With more than 80% of Australians aged 85 or older still living at home rather than in residential aged care, unpaid carers remain the invisible but essential sinews of Australia’s aged care system.
But leading Canadian geriatrician and policy advisor Dr Samir Sinha, a keynote speaker at the International Dementia Conference in Sydney later this year, warns the reliance in his country and Australia on the quiet generosity of unpaid carers – often family members and friends – is increasingly under threat.
“Changing family arrangements, fewer children, and increasingly living further apart means that, without change, in 20 years’ time there will be 30% fewer available family members available to provide unpaid care,” said Dr Sinha, Director of Geriatrics at Toronto’s Sinai Health System and University Health Network.
“Family caregivers are mostly women, who if also employed often forgo promotions and retire early to balance their paid work responsibilities with their unpaid caregiving duties.
“Further, they often experience higher health and wellbeing risks, and get little external support and recognition for their caregiving contributions, and government compensation remains inadequate even though they save governments billions of dollars.”
Dr Sinha, also Director of Health Policy Research at Canada’s National Institute on Ageing (NIA), will explore potential responses to the disappearing unpaid carer workforce at the biennial International Dementia Conference at the Sydney Hilton on September 5-6.
A new NIA study he recently co-authored comparing the aged care systems of Canada and Australia (Enhancing Care for Older Adults in Canada and Down Under) points out one shared similarity is their reliance on unpaid carers.
In Australia, almost 1.1 million older people last year received Home Care or Home Support payments and 934,000 carers were paid government allowances or income compensation, whereas only 185,000 people lived permanently in aged care residences.
But, while six times as many people receive aged care support payments at home, the Australian government spends almost twice as much on residential aged care residences – known as Long Term Care (LTC) homes in Canada - as on home care services, according to a 2023 NIA report (Caring for an Ageing Australia, p.42).
There were 3 million unpaid carers in Australian households in 2022, according to the latest official statistics and 1.2 million of those provided primary care, up from 861,600 in 2018. Most, but not all of the carers looked after people aged 65 years or over.
The proportion of the Australian population providing primary, secondary or other unpaid care in households increased to 11.9% from 10.8% in the four years since 2018.
“The importance of unpaid carers to aged care systems in both Australia and Canada cannot be overstated, nor the growing risk that demographic changes will reduce their numbers significantly,” said Dr Sinha.
In fact the NIA has demonstrated that to maintain the current level of unpaid care that family members are providing in Canda by 2050, the fewer family members that are available to do so will need to increase their efforts by at least 40% - and some much more than others.
“Government policies need to improve their financial security – both by direct payments and more flexible workplace conditions – practical assistance in the home, education and respite opportunities.”
Col said what is required for a caring role is plenty of empathy. He believes some people, especially men, don’t have the required love and empathy and a diagnosis like dementia can break up a marriage. It's hard work.
“Shirley cared for me and our 4 children for more than 40 years, so the way I look at it, this is our time to provide her with care. It’s time to give back,” he said.
He said his wife is very aware of her diagnosis and he says he is conscious of not doing “too much” out of respect for her. “Shirley is still Shirley,” he said.
IDC2024 is being run by The Dementia Centre, which over almost 30 years has provided world-leading research, consultancy and education in the field of dementia care.