Towards An Integrated Elderly Care Policy (Model) In Ghana: Expectations, Prospects And Challenges

The phenomenon of an ageing population is becoming a concern and the problems that accompany it are not hidden. Increase in life expectancy and low fertility is gradually resulting in the increasing numbers of the aged in developed and developing nations. Consequently, social welfare states all over the world are struggling with the increasing burden of the socio-economic and medical needs of this growing older population. A recent United Nations report describes population ageing as Pervasive, enduring and with profound implications; pervasive because it is a global phenomenon affecting every human being (man, woman and child) and country, but different countries experience it at different stages and at a varying pace. And those countries that do not start the process early enough are bound to have problems getting enough time to adjust. The report also says population ageing is enduring because we will never go back to the younger generation that our ancestors experienced and it has several implications for the various stages of life UN (2012).According to UN, there has been an increase in the percentage of elderly population from 9.2 in 1990 to 11.7 in 2013 and it is predicted to reach 21.1 per cent by 2050. The number of elderly or aged in Africa continues to increase just as its population grows. The United Nations Population Fund estimates that about 50 million people above the age of 60 account for 5% of the population of Sub- Saharan Africa. It is therefore evident that the phenomenon of population ageing is no longer a con cern of only developed economies but also of the developing world like Africa and other developing economies. The emerging phenomenon of population ageing represents a major challenge to Ghana's political leaders. Very little is known in Ghana and many African countries about population ageing. But more importantly very little is being done about care or the welfare of the elderly in GhanaThis study had seven objectives. The first was to examine the characteristics and trends of the elderly population in Ghana and its implication for national development and the second was to evaluate the weaknesses of the integrated policy for the elderly care in Ghana in relation to current models of elderly care. The third was to compare and contrast the needs and satisfaction level of the care services for elderly people in Ghana and the fourth was to determine the causes of the satisfaction gap in care services for elderly people in Ghana. The fifth objective was to analyse the impact of integrated care service approach on satisfaction of care service for elderly people in Ghana. An integrated elderly care service is a coherent set of methods and models on the funding, administrative, organizational, service delivery and clinical levels designed to create connectivity, alignment and collaboration within and between the cure and care sector to enhance quality of care and quality of life,consumer satisfaction and system efficiency for patients with complex problems cutting across multiple services, providers and settings. The sixth was to evaluate the challenges of adopting an integrated elderly care approach in Ghana. The last was to make policy recommendations to enhance elderly care practices in Ghana based on the analysis.The significance of this research stems from limited literature on the subject of elderly care in Ghana in particular. It is a fact as indicated in the national ageing policy that "Today's generation needs to honour and guarantee better living conditions for our "older persons". We need to acknowledge that our society as it is today is as a result of the toil and sacrifices of previous generations who today are old and need our support in return. We must make the effort to provide them with efficient health care services and a conducive living environment to ensure that they age actively and with adequate security and recognizable dignity.In this work, data was collected from secondary and primary data sources. Secondary research data was collected from the 2010 Population and Housing Census Data while primary research data was collected from the 1474 respondents selected from four districts in the Brong Ahafo Region of Ghana which is the study area. An ensemble of inferential statistics tools are used to analyse and draw conclusions from the data. The results suggest that integrated approach to elderly care management provides an important contribution towards the elimination of some of the possible challenges which confront elderly care practices in Ghana albeit challenges. The integrated elderly care management approach is an important tool in facilitating the elimination of inaccessible care, untimely care, poor quality care, unreliable care, unsatisfactory care,inequitable care, irresponsive care, inefficient care, low empathetic care and low assurance care as well as many of the challenges outlined by the respondents in this research. The presence of different elderly care professionals leads to increase in recognition of behavioural needs and disorders. Integrated elderly care produces significant positive results, including decrease in elder's depression levels,improvement in quality of life,decreased stress and lower rates of psychiatric hospitalization. With integrated elderly care, more people will be reached and more access afforded if elderly care is based in primary care settings. With integrated elderly care approach,both medical and social professionals can get the "full picture" about the clients they are treating. Offering elderly care services in an integrated setting encourages participation by people wanting to avoid the stigma surrounding mental health treatment. Studies have demonstrated possible effects of perceived stigma by showing that elders are less likely to follow up on referrals made to mental health settings than they are to in-house services.Integrated care leads to a reduction of inappropriate use of medical services and a cost-savings in big-ticket items like emergency room visits and hospitalization. Integrated care leads to easy identification of the gaps relating care managers' perceptions of elders' expectations and the relative importance they attach to the quality of service. Integrated care leads to easy identification of the gaps relating the difference between what policy management believes the elders want and what the elders expect the policy to provide. Integrated care leads to easy identification of the gaps relating the difference between the service provided by the staff of the business and the specifications set by management. Integrated care leads to easy identification of the gaps relating to the promises communicated by the service providers to the patients do not match the elders' expectations of those promises. Integrated care leads to easy identification of the gaps relating to the difference between the elders' internal perceptions and expectations of the service.But the actualisation of all of the above objectives of integrated elderly care is significantly linked to the extent to which the challenges of integrated care can be adequately overcome. In essence there is the constraint of being able to design a system with shared vision,principles and values, criteria for operational success, coherence with other policies, incentive and sanctions,monitoring and evaluation, regulation and inspection, implementation and support.This paper has put forward a new community based integrated elderly care model designed specifically to suit the political, economic, socio-cultural and technological exigencies of Ghana.If this is well implemented it will be a significant step towards the attainment of the aspiration of the national ageing policy which is intended to support elderly people to maintain a reasonable and dignified life. The main innovations are as followings.Firstly,as the first of its kind this study has attempted to evaluate Ghana's elderly care policy from the much acclaimed integrated care service perspective using a more rigorous, holistic,time-tested, multicultural, transnational and transcultural benchmark as in the CARMEN model jointly developed by the 35 countries of the European Union. From this perspective the study has been able to establish the main indicators that can facilitate effective care policy and the associated challenges. In effect this research has pointed out the influential factors and management dynamics that developing countries such as Ghana can adopt to achieve the same level of effectiveness in caring for their growing elderly population as developing countries in Europe despite the political and socio-cultural differences as well as economic and technological limitations.Secondly, a key argument in this research is that while there is some modicum of policy established in Ghana and many sub Saharan African countries to address issues that concerns the elderly, there are no specific programs or models that have been designed to actualise or serve as mechanism by which these policies can be actualised. Having analysed some of the models that have been designed in different parts of the world such as Japan,USA etc and mindful of the peculiarities of Ghana,this research has come out with a new and comprehensive model of elderly policy that is underpinned by Ghana's unique cultural and geographic characteristics.This new model of elderly care policy is designed on the basis of Ghana's,strong local governance system with adequate representation of elders themselves,religious institutions,non-governmental organisations, families of elderly people and institutions that are responsible for the care of elderly such as hospitals and community health officials. Also very important in this regard is that for the first time a program of action which has elders themselves being at the centre have been designed by looking firstly not at what community wants for elders but what elders want for themselves. In effect this new model takes a bottom-Up approach to integration rather than a top-bottom approach hence its effectiveness in addressing the most critical issues in elderly care service in a complex and often unpredictable area like Africa.In terms of theory, this research uses a logical process to prove the need for constructionism in the design of elderly care policy. Using an ensemble of econometric methods which includes the Malthus's forecasting model, the Fitted Logistic Regression Model and Pearson Chi-square,Neyman- Pearson lemma, the Likelihood Ratio Test, the Bayes Factors, Method of least squares regression, Chi-Square goodness-of-fit test and Kolmogorov-Smirnov (KS) Goodness of Fit Test, the study has found out that the most appropriate elderly care program or model must evolve from the specific social phenomena or give consideration to the particular social context.This is because the concepts or practices in a particular context may seem obvious and natural but are actually artefacts of that context. Individuals and groups participate in the creation of their perceived social reality and this reality is ever evolving as social interactions occur. In essence one cannot simply take a particular elderly care program because it is effective in one country and implement it in another country or society. Even though the principles may be the same,the specific operational procedures and process must conform or fit the society.