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PT and the Greater Good

The Big Care Debate Part 2

Published April 28, 2010 10:03 AM by Dean Metz

I just finished a paper for my master's in public health about the public health implications of an aging population. When Medicare and social security were introduced the life expectancy was only 67 years. People are now living 10 times beyond what was expected when these programs started. There is the problem. The elderly are draining the resources because they are benefiting from an extended life expectancy. In the UK as in the USA, the growth of the very old is increasing while the birth rate decreases. From a purely financial point of view, this is disaster.

I posted on November 18, 2009, that I was part of a town hall discussion about the "Big Care Debate." There is, in addition to the NHS, now something called the NCS or National Care Service in the UK. This is the service that provides for the social issues that arise from disability or advanced age. Two years ago there was a green paper (a document outlining a plan for a future change in a government program) about how to improve the care provided to the elderly or disabled in this country. There were town hall meetings about it and feedback from the public (service users) was encouraged. This is what I wrote about in November.

Now the white paper (bill that will go before parliament) has been published and a conference was held to describe its implications. Here is a link to the site ( that has a video of the launch. It is not brief, nearly an hour in length, but something worth watching to the very end. It outlines so much of what differentiates British society from American society. There are plans in place about how to take care of those benefiting from an extended life expectancy and how to enable careers (not professional help, but rather family and friends who assist the aged) to provide for the needs of the elderly.

I got into this profession to help people. I became involved with geriatrics because I felt they were the most vulnerable. I became frustrated with Medicare and managed care providers who wouldn't provide for additional home health aide services that could have kept someone at home. I saw the futility of people who had to sell their homes to pay for residential care because there was no other option when stroke, Alzheimer's or any other life-altering illness struck. I'm beginning to think the British have a better idea on this one.

If you can sit out this video, I really want to know your thoughts and whether such an idea could (or should) work in America.


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About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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