Natalya Tarasova How to create a care system for the elderly? 28.11.2023, 08:03

Improving the quality and accessibility of medical services, expanding the scope of preventive medical examinations, motivation for a healthy lifestyle, the development of sports and many other socio-economic factors have led to an increase in life expectancy. It allows people to enjoy life more fully and for longer. This situation also leads to an increase in the number of elderly people and an increase in the number of elderly people with cognitive impairment.

In many countries, private insurance products already exist whose purpose is to provide reasonable support and medical care to people with similar illnesses. It’s time to introduce these practices here too.

According to new calculations by Rosstat, life expectancy in 2023 will be 73.1 years (72.73 years in 2022). In 2030, this figure will increase to 75.79 years, in 2037 to 78 years, and in 2046 to 79.83 years. This is definitely a positive trend and one can only be happy that demographic indicators are improving in our country.

But at the same time, there is an increase in the number of older people. Among them, the proportion of people with cognitive diseases is also increasing. According to the research results, 20% of people aged 60-69 and more than 40% of people over 85 years of age have cognitive impairment. Moreover, by 2050, the number of people suffering from, for example, dementia (one of the symptoms of cognitive impairment) may increase significantly.

Cognitive impairment in people over 65 years of age is expressed in various mental disorders. Their numbers increased even more after the coronavirus pandemic, which caused an increase in such diseases, especially in the elderly.

It is highly likely that the increase in such diseases will also lead to an increase in the demand for long-term care services. In our society, it is common for relatives to take care of the elderly. But as practice and research show, this is not always a good option. Such patients require constant professional care. Their relatives who care for them are forced to quit their jobs and devote their lives entirely to their relatives. Often this leads to depression in the caregivers themselves.

Almost no country in the world is able to provide a comfortable level of support and medical care to citizens with cognitive impairment. Therefore, a product such as insurance in case of need for long-term care abroad has been developed for a long time. There are different mechanisms for the operation of this insurance. In some countries, a combined system operates in which the employer deducts a certain percentage (tax) for insurance payment, and the client himself contributes part of the funds. Other states have adopted a fully private model where people get their own long-term care insurance policies. The essence of these insurances is the same: if a cognitive disorder is diagnosed, the client receives high-quality medical services and accommodation in a medical center at the insurer’s expense.

There is no such insurance and infrastructure for people with cognitive impairment in Russia. There are only beginnings. These are either very expensive medical centers or private nursing homes that sometimes operate without a medical license. Accommodation there is cheap, but the quality and level of services there are not controlled by anyone. They can also sometimes be unsafe, for example due to inadequate fire control.

I think there was a need for more than one major insurance company to launch an insurance product at the same time. The mechanism of its action is extremely simple. For example, a person over the age of 50 can take out a long-term care insurance policy. Its annual cost is comparable to the cost of a month’s stay in a specialized institution at today’s prices for Moscow, which is about 50 thousand rubles a year. A lot or a little? Services of a private medical center now cost about 1 million rubles a year: this includes accommodation, medicines and various additional services. Therefore, 50 thousand rubles can be considered a small price to pay for the confidence that the insurance company will pay for care and medical services for seven to ten years in case of a diagnosis of cognitive impairment.

By the way, the forms of such care may be different: this is permanent residence in some specialized institution, payment for home nurse services or some other service.

Bringing such an insurance product to market is only the first step. Russia does not yet have sufficient infrastructure for operating a long-term care system, and this needs to be created in all regions. This includes building hundreds more private medical centers, installing modern equipment in these centers, training staff, etc. It means it should. Implementing such a large project requires serious investments, and insurers can participate in this together with the state. It is important that insurance companies, for example, can invest part of their reserves in the creation of such institutions. This will require changes to the legislation, as it is currently not possible for insurance companies to invest in such projects.

We believe that it is possible and necessary to create a new care system for the elderly in this way and, of course, to create a network of long-term care institutions with the participation of the state.