elderly care elderly care elderly care, or simply eldercare (also known in parts of the english-speaking world as aged care), serves the needs of old adults. it encompasses assisted living, adult daycare, long-term care, nursing homes (often called residential care), hospice care, and home care. an old man at a nursing home in norway elderly care emphasizes the social and personal requirements of senior citizens who wish to age with dignity while needing assistance with daily activities and with healthcare. much elderly care is unpaid. elderly care includes a broad range of practices and institutions, as there is a wide variety of elderly care needs and cultural perspectives on the elderly throughout the world. cultural and geographic differences a nurse at a nursing home in norway the form of care provided for older adults varies greatly by country and even region, and is changing rapidly. older people worldwide consume the most health spending of any age group. there is also an increasingly large proportion of older people worldwide, especially in developing nations with continued pressure to limit fertility and shrink families. traditionally, care for older adults has been the responsibility of family members and was provided within the extended family home. increasingly in modern societies, care is now provided by state or charitable institutions. the reasons for this change include shrinking families, longer life expectancy and geographical dispersion of families. although these changes have affected european and north american countries first, they are now increasingly affecting asian countries. in most western countries, care facilities for older adults are residential family care homes, freestanding assisted living facilities, nursing homes, and continuing care retirement communities (ccrcs). a family care home is a residential home with support and supervisory personnel by an agency, organization, or individual that provides room and board, personal care and habilitation services in a family environment for at least two and no more than six persons. due to the wide variety of elderly care needs and cultural perspectives on the elderly, there is a broad range of practices and institutions across different parts of the world. for example, in many asian countries whereby younger generations often care for the elderly due to societal norms, government-run elderly care is seldom used in developing countries throughout asia due to a lack of sufficient taxation necessary to provide an adequate standard of care, whilst privately-run elderly care in developing countries throughout asia is relatively uncommon due to the stigma of exhibiting insufficient filial piety, having a relatively relaxed work–life interface and insufficient funding from family to pay for privately-run elderly care. however, institutional elderly care is increasingly adopted across various asian societies, as the work–life interface becomes more constrained and people with increasing incomes being able to afford the cost of elderly care. gender discrepancies in caregivers according to family caregiver alliance, the majority of family caregivers are women: "many studies have looked at the role of women as family caregivers. although not all have addressed gender issues and caregiving specifically, the results are still generalizable to estimates of the age of family or informal caregivers who are women range from 59% to 75%. the average caregiver is age 46, female, married and worked outside the home earning an annual income of $35,000. although men also provide assistance, female caregivers may spend as much as 50% more time providing care than male caregivers." australia total employment in residential care services in australia (thousands of people) since 1984 aged care in australia is designed to make sure that every australian can contribute as much as possible towards their cost of care, depending on their individual income and assets. that means that residents pay only what they can afford, and the commonwealth government pays what the residents cannot pay. an australian statutory authority, the productivity commission, conducted a review of aged care commencing in 2010 and reporting in 2011. the review concluded that approximately 80% of care for older australians is informal care provided by family, friends and neighbours. around a million people received government-subsidised aged care services, most of these received low-level community care support, with 160,000 people in permanent residential care. expenditure on aged care by all governments in 2009-10 was approximately $11 billion. the need to increase the level of care, and known weaknesses in the care system (such as skilled workforce shortages and rationing of available care places), led several reviews in the 2000s to conclude that australia's aged care system needs reform. this culminated in the 2011 productivity commission report and subsequent reform proposals. in accordance with the living longer, living better amendments of 2013, assistance is provided in accordance with assessed care needs, with additional supplements available for people experiencing homelessness, dementia and veterans. australian aged care is often considered complicated due to various state and federal funding. furthermore, there are many acronyms that customers need to be aware of, including acat, acar, nrcp, hacc, cacp, each, each-d and cdc (consumer directed care) to name a few. canada private for-profit and not-for-profit facilities exist in canada, but due to cost factors, some provinces operate or subsidize public facilities run by the provincial ministry of health. in public care homes, elderly canadians may pay for their care on a sliding scale, based on annual income. the scale that they are charged on depends on whether they are considered for "long term care" or "assisted living." for example, in january 2010, seniors living in british columbia's government-subsidized "long term care" (also called "residential care") started paying 80% of their after-tax income unless their after-tax income is less than $16,500. the "assisted living" tariff is calculated more simply as 70% of the after-tax income. as seen in ontario, there are waiting lists for many long-term care homes, so families may need to resort to hiring home healthcare or paying to stay in a private retirement home. united kingdom care for the elderly in the uk has traditionally been funded by the state, but it is increasingly rationed, according to a joint report by the king's fund and nuffield trust, as the cost of care to the nation rises. people who have minimal savings or other assets are provided with care either in their own home (from visiting carers) or by moving to a residential care home or nursing home. larger numbers of old people need help because of an aging population and medical advances increasing life expectancy, but less is being paid out by the government to help them. a million people who need care get neither formal nor informal help. a growing number of retirement communities, retirement villages or sheltered housing in the uk also offer an alternative to care homes but only for those with simple care needs. extra care housing provision can be suitable for older people with more complex needs. these models allow older people to live independently in a residential community or housing complex with other older people, helping to combat problems common amongst older people such as isolation. in these communities, residents may access shared services, amenities, and access care services if required. in general, retirement communities are privately owned and operated, representing a shift from a ‘care as service’ to ‘care as business’ model. some commercially operated villages have come under scrutiny for a lack of transparency over exit fees or ‘event fees’. it has been noted, however, that paying less now and more later may suit ‘an equity-rich, yet cash-poor, generation of british pensioners.’ although most retirement village operators are run for profit, there are some charitable organisations in the space: for example, the extracare charitable trust, which operates 14 retirement villages mostly in the midlands, is a registered charity. charities may derive additional funding from sources such as statutory agencies, charity appeals, legacies, and income from charity shops. surplus funds are used to support residents' housing, health and well-being programmes, and for the development of new villages to meet growing national demand. extra care housing usually involves provision of: purpose-built, accessible housing design safety and security e.g. controlled entry to the building fully self-contained properties, where occupants have their own front doors, and legal status as tenants with security of tenure tenants have the right to control who enters their home office space for use by staff serving the scheme (and sometimes the wider community) some communal spaces and facilities access to care and support services 24 hours per day community alarms and other assistive technologies. united states "old ladies home" (sic) in toledo, ohio, 1895 according to the united states department of health and human services, the older population—persons 65 years or older—numbered 39.6 million in 2009. they represented 12.9% of the u.s. population, about one in every eight americans. by 2030, there will be about 72.1 million older persons, more than twice their number in 2000. people aged over 65 years represented 12.4% of the population in the year 2000, but that is expected to grow to be 19% of the population by 2030. this means there will be more demand for elderly care facilities in the coming years. there were more than 36,000 assisted living facilities in the united states in 2009, according to the assisted living federation of america. more than 1 million senior citizens are served by these assisted living facilities. last-year-of-life expenses represent 22% of all medical spending in the united states, 26% of all medicare spending, 18% of all non-medicare spending, and 25% of all medicaid spending for the poor. a november 2020 study by the west health policy center stated that more than 1.1 million senior citizens in the u.s. medicare program are expected to die prematurely over the next decade because they will be unable to afford their prescription medications, requiring an additional $17.7 billion to be spent annually on avoidable medical costs due to health complications. in the united states, most of the large multi-facility providers are publicly owned and managed as for-profit businesses. however, there are exceptions; the largest operator in the us is the evangelical lutheran good samaritan society, a not-for-profit organization that manages 6,531 beds in 22 states, according to a study by the american health care association in 1995. given the choice, most older adults would prefer to continue to live in their homes (aging in place). many elderly people gradually lose functioning ability and require either additional assistance in the home or a move to an eldercare facility. their adult children often find it challenging to help their elderly parents make the right choices. assisted living is one option for the elderly who need assistance with everyday tasks. it costs less than nursing home care but is still considered expensive for most people. home care services may allow seniors to live in their own home for a longer period of time. one relatively new service in the united states that can help keep older people in their homes longer is respite care. this type of care allows caregivers the opportunity to go on a vacation or a business trip and to know that their family member has good quality temporary care. also, without this help the elder might have to move permanently to an outside facility. another unique type of care cropping in u.s. hospitals is called acute care of elder units, or ace units, which provide "a homelike setting" within a medical center specifically for older adults. staff at on lok senior health services interact with participants in their senior day care program in san francisco's chinatown, mid 1970s. senior at san francisco's on lok senior health services at the powell street location takes a rest after social activities, mid 1970s. information about long-term care options in the united states can be found by contacting the local area agency on aging, searching through zip code, or elder referral agencies such as silver living or a place for mom. furthermore, the u.s. government recommends evaluation of health care facilities through websites using data collected from sources such as medicare records. china population ageing is a challenge across the world, and china is no exception. due to the one-child policy, rural/urban migration and other social changes, the traditional long-term care (ltc) for the elderly which was through direct family care in the past will no longer suffice. barely existent now, both institutional and community-based services are