Longevity – Its Impact on Elderly and Care Facilities

Rising life expectancy is noticeably changing the reality in nursing and care homes. In his latest column, sociologist and ageing expert Prof. Dr. phil. François Höpflinger explores how demographic change is transforming care institutions – from shorter lengths of stay and increased care intensity to new demands on caregiving, staffing, and funding.

François Höpflinger, Prof. Dr. phil., is a renowned social scientist, emeritus titular professor and member of the steering committee of the Centre for Gerontology at the University of Zurich. With his many years of expertise, he is probably the most sought-after expert on ageing in Switzerland and a key voice in the debate on the challenges and opportunities of an ageing society.

The increasing life expectancy contributes to the fact that the average age at admission to a residential and care facility has risen (2008: 81 years, 2023: 85 years). At the end of 2023, one third of the long-term residents of nursing and care homes were aged 90 and over. A high age at admission shortens the length of stay – a trend that is reinforced by increased use of transitional care forms. In 2023, the average length of stay was 2.6 years. However, average values conceal significant differences in life situations, for example between elderly people who move into a care facility shortly before the end of their lives and elderly people who are cared for on a long-term basis, such as older people with dementia without cardiovascular diseases.

The increasing age of nursing home residents is associated with a higher level of care intensity. Between 2013 and 2023, the average daily care time increased from 112 to 127 minutes. The proportion of only slightly care-dependent persons declined (2013: 20%, 2023: 11%), reinforced by cantonal strategies to finance inpatient care only in cases of pronounced care dependency. In any case, the proportion of persons in nursing and care homes who are polymorbid and take several medications is increasing. Since somatic age-related diseases such as hip problems, heart and circulatory diseases can (for the time being) still be treated more readily than organic brain diseases, the proportion of people with dementia in nursing and care homes is rising in particular. This is also because outpatient care for severe dementia in people living alone is hardly possible anymore. Of the dementia patients who died between 2017 and 2021, 72% had lived in a nursing home before their death (and a further 19% had had at least one temporary nursing home stay).

All of these well-known consequences of increasing life expectancy raise the demands on a high level of professional care and nursing quality in residential and care facilities. Longevity also has both direct and indirect financial consequences. Due to the trends mentioned above – which will intensify in the future – the financial expenditure of nursing and care homes is increasing. Moreover, polymorbid elderly people with differing biographical backgrounds can hardly be cared for in a ‘standardised’ manner. Good quality management can indirectly contribute to ‘cost savings’, for example because relieving nursing professionals of administrative tasks and good generational management (in which younger and older professionals work closely together) can reduce resignation rates – and thus the associated additional costs.

However, even for a not insignificant part of the nursing home population, new financial longevity risks may arise. This applies in particular to more recent generations (baby boomers) who, in old age and due to care needs, have to sell owner-occupied property or other assets. Higher inflation – as is emerging in the longer term – can gradually reduce the value of occupational pensions and contribute to relative impoverishment in old age, or lead to an increased need for supplementary AHV benefits in the final years of life (and depending on the canton, in the future, uncovered funeral costs may also occur more frequently).

Longevity has further effects on care in old age that are less well known and less discussed.

The obvious downside of a high age is the fact that generational differences with care staff widen and intensify. Many people who are very old today experienced a childhood and youth in poverty and hardship and often grew up in rural-traditional or working-class environments. In the 1950s and 1960s – when today’s elderly people were founding their families – marriage and family life in the still predominantly small-town and petty-bourgeois Switzerland were traditionally shaped, which continues to influence the family concepts of elderly women and men to this day. The imprint of now-disappeared language formulas, forms of politeness or normative-religious values leads to significant behavioural differences in contact between the very old and younger people (and not infrequently, elderly people have difficulty understanding the language of today’s youth at all). At the same time, the physical, psychological and social fragility of elderly people in residential and care homes means that their resources to proactively adapt to younger people decrease. In old age, existing generational differences can generally no longer be bridged by the elderly themselves; instead, it is primarily the younger generation (the care staff) who must adapt to the life histories and values of the representatives of older generations.

Hidden and unconscious age stereotypes among young care professionals can also have negative effects in care situations. Negative expectations towards elderly people can contribute to communicative misconduct, for example when staff, but also volunteers or visitors, address elderly people too loudly, overly simplify their vocabulary (‘secondary baby talk’) or behave in an exaggeratedly familiar manner.

A high age among nursing home residents often has another indirect effect: relatives (daughters, sons) are often themselves already at an age where physical ageing processes are becoming more apparent, which can cause the nursing home situation of the mother or father to trigger increased reflections and fears about their own ageing. This can contribute to the next generation placing high demands on the quality of elderly care. In individual cases, old family conflicts and feelings of guilt can also resurface.

In our individualised society, relatively few elderly parents live with or alongside their adult children.

The proportion of people aged 80 and over who live with adult children in the same household is currently less than 5% in Switzerland. Even lower is the proportion of elderly people who live in three-generation households. Among those with descendants, at most 2% to 3% of grandparents currently live together with their grandchildren in the same household.

In later life – after the children have moved out – the vast majority of elderly women and men live in one- or two-person households. In later life, the proportion of people living alone increases, particularly among women, who, thanks to higher life expectancy, more often outlive their partners. In recent decades, the proportion of elderly people living alone has risen significantly (partly thanks to outpatient care as well as a strong emphasis on personal independence in old age). Between 1970 and 2022, the proportion of men over 79 living alone increased from 19% to 27%, and among women over 79 even from 39% to 64%.

We therefore have more and more elderly people who have lived alone for years and then, in advanced old age, move into a socially densely populated living environment (with many other residents and much care staff) in a residential and care facility. This change from a hyper-individual to a social and multi-generational living arrangement can, at least temporarily, lead to social overstrain for those affected. Good quality management in nursing and care homes therefore also includes good support after moving into a home (including the provision of retreat spaces or contact persons during the initial phase).