The care cliff is coming: Bernard Salt on the future of family, aging & letting go

My pleasure.

I like the idea of taking simple numbers and looking for the story behind the numbers. And to my surprise, over the years I've discovered that business likes that as well, because I think they're getting advice from advisors saying, well, I think this or I reckon that or whatever. Whereas I say here are some numbers and here is what I think they are saying about Australian values, Australian behaviour. So there's a metric basis to what I say. Whether in fact what I'm saying is right or not is another question, but at least there is some sort of basis to what I'm saying.

It most certainly did hit a nerve, not just in Australia, but globally as well. So. But you know, I think that's part of the challenge, you know, to raise stories or raise issues and to do it in a way that connects with people, I think. Yeah.

A lot of my colour in my analysis involves food. So smashed avocados or sandwich. Sandwich generation. Very early on in my career I talked about the donut effect, which is where people were leaving the inner city and creating this doughnut. It's all filled in, of course, since then, but I think being able to connect a movement or a social observation to something that is every day that people connect with, it's just part of the way of building the, the connection, the story. In fact, the sandwich generation effectively defines people in their 50s who are looking after their 80 something parents and at the same time they have responsibility in many ways for their 20 something kids as well now adults, but forming relationships and getting jobs and whatever and also managing their own work, their own relationships. So they feel as though, and to be fair, that they're at that time in life where they are the meat in the sandwich, the filling in the.

Decker, the club sandwich generation, if we want to be really specific about it. But yes, and that, that is effectively generation X at the moment dealing with, dealing with parents and their aging parents and coming age kids as well, and managing in many respects their own circumstances because they're still at work and relationships and whatever.

Well, I think there's a number of ways that you can measure or reflect the, the aging of the population. The one that I like to use is what I call the, the 85 plus bucket. So the total population in Australia aged 80 plus is increasing over time because of longevity. We're living longer, healthier lives. So there's more people hanging around beyond the age of 85. And the issue is the way in which this is going to escalate in the future. At the moment, the number of people turning 85 and remaining alive right through into their 90s and so forth, that bucket is growing by around about 1012, maybe 15,000 people per year. So that goes to the issue of how many nursing home beds and aged care workers you might need. Now. Not everyone over the age of 85 requires those services. But to be fair, if you're 85 plus, you're in the zone. And we need to be ratcheting up the infrastructure and the spending to maintain quality of life for people aged 85 plus. The issue is that the number of people in that bucket has been growing at 5, 10, up to 15,000 per year for the last 50 years. We've gotten used to that. Over the next six years, the rate of growth is going to go from 10, 15 to in fact it was 62,000 people per year in the early 2000-30s. And the reason for that is that the very first baby boomer ever Invented, born in 1946, tips across the 85 line in 2031, 2032 or so. And so it's the baby boomer generation remaining healthy, living longer, living into later life, living beyond the age of 85 in accelerating numbers literally over the next 10 years and exponentially over the next five or six years, that creates the challenge or the problem.

It's a five fold increase. And when you've probably built a career in healthcare, aged care, public administration, Coping with the 85 plus bucket expanding by 5 or 10,000 per year, you can kind of manage it. If it all of a sudden then goes to 60,000, then it explodes. And I think this is the issue with the baby generation. At every stage of the life cycle, they have had an impact as hippies, punks, dinks and yuppies. So they created the hippie movement in Australian major cities. When they went to universities in their teenage, late teenage years, 20 something went to build new universities like Macquarie in Sydney, Flinders in Adelaide, Griffith in Brisbane, Monash in Melbourne. So when they pass through a stage in the life cycle, there is an impact. And while they remain in the workforce, well, that generates wealth and prosperity. They're earning an income, they're paying tax, the tax base rises. It kind of is an issue in the 2020s as they start to come out of the workforce. It is a real issue when they start impacting the 85+ bucket, where the demand for healthcare and care services absolutely skyrockets. And that's the phase that we're going through over the next 10 years.

Well, I always argue that it's not just the 85 plus people themselves, of course, needing services and care and support and so forth. It is the families that reverberate down the next generation, the people caring for them, the people probably administering and managing their care in their 50s. Today's Generation X's and grandchildren, of course, in their teens and early 20s. So what happens to the 85 plus bucket has an echo effect in the 50s and in the 20s as well. There's another, there's another piece of information, demographic information, I think is really important in this story, and that is that there is a, there is a new question that was asked at the last census, we have a census every five years. We ask 62 questions. The Americans have a census every 10 years. They ask 12 questions. It's a big deal to whack another question into the census. We've already got 62, you can't be adding questions willy nilly. The question that got across the line was, have you ever been told by a healthcare professional, doctor or a nurse that you have a long term mental health condition, anxiety or depression? The, the answers to that question were absolutely significant. About 10% of the population said yes that they have been told at some time in their life. When you look at it across the age profile, it the anxiety and depression in the average Australian subsides after the age of 65. The minute you leave work, all your anxiety and depression and you know, you've got grandkids arriving, you've paid off your house, your kids are partnered up, you know, everything seems to be fine. Yeah, they're gone years and you know, you might have a couple of health issues, but they're not dire in your late 60s and 70s generally. But it skyrockets at the age of 78, 79 and 80 and remains elevated right across the 80s and gets even worse into the 90s. And the reason for that, I think is the loss of a life partner. Typically the male grandpa will pass away at about 70, 78, 79, 80, grandma is left alone. And of course that then creates what I think we're going to see with the aging of the baby boomers, a loneliness epidemic. The oldest baby boomer today, born in 1946, is 79. So we've got 5 million baby boomers pushing into their late 70s, early 80s and progressively, literally over the next five years, we are going to see a rise in people living singly and we're going to see a rise in loneliness. Now, loneliness is offset by connectivity, connectivity to the community and to the family. So these are the issues that we will need to be addressing as a nation. In addition to the straight health care age care costs that come with the arrival of that generation.

Well, grief and bereavement is very real, of course, and especially for, for people who've been married for 50 years or so, their way of life, the whole family, the whole community is interlinked with someone else and then all of a sudden they pass away. And that is not always an easy transition. It often comes more often than not.

Very painful, very difficult, very stressful and requires not just, not just the engagement of a life partner, but also your kids. Losing a parent in your 50s is still a painful experience. Grief and in fact, in many respects there's so much history, so much connectivity, so much emotion, identity. And so yes, it does cause stress. I will also say that there's another stress that comes with this, that not everyone comes from a happy family that is functioning and works together where all the siblings are.

Every time I raise this, everyone puts their hand up and says, oh, that's us, that's us.

But you know, in an ideal world, it's hard enough when everyone is working together, has the same values, the same thinking, same priorities in making these transitions for mum and dad or for mum, because dad's passed away or whatever.

Well, it is, it's very, very stressful, very difficult. And there is another layer to this around inheritance and wills and assets and money, money and family meaning money here. So yes, it is fraught. It is fraught and it's hardest, it's hard with the best circumstances and it's doubly triply fraught when there are unique family dynamics driving this as well.

Yep. I wonder whether in fact, there's things that we can be doing. Public programs, public awareness programs. Look, we get it that not everyone comes from, you know, the perfect family. What can we do? What are some easy steps in order to facilitate this or make it as easy and as seamless as possible? If you think of some basic healthcare advice, look, you might not be wanting to jog every day or whatever, but here are some basic things you can do. Don't smoke, don't take drugs, have a balanced diet, for example. Well, here are three things that you can do in your 50s to help create that. That preferred transition for your parents in their. In their 80s and your. And for your siblings and the next generation as well.

Well, I agree. And I think these basic healthcare measures, it goes to a core value that I think applies to Australians. My overarching view, you know, my 40 years in demographics and I formed some views about what drives Australians and it is the relentless pursuit of lifestyle, quality of life. It's why housing is so important to Australians as well as travel. We're a colonial people, long way away. We like to travel, we like to invest in our homes and to maintain good quality of life. Now, the whole Daryl Kerrigan thing absolutely hit the button. An aspect of that. Once lifestyle and housing is managed, the next thing I think is wellness and quality of life. In later, more years, lived better at a. At a better quality of life. So I think Australians are interested, very interested in wellness, keeping fit, keeping healthy, not necessarily at. At Olympian levels, but at, you know, what can I do to live a good quality of life, to enjoy my quality of life, remain mobile, remain connected into my 60s, 70s, 80s and beyond? I think it goes to that core Australian value of quality of life.

Very interestingly, there's another question in the census that I'm a big fan of. The census?

I imagine the question around what a. Your religious affiliation? Now, most Australians these days say they're nothing, you know, that's tick the box, say that they don't have any religious affiliation. But of those that do, and there's a little more than half do, when you look at the age profile, the people least likely to say they have a religious affiliation are age 23. At 23, you're young, you're fit, you're healthy, your parents are alive, you don't have kids, so you don't have to think about that. And even your grandparents are probably still around, so don't kind of think of it, I suppose. But then it steadily rises the proportion of people who say they have some form of religious belief system. And the people most likely to believe in a God are aged in their late 80s. The closer you get to the end of life, the more you do think about these sorts of things. Now, is it because you're thinking about the end of life or is it because if you're in your 80s, almost 90 now, you've gone, you probably remember, maybe even remember the Depression, the Second World War, all of the privations thereof. And you might come from an era where religious belief systems were stronger, perhaps, or you become more reflective, more concerned about the meaning of life. It's very interesting. My own mother died at the age of 95. She was very devout right throughout her life and so. But she, she would say is very philosophical, had wonderful discussions with her. She would say, you know, later in life, even with her belief system, she would say her question was, what is the purpose? What is the, what is the. It's that question, what is the meaning of life? And so I think that you do grapple with those issues in your 80s and 90s. In fact, it's a different perspective on life when you're 23, 33, 43, young, you fit, you're healthy, you're pursuing a career, you're building a home, all that sort of thing. There's not the Space to actually focus on, well, religion.

There's no doubt that there is a tremendous role that, that is fulfilled by religious belief systems for those in what they would say is their hour of need, their time of need. And I think it's a human condition or need that is not just relevant today. It's been for thousands of years.

Well, that's true. I'm not quite sure what that. That is. Maybe there's a. There's a role for influences to say, look, here is how to discuss the pathway forward, to normalize it. Exactly. And that's right.

Yes, very, very much so. In fact, I interviewed her, rang her. I live in Melbourne, she lives in a. Lived in a Victorian country town. So I rang her and said, would you mind if I interviewed you for my column in the Australian? And she was delighted, of course. And so I had the chance to ask her at the ages. She was 94, coming up for a 95th birthday and she died two weeks after her 95th birthday. And so it was an excuse for me to ask questions. Sometimes you need that. You can't just bowl up after 50 years and start asking questions. It kind of looks odd.

Yeah, that's right. But I had the. And one of the questions I asked was. And I wrote about this mum, now that you're, you know, you're approaching 95, you know, you must see that this is. You're coming towards the close of life and so forth. Are you concerned about dying? That's the question I wanted to ask. I couched it as politely as I possibly could. She scoffed and said, no, no, I'm ready, I'm ready. And she was, she was incredibly devout Catholic, of course, and she prayed the rosary twice a day since she was 8 years old. So was that 88 years? Twice? I don't know what the mathematics are of that.

And I mean, I'm not a church going Catholic myself, but a rosary is 50 prayers, 55 prayers or whatever it is. And she and her sister would say, I could knock it off in 10 minutes without knocking off the rosary.

But if you think about it, saying the same words twice a day, 50 words, 50 prayers twice a day for 88 years, it is akin to meditation in a modern sense. We'd say this is pure mindfulness. And when I look at the person, I wasn't aware. I knew she was devout, but I didn't know until that moment, it was effectively a month before she died, that this was twice a day in fact. And you think, well, that explains the strength of character, her surety, the anchor. The anchor, in fact. So it's so Interesting. And it also has been very. It was very reassuring for me in the sense that, well, 95, it's pretty good innings, as they say. And she was not concerned. Oh, she died in her sleep, in fact. So it was perfect from that point of view. And I think I will mum. She died on her terms, in her way, and she was ready. And to me that was. I could not have asked for and she would not have asked for anything, anything better. I think so. But I'm deeply aware that this is not everyone's experience. I feel incredibly lucky to have had that, that experience also, just the way.

I think, I think she knew the end was near and I think she was reassuring me in her words. If I look back and I've analyzed the words, of course. And so I think it was her making it easy for me. And I thought, you know, if I'm in that situation years, decades into the future. Yes, I think that's probably what I would want.

I have. I have indeed. Yes, that's right.

Well, I think this is very much the way of the future. In fact, I've done quite a bit of work in ageing, demographics of ageing with the hospital sector around Australia and there's a movement called hospital in the home. So you're quite right. Work from home Shop from home, telehealth from home, care is provided in home and hospital in the home. And I think ultimately working towards a situation where if this is your choice, to be able to pass away, to die at home, not necessarily surrounded by your family, but in, but in circumstances that you are comfortable with. And there's also a practical element to this. There are so many baby boomers that are pushing into their 80s who will pass away over the next five, 10, 20 years or so. It simply is. Makes good economic sense for. To open up this option for those who feel that this is a pathway that, that I would prefer as opposed to the, the alternative pathway, which is to go into care and, and to possibly be separated from family or whatever at the time when it happens, or.

Well, this, this goes to my issue of how do we make this pathway easier for people and for families into the future? And you use the phrase some people have not had the discussions or need to have. We need systems to enable these discussions to take place Now. I was very lucky because I had the excuse. Can I write a column on you? I'm turning 95. I'm sure I would have inspired a.

Well, I would like to, I would like to think I would have found another pathway, but I didn't know the end was only a month away at that, at that stage. So is there a way in which you can build in a way of normalizing those discussions? Can it be on their birthday? Can it be on their wedding anniversary? Or can it be at Christmas time where seemingly or hitherto difficult discussions can be broached, in fact, and to secure a conversation with the older person as to what they would want. I know it's very confronting, it's very, very delicate. I was very fortunate being able to navigate it. But it has been such. I think it was also help to my mother and it was been incredibly helpful to me as well to say, well, yes, you know, it's what she wanted, she was happy. And of course it has to happen to all of us at some point. If it must happen, then here is the best way for it to occur.

There was another point of that discussion that I thought was very, very interesting. My mother didn't swear, of course. Of course. And, you know, not even, not even in the slightest way, you know, not even a. I did her refer once. She said, you know, this, this kid said the B word. I don't even. She probably does know there are other, other letter words or whatever, but she would never say oh my God. Even, even oh my God. Which is OMG these days. And it had never occurred to me until I was in that discussion. Mum, I've never heard you even say something like oh, my God, have you ever? She said no. And I said, that's a choice, isn't it? She said, yes. And again, it comes back to this incredible self discipline. She never told us not to. That is what worked for her. I did not discover that until a month before she, before she died.

My. My sister, I think, had discussions, but not, not in the forensic way that. Interview your mum, I think she interviewed her. But, you know, none of this, none of these sorts of observations really, really surprised them at all. So anyway, look, it was. When I look back, it was. It was a positive experience in many respects and a releasing experience in that. In that. That conversation enabled me to move on in a very positive, happy, relieving sort of. Sort of way.

Well, yes, I think it is something that we can not talk about, but it's going to come up and bite us on the backside at some point. And yes, I do, I do make the point that it is 58 year old women who do most of the care. And that goes to the census question of do you provide unpaid care to anyone? And the people that say yes, they do the most are 58 year old women. And then it drops away because at 59 and 60, mum or dad has died off. There is a sense of relief. In fact, that's typically the way it works. But I suppose I wonder whether in fact aging and the baby boomer needs and so forth, healthcare needs and you know, the transition to passing on this is all five, ten plus years out beyond the electoral cycle perhaps. But I'm hopeful that as these trends gather momentum and escalate over 20, 25, 26, 27, 28, towards 2032, that will develop an appetite. We can see what's coming and we do need to take action in order to deliver the services and the systems to manage this.

Well, you can, you can see it gathering momentum. It's like you can tell after a long dry summer. You can smell rain from beyond the horizon, you can see the clouds, you can, you know, there's temperature change, you can actually see that there's, there's something coming. A good example of seeing what's coming is the, the Australian Bureau of Statistics estimates of the number of people in a single occupation. That occupation being aged and disabled carer is the time that the job, it's about 400,000 of them at the moment. And they are growing. That category of worker is growing at about two and a half thousand per month. And it's been doing that per month. And my expectation is that by 2030. By 20, by 2032, it'll be the largest single occupation in Australia, replacing shop assistant, which is about half a million at the moment. And so the whole issue there is one of. So there's two and a half thousand extra aged care workers finding employment every month. How many people do you need to interview to get two and a half thousand net extra? It'd be three and a half thousand. Who is training? What is the accreditation system? What is the process by which these workers? And the oldest baby boomer is barely 79. They're not even in the real zone yet. So this is gathering momentum at a rate of knots and the peak is still in the early2030s. In fact, you can feel the storm clouds gathering or see the storm clouds gathering for what lies not in this electoral cycle, but in the next electoral.

Well, yes, you could argue that it is a drag on productivity. However, in a civil society, this is what is required when you have this number of people at that stage in the life cycle. There's also the argument that technology can play a role here and not necessarily technology in aged care worker. There might be little bits and pieces, but managing a care is a very human tactile thing. You need to be able to to be there. However, a good example of this is the number of waiters on the Australian continent peaked five years ago 2019. Number of people taking orders at a cafe, bar, restaurant, whatever it is, we still have not recovered to the number of waiters we had in 2019. And I'm thinking, okay, so people who were waiters have gone off during the pandemic and found something else to do. Do they move into aged care worker? Because waiters these days have been partially offset with technology by QR codes.

Sit down to cafe that was born.

So technology QR codes has released labor from one area to enable it to go to another area. So there are ways in which I think technology can deliver productivity gains. But the fact of the matter is we are a civil society with a sense of civic responsibility to caring for those who need care. And for the first time in human history, we're going to have vast proportions of our population over the age of 80, over the age of 85. We need to come up with a system that delivers the care that that cohort will require.

Most certainly we do. And I think this is one of the great challenges for our generation. How long have Homo sapiens been on the planet? I think it's like we can go back millions of years, but certainly Homo sapiens 3, 4, 500,000 years. We are the first generation to actually have a vast number of people beyond the working stage of the life cycle. Well beyond the working stage of the life cycle, requiring care from the entire community. We need a political system, we need an economic system to actually deliver that care. So we need to develop the protocols, the systems that actually will deliver that. At its peak, its peak will come in the2030s. You can actually project it and you.

And we need to have those discussions now. Now, this is not something we need to be panicking about, but quietly, purposefully planning and responding to those challenges is the great challenge of the next decade.

Thanks, Melissa. It's been a pleasure.