FAMILY CAREGIVING: HOW WE APPROACH IT IN THE US VS. OTHER PARTS OF THE WORLD

What We’re Doing Right and What We Can Do Better!

In a small Japanese village, nestled between whispering bamboo forests and the serene Pacific, lived Mr. Sato, an octogenarian whose hands told tales of decades past. His son, Kenji, worked in bustling Tokyo, close in distance but a world away from the village's timeless embrace. Meanwhile, across the ocean in a New York suburb, Mrs. Anderson, also in her eighties, gazed out of her window, her thoughts a silent companion.

Kenji, loyal to the deep-seated Japanese value of filial piety, returned to the village each month, his visits a cherished ritual. They'd sit by the irori, sipping green tea as Mrs. Sato recounted stories of Kenji's ancestors, their lives intricately woven into the fabric of the village's history. Despite the physical toll, Kenji's commitment never wavered; caring for his father was an honor, a sacred duty that connected him to his roots.

In contrast, Mrs. Anderson's days were marked by the quiet hum of the TV, her interactions limited to brief, weekly calls with her son, Michael. The distance felt not just in miles but in the unsaid, in every missed birthday and every holiday spent alone. Michael, a good son at heart, but pressured by the fast-paced American lifestyle, found solace in sending checks, convincing himself that financial support was enough to feel he cared.

The story of Mrs. Sato and Mrs. Anderson, oceans apart, mirrors the stark differences in elder care across cultures. One, a testament to the enduring bonds of family and tradition; the other, a reflection of the individualism that defines the West. Both stories, though different, share a common thread of love and the universal truth that caring comes in many forms, each leaving its mark on the hearts of those it touches.

The caregiving process varies significantly around the world, influenced by cultural, social, economic, and governmental factors. These differences manifest in how societies approach caregiving for children, the elderly, and individuals with disabilities or chronic illnesses. The efficiency and quality of these systems also vary, impacting the ability of families to not just cope but thrive. 

Our system is FAR from perfect. For now, it almost works, but as the population demographic shifts, the strain will be unbearable in just a few years, and EVERYONE’s going to feel the squeeze!

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But in order to get a good grasp on the topic, we have to start with…

Cultural Influences

Collectivist vs. Individualist Societies: 

In collectivist societies (e.g., many Asian and African countries), family and community play a central role in caregiving, often with a strong sense of duty towards elder care and child-rearing within the family unit. 

In contrast, individualist societies (e.g., the United States and many European countries) may emphasize independence, with formal institutions and services playing a larger role in caregiving.

Intergenerational Living: 

Common in many parts of Asia, Latin America, and Africa, multiple generations living together facilitates caregiving, with younger family members caring for the elderly and vice versa. This arrangement can lead to stronger family bonds and shared responsibilities.

Economic and Social Policies

Scandinavian Countries: 

Nations like Sweden, Denmark, and Norway are often cited for their high-quality, efficient caregiving systems, supported by robust social welfare policies. These countries offer generous parental leave, subsidized child care, and comprehensive elder care, allowing families to balance work and caregiving responsibilities effectively.

Germany: 

Known for its long-term care insurance system, Germany offers support for both in-home and professional care for the elderly, providing families with financial assistance and services to manage elder care.

Challenges in Developing Countries

Limited Resources: 

In many developing countries, formal caregiving support systems may be underdeveloped or inaccessible to the majority of the population. Families often rely on informal networks for care, which can place a significant burden on caregivers and limit economic opportunities, particularly for women.

Rapid Urbanization: 

Urbanization can strain traditional family structures and caregiving arrangements, as individuals move to cities for work, leaving behind elderly family members or struggling to find affordable caregiving solutions.

But let’s dive a little deeper… 

Here’s how the top 10 developed countries approach caregiving and long-term care (LTC) challenges reveals a tapestry of strategies, policies, and cultural practices.

The truth is the entire world is aging faster.… But for a comprehensive analysis, we'll look at countries often ranked highly in terms of development, such as the United States, Canada, Germany, Sweden, Japan, Australia, Norway, Denmark, Switzerland, and the Netherlands, focusing on their strategies for addressing the needs of the elderly and disabled.

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United States

Approach: Primarily private-sector driven, with significant reliance on family caregivers. Medicaid provides LTC for the low-income population, but there's a notable gap in coverage for the middle class.

Challenges: High costs of care, lack of universal health coverage, and insufficient support for family caregivers.

Canada

Approach: Publicly funded healthcare system with provincial responsibility for LTC. There's a blend of home-based, community, and institutional care services.

Challenges: Rising demand leading to long wait times for LTC beds and services. Variation in quality and availability of services between provinces.

Germany

Approach: Social insurance model covering LTC needs, introduced in the 1990s. Mandatory LTC insurance for all citizens, offering both in-kind and cash benefits.

Challenges: Growing elderly population putting pressure on the system, leading to discussions about sustainability and workforce shortages.

Sweden

Approach: Extensive welfare state with significant public funding for LTC. Strong emphasis on home and community-based services.

Challenges: Maintaining high standards of care amidst increasing costs and demographic changes.

Japan

Approach: Comprehensive public LTC insurance system introduced in 2000, responding to rapidly aging population. Emphasis on community-based services and innovation in care technologies.

Challenges: Extremely high proportion of elderly citizens, leading to financial sustainability concerns and caregiver shortages.

Australia

Approach: Mix of government and private sector provision. Recent reforms to increase home and community-based care, funded through taxation and mandatory savings schemes.

Challenges: Balancing demand with supply, regional disparities in access to care, and ensuring quality.

Norway

Approach: Universal welfare model, heavily subsidized by the state. Focus on integrating health and social services, with a push towards home-based care.

Challenges: Geographical challenges affecting service delivery in rural areas, and managing costs with an aging population.

Denmark

Approach: Highly decentralized system, with municipalities responsible for delivering LTC. Strong focus on preventive care and home-based services.

Challenges: Coordination between different levels of government and services, and adapting to changing demographics.

Switzerland

Approach: Combination of compulsory health insurance, private savings, and state subsidies. High quality of institutional and home-based care.

Challenges: High costs of care and ensuring adequate coverage for all segments of the population.

Netherlands

Approach: Universal LTC insurance system, with a focus on promoting independence and home-based care. Significant reforms in recent years to contain costs and improve efficiency.

Challenges: Balancing individual care needs with budget constraints, and integrating health and social care services.

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But let’s take for example the North American model vs The Scandinavian model… 

The caregiving systems in North America and Scandinavia represent two ends of the spectrum in terms of state involvement and support for families. 

The Scandinavian model, characterized by extensive social welfare policies, offers a high level of support for caregivers, resulting in better work-life balance, gender equality, and societal well-being. 

The North American model, particularly in the U.S., emphasizes individual responsibility and market-based solutions, offering greater flexibility and innovation in caregiving services but also leading to significant disparities in access and quality of care.

Pros of the Scandinavian Model:

• Comprehensive support reduces financial and emotional stress on families.

• High levels of social participation and gender equality.

• Strong safety nets ensure a high standard of care for all citizens.

Cons of the Scandinavian Model:

• High taxes to fund social welfare programs.

• Potential for dependency on state support.

Pros of the North American Model:

• Emphasis on innovation and flexibility in caregiving solutions.

• Opportunities for personalized care and services.

Cons of the North American Model:

• Significant disparities in access to care based on income, employment, and geography.

• Greater burden on families, leading to stress and potential financial strain.

I’m not sure which one’s better, though the data skews toward the Scandinavian model. But leaving politics aside, here’s how I feel about it…

The fact is that if you’re a middle class citizen in the U.S, and dealing with a loved one at home requiring LTC, without access to Medicaid, Long Term Care insurance, or private funds, you’re looking at spending $200-$600K in the next 5 years.

I don’t care what your politics are… if you’re up this creek without a paddle, you’d wish you had the Scandinavian model, and the heck with the taxes… PLEASE RAISE THEM!

What I mean is, if you haven’t slept for 3 days because your ALZ Mom or Dad is sundowning, and you’re desperate, frustrated, and about to ask for your 4th day off from work… you won’t care who’s president or even if you voted for him or her. 

On the other hand, if a Long Term Care (LTC) family scenario is not hitting close to home, then out of sight - out of mind. And that’s how we deal with most issues in our culture. If it’s not happening to me, it doesn’t exist, and my politics and opinion on the subject will matter ONLY to the degree the issue affects me at that moment.

A shortsighted way of looking at things, but hey we invented fast food so whatcha expect!

Here’s what it boils down to… the LTC system in the U.S. is marked by its reliance on private funding and provision, resulting in significant disparities in access and quality of care. And since LTC services are funded mostly by Medicaid, it affects the middle class (which is most Americans) the most. 

In contrast, other developed countries often have more robust public systems aimed at ensuring broader coverage and support for both individuals in need of care and their caregivers. 

While each system has its strengths and weaknesses, the U.S. faces unique challenges related to affordability, equity, and the sustainability of care models in the face of massive demographic changes, not to mention a significantly higher population of older adults in comparison to other developed countries.

But we can all do better, by starting to take responsibility and action on the topic today…

Because whether you live in the U.S or abroad, none of the data or opinion should excuse the fact that when it comes to LTC the conversation must begin at the family level, with individual needs and early planning in play…because one thing’s for sure, none of us will beat the clock.

Till next week!

Claudio