Population ageing challenges health and social services: the growth in service need must be anticipated

In Finland, people are living longer and healthier lives than ever before. Life expectancy has risen steadily, and most older people live independently. Population ageing reflects the success of our society: standards of living and health care have improved.

Even so, population ageing will inevitably increase the need for health and social services. In the coming years, the large age cohorts will reach the age at which the need for services typically grows. Memory disorders and cancers are becoming more common, the functional capacity of more and more people is declining, and more and more people need support in everyday life. Although healthy life years are increasing, the period during which services are needed is also becoming longer.

At the same time, the dependency ratio is weakening, and it is becoming increasingly difficult to recruit health and social services staff.

“The challenge of population ageing is that we have fewer people in work, while at the same time more and more people are needed to care for older people. The low birth rate makes the situation worse. It aggravates labour shortages, narrows the tax base and weakens the potential for economic growth,” says THL Leading Researcher Juha Honkatukia.

Care for older people accounts for half of the growth in health and social service need

According to a recent forecast, the need for health and social services will grow by roughly one per cent per year in the coming years. Half of that growth comes from care for older people. This is due in particular to the labour-intensive nature of services for older people.

“Population ageing is visible in specialized health care, but the highest costs arise from services for older people. The final years of life are the most expensive, because round-the-clock care requires staff and infrastructure,” Honkatukia says.

Alongside service need, the need for staff will also increase. If the service structure remains unchanged, a total of 53,000 more health and social services staff will be needed by 2040 than at present. Of these, 26,000 will be practical nurses. At the same time, 200,000 nurses and care workers will reach retirement age.

Wellbeing services counties are responding to the situation from different starting points.

“In municipalities with population loss, the proportion of older people is more pronounced and services must be provided for a smaller population, although the infrastructure may already be in place. Uusimaa is in a different situation. Even though the working-age population is growing, the service structure may not be prepared to care for tens of thousands of people in need of services,” Honkatukia says.

Although the growth in service need should be anticipated, the system is seeking savings. Honkatukia sees the situation as contradictory.

“Health and social services are simultaneously facing staff shortages and a continuous increase in service need. The situation is challenging, but the focus is now too heavily on short-term savings. The growth in service need will continue for decades,” he estimates.

Resources for supporting living at home and prevention

According to national policy guidelines, the focus of services for older people is already on living at home. This means that older people must have sufficient functional capacity to live at home, and that adequate care and support services must be available to support living at home.

Older people should be offered support for physical activity, healthy lifestyles and social relationships already while they are still in good condition. The services provided by municipalities and wellbeing services counties, together with health and wellbeing promotion, are indispensable here.

“If round-the-clock care is provided only later, people must be able to live at home longer with the support of home services or in communal housing. But that requires resources to be directed to those services,” Honkatukia says.

“Preventive measures are needed to ensure the service system remains sustainable,” says THL Leading Specialist Sari Kehusmaa.

This means that older people should be offered support for physical activity, healthy lifestyles and social relationships already while they are still in good condition. The services provided by municipalities and wellbeing services counties, together with health and wellbeing promotion, are indispensable here.

According to Kehusmaa, services that maintain functional capacity are needed even more urgently for older people whose functional capacity has already declined. In such cases, it is important to prevent further deterioration in physical and mental functional capacity, for example through rehabilitative day activities. This also supports living at home.

“If the need for round-the-clock services can be delayed even by a few months, large sums can be saved both at the level of the wellbeing services county and nationally. For example, three months of round-the-clock care for 1,000 people costs about EUR 15 million. Client fees cover part of the costs,” Kehusmaa says.

To promote the wellbeing and health of older people, a new kind of cooperation is needed between municipalities and wellbeing services counties: leadership, joint plans, agreed job descriptions and directing work towards effective activities.

There is also potential in improving the operating models of services. For example, there are differences in how home care is delivered, and the areas could make greater use of each other’s best practices. Technology, such as the use of remote services, also brings new opportunities, which according to Honkatukia are already visible in unit-level costs.

“The large age cohorts once reshaped the structures of society in education and working life. Now, with them, it is time to reform the structures and operating models of services for older people,” Kehusmaa says.