The challenges associated with aging demographics go well beyond the usual and customary calls for more professional, trained personnel, age appropriate accommodations, or medical and rehabilitation services. While all of these are needed, according to Claudette Fleming, DDippl, the Executive Director of Age Concern Bermuda, the history of how we got where we are, or as Dr. Fleming put it, “perspectives” informs what’s possible for the immediate and long-term future. Speaking at the Summer Leadership Conference 2016, hosted at the Fairmont in Southampton, Dr. Fleming described how the Bermudian and US age care systems are headed toward a period of “integration,” after periods of “institutionalization” and “medicalization.”
This is certainly true in both Bermuda and the United States. With very similar demographics, including progressively aging populations, and growing dependency ratios, post-acute care services are drawing significant new attention. Government bodies in the US such as the Centers for Medicare and Medicaid Services (CMS), as well as private intermediaries are looking for efficiencies and economies in the post-acute, or long-term care systems. Dr. Fleming described the current situation in Bermuda for lodging, rehabilitative, and respite services as, “a crisis situation,” and suggested that only political will would resolve the current difficulties. While the supply and demand situation in the US probably isn’t at a crisis, there certainly are imbalances which government and private market forces are attempting to rebalance. Claudette described the government penchant for commissioning study after study, while the underlying issues go unaddressed. In the US, we call this “kicking the can down the road”.
Another painful fact which Bermuda shares with the US is the extraordinarily high cost of healthcare. While it is common to refer to the United States as the most expensive health care system in the world, in fact, Bermuda ranks 3rd among developed economies. Amazing, considering the small size of the country.
The cost of health insurance is another painful similarity. The Bermuda market is of course much smaller than the US, with a population of only 64,000 versus 384,000, the actuarial characteristics of the risk pool mean that health insurance is staggeringly expensive for the average Bermudian family, often costing $10-$15,000 per year. There is no “safety net” insurance available for the island’s poor, such as the Medicaid program in the US. Moreover, with an age-targeted infrastructure that has been developed like topsy, many Bermudian hospital beds are taken by aged consumers who, while not in need of acute-care hospital services, have no other place to go where their chronic care needs can be met.
There certainly are lessons to be drawn from developed countries around the world, including the US and Bermuda, about how to address the expensive and culturally critical care needs of each populations. Dr. Fleming’s “perspectives” are an excellent place to start.
You can see Dr. Fleming’s full presentation here: http://summerleadershipconference.org/wp-content/uploads/2016/07/Perspectives-on-LTC-in-Bermuda-Summer-Leadership-Conference-2016.pdf