building a society for all ages, clearly stress upon work together of the government, local authorities, civil society/NGOs, private sector, voluntary organizations, older persons themselves and associations for and of older persons, as well as families and communities in promoting, providing and ensuring access to basic social services, bearing in mind specific needs of older persons. (Article 13)
A key premise for care and services would be ensuring quality of services at the minimum level of nationally agreed and adopted standards. This should be applicable for all forms of interventions for OPs – through centre-based services, family-based services or public services like Safety net and Income generation supports.
Sets of generic quality parameters should be developed and maintained covering essential service provisions which includes, but not limited to, housing (accommodation), food, clothes, personal hygiene, sanitation, health care, recreation, counseling, education, skills updating, access to news and information, provision for economic activities (depending on the ability of OPs), engagement in advisory services (capitalizing their wisdom), legal services (if required).
The quality standard aspect can be taken as an overarching element for developing a framework for services to OPs and during planning of (a) Direct caring services for OPs, (b) Caregivers' education and training, (c) Promoting community support; and (d) Developing institutional support system through establishment of functional linkage with GO, NGO and private sector services.
- Development of a continuum of health care to meet the needs of OPs.
- Development of comprehensive mental health-care services ranging from prevention to early intervention, the provision of treatment services and the management of mental health problems in OPs.
- Elimination of social and economic inequalities based on age, gender or any other ground.
- Development and strengthening of primary health-care services to meet the needs of OPs and promote their inclusion in the process.
- Involvement of OPs in the development and strengthening of primary and long-term care services.