The
Development Planning Unit
Government of the British Virgin Islands

AGING AND THE ELDERLY

1. Introduction

The demographics of our country suggest that Aging and the Elderly will require significant attention in the next few decades. The issues associated with aging covers the entire spectrum of modern life in the Information and Knowledge Ages. The Elderly, like in the western industrialized countries, is going to become an unavoidable political force but in the interim there is the need for a powerful force to advocate for their interests. It must be remembered that the workforce of today is the Elderly Dependent population of the future. There are not yet some elderly who are not focusing on the issues that will confront them in their second period of vulnerability during their life cycle.

Aging is inevitable and it might as well be enjoyable and secure in as much as our economy has the will and the resources to facilitate it. Aging must be put in a positive light not only with adequate financial resources but also with human dignity and sense of independence and preparedness. The responsibility of the State is to ensure that Positive Aging become a reality through the collaborative efforts government agencies, community organizations, the private sector and the Elderly themselves. This concept of Positive Aging is derived from the idea that from the principle that they have contributed when they were in a position to do: however, this is no longer possible so society owes them a good final experience.

Table 1:
Elderly (65+)
By Age and
Sex, 1980

By 1991, males exceeded females in every age group but the distribution was now 53.85% for males and 46.15% for females. This was the case because the effect of migration (on all age groups) was now full blown as migrants were now graduating from the active age groups to the old age ones. 

There were practically no elderly persons unemployed in 1980. Those who were not working were not in the labor force. Such was also the case in 1991. However, the percentage of those employed dropped from 28.48% in 1980 to 21.85% in 1991. 

Table 2:
Elderly by labor Status, 1980.

This could be because of the more organized and efficient social security, transfer and other systems in 1991, the elderly can now retire earlier and feel confident that they would be financially cared for. In 1991, those elderly persons that worked were mostly involved in Agriculture and Elementary occupations. As the age increased, the percentage of those involved in Agriculture increased while those involved in Elementary occupations decreased. There were also a significant percentage of them doing Craft and Related jobs. 

Table 3:
Elderly By Occupation, 1991

     
  And also, as the age increases, the percentage of those with primary education level or lower increased while those with university level education decreased. The majority of the elderly that were employed earned low incomes.

Table 4:
Elderly by Educational Level, 1991.

Most of the elderly were nationals but substantial proportions (especially at the lower old ages) were non-nationals. And as the age increased, these percentages of non-nationals become lower and lower. This was the case because immigrants were only then beginning to filter into these upper old-age groups. 

Table 5
Elderly by Level of Income Status, 1991.

    
The majority of the elderly were living in private houses and these percentages increased as the ages increased. The majority of these households had walls of concrete but the percentages of them living in wooden houses were above the national level. The main type of toilet facility was the septic tank, but again the percentage of them (at the older ages) still using pit latrines was well above the national level. Most of them lived in houses with between 2 to 5 rooms and they mostly lived in households with either 1 or 2 persons.


Table 6
Elderly by Type of Dwelling, 1991.

Conclusions and Recommendations:

Due to the large increases in the percentage of the active age group, there were reductions in the young and the old dependency ratios. This will cause less relative demand to be placed on the educational facilities and related resources (by the young) and on health facilities and related resources (by the old). Consequently, more financial resources would be available for investment in the provision of other necessities. However, these reducing dependency ratios did not imply that these age groups were decreasing in absolute numbers. They mean that the rates at which they (young and old) were increasing could not parallel the rate at which the immigrant-driven active segment was increasing. Therefore, despite the reducing ratios, there is still the need to plan carefully as to how to accommodate these segments of the population. The facilities and resources that they demand will still have to be supplied at or above the rate at which at which they are increasing. The advantage is however, that a smaller portion of the relative contribution of the active segment has to go towards their support since they (the active) are now proportionately increased more than the young and the old. 

There were a high percentage of children living in households in which there were single mothers. This issue was touched on quite a few occasions in this analysis. It was uncovered that these households were the ones most susceptible to the possibility of poverty. Also, a high percentage of these children in these single-mother households were the youngest children. This implies that the proportion of illegitimate children could be substantial in the British Virgin Islands. This in turn would have implications for the social upbringing of these children. Studies have shown that children that are nurtured in fatherless households tend to have more social problems. On the same point, it was also found that when comparing household head by sex, a higher percentage of the female-headed ones had children in them. And, about 50% of households with children were surviving on low levels of income. Such a situation could have implication for the nutritional status of the children. Inadequate nutrition has negative effects on both the physiological and the psychological development of the child.

Generally, children were living under good housing conditions. Of concern however, was the high percentage of children that were living in apartments. These households were those that were mainly headed by young and single females. The extra burden of rented accommodations can only enhance their probability of experiencing poverty. This could therefore lead these females into situations, which may not be conducive to the proper upbringing of the children. The conclusion is that, these households headed by these single female households needs to be monitored carefully since many of them are living in situation which can be potentially detrimental to the overall wellbeing of the children that live in them. Children represent the future human resource, and this resource is the most important resource in the realization of socio-economic development.

There was an increase from 1980 to 1991 in the proportion of unmarried youths in the British Virgin Islands and a consequent decrease in the percentage of married youths. This was mainly due to the single immigrants. This situation ultimately leads to the problem of illegitimate children (as was seen earlier) since the incidence of cohabiting and visiting is greatly enhanced. The implication of these children was previously discussed. 

A larger percentage of the youngest youths were unemployed. This is a normal situation but it is one that can cause many social problems. Therefore, in an effort to avoid these problems, programmes need to be implemented to occupy the spare time of these idle youths. Programmes that are related to sports are normally quite effective. This would serve to take youths of the streets and the potential for them to form and join gangs will be greatly reduced. The possibility of social disturbances will also be reduced in the process. 

Another finding is that practically no youths were involved in agriculture. The percentage reduced from a minuscule level in 1980 to practically nothing by 1991. This is the sign of a dying sector. The involvement of youths in any activity ensures the continuation of such activity. Given the climate and other factors, this sector cannot be as important as the services and other sector in the British Virgin Islands. But, it can help to reduce an already bloated negative Balance of Trade, if the country could at least be self-sufficient in the products that are associated with this sector. And also, it is in the best interest for any country to have a diversified economic base so that when one economic activity falls in a lull, the other activities can be relied upon.

Among the youths, it was found that the public administration moved from being the third most important employment-generating sector in 1980 to the number 4 spot in 1991. This indicates the success that the country has had in stimulating private investment, which in turn created employment. This takes some of the burden off the public sector to create jobs for new entrants into the labor force.

The young were generally living under good housing conditions. However, as was previously mentioned, too many of them were living in apartments.

The concentration of the elderly in the Agricultural sector exceeds that of the national level. This implies that it was basically only the elderly who were involved in this sector. The analysis of the youths indicated that they were non-existent in this sector. The problem remains that the elderly would not be able to sustain this sector much longer, and then the sector will die. Therefore, steps need to be taken to promote this sector. One approach would be to put it on the schools' curriculums and thereby alerting the children about the importance of agriculture.

Another matter of concern was the relatively high proportion of the elderly that were still residing in wooden houses and used pit latrines as their toilet facilities. The wooden houses can be potentially dangerous given the possibilities of natural disasters such as hurricanes. Pit latrines leave much to be desired when it comes to good sanitation. If these facilities are not properly and continuously maintained, they could cause serious health problems. This could especially be a problem since many of the elderly live alone and may not be able to render the proper maintenance to these facilities. 

1.1 Definition of Aging and the Elderly

The term elderly is a relative one and refers to a group of persons who have attained a certain age level. This “certain age level” is determined by the age at which retirement from the workforce, in principle, is mandatory. This mandatory retirement age is different for different countries and varies from as low as 55 years to as high as 65 years. However, the age 65 years is the most common retirement age among countries and therefore, in most instances, persons at or above this age are referred to as “the elderly”.

With the advancement of medical technology and the emergency of more health-conscious attitudes among the population, the level of life expectancy has shown remarkable improvements over the last decade. People are now living much longer. This phenomenon has had serious adverse implication for all aspects of the social security systems put in place to aid the elderly. I some countries, measures are being considered to redefine, upwards, the mandatory retirement age in an effort to ease the pressures placed on the social security systems. In these countries, the concept of who is the elderly would be redefined.

Health

• Key Points
  
• People aged 65 and over are major users of health services.
  
• The cost of providing health services to older people is increasing, partly as a result of the aging population.
  
• The British Virgin Islands are living longer, however it is not clear whether increased longevity is matched by improved health status.
  
• Promotion health and well being throughout the life stages is an important strategy for improving the health of the older population.
  
• Recent Government policy has been to support the concept of aging in place and to promote community cares options in preference to expensive residential care.
  
• Introduction

In 1994, the population aged 65 and over comprised of the total population, while it accounted for of all health costs. People aged 65 and over are major users of health services and older people are a growing proportion of the population. This will present significant challenges to the health care infrastructure and has profound funding implications for Government.

While the reports that most people in their 60’s and early 70’s share many of the same health and social characteristics as younger adults, after the age of 60, average personal health care expenditure grows steeply, with preliminary estimates suggesting that per capita expenditures around age 70 are twice the average, peaking to four times higher for those aged 80 and above. The British Virgin Islands health data shows that from age 85 the cost per head is approximately eight times that for adults aged 45 to 64 years.

The most significant feature of the aging population, in relation to health expenditure, is that the most rapid increases will occur amongst the “old-old” (those aged 80 years and over), who will grow by persons) in the five years. By this time the “old-old” will make the population aged 65 and over. By the year people aged 80 and over are expected to number

A major contributor to the increased cost of health care for older people is expenditure on residential care services, such as long-term rest home or hospital care. The states that the increases in expenditure are less pronounced in other areas such as consultations with physicians, pharmaceuticals, medical appliances and other ambulatory services. Some of the most expensive chronic conditions such as dementia occur mainly in older age. An analysis of the cost of health care for older people illustrates that major health expenses are directly related to chronic illness and incapacity, much of which does not occur until very old age.

• Health Status

To date, there has not been a definitive study of the health status of older people in The British Virgin Islands, although older people are regarded as the age group most likely to experience poor health and/or disability.

The survey demonstrates a disparity between individual’s perceptions of their health status and popular perceptions of relative health and disability. For example, a person may have impaired mobility, requiring them to use a walking stick, but may nevertheless consider themselves to be in excellent health and able to maintain an independent life-style.

The Ministry of Health has commissioned two surveys on the health of The British Virgin Islanders; A British Virgin Islands Health Survey and A National Nutrition Survey. The two surveys, to be run from will provide the Ministry of Health with information on which health services can be planned and programmes developed.

Life expectancy has increased significantly in recent decades. For instance, between and life expectancy at birth for men and women increased by and years respectively. However, it is not clear whether increased longevity has been matched by improved health status. Three competing theories dominate international debate in this area:

1. as people live longer, the ratio of “well” to “disabled” years will remain relatively 
   unchanged;
   
2. improvements in technology means that fewer years will be spent “disabled”, and
   
3. more years will be spent “disabled” as improvements are unable to keep pace with gains in life expectancy.

At the current time, there is little research to support any one of these theories over the others. However, it would appear that the third theory fits contemporary evidence best. That is, while people live longer “well”, they also live longer “disabled”.

As noted above, chronic ill health is generally concentrated among the very old, particularly in the year or two preceding deaths. While physical changes do take place throughout the aging process, much of the physical decline commonly associated with older age can be attributed to inactivity, rather than the “aging process”. The notes that the health characteristics of most people in their 60’s and on into their 70’s are broadly similar to the rest of the adult population.

The incidence of mental disorders does appear to increase with age, especially for conditions such as Alzheimer’s Disease and related dementia. It is estimated that 10% of people aged over 65 have some form of dementia and that this figure rises to 20% in the 80 plus population. By , it is estimated that there will be people in The British Virgin with dementia. It is anticipated that the incidence of dementia will further increase in line with the forecast growth of the older population, particularly in the 80 and over age group.

Older people receive hospital care at higher rates than younger adults, and have longer average stays in hospital. From to , hospital discharge rates for people aged 75 and over rose by around compared to an increase in number of people in this population cohort. The increase in hospital discharge rates cannot, therefore, be attributed entirely to an increase in the cohort size.

In summary, while some older people may experience increased ill health as they age, there is considerable individual variation in the health status of older people. For this reason, it is important that old age is not treated as a medical condition.

• Health Promotion

Addressing the issues of health and well being at each of the life stages is an important strategy for improving the health of the older population. Health promotion needs to start at an early age, recognizing that an individual’s early life-style impacts on their future health and well being. Such a strategic approach, while not producing immediate results, will have a significant impact in the longer term.

Demographic factors, socio-economic status, the physical environment, food and nutrition and other life-style factors such as physical activity all have an influence on health status. These determinants may act alone, but more generally interact. For example, demographic factors such gender and ethnicity may also influence determine health status. The responsibility for the promotion of good health must therefore be shared across a range of sectors.

Significant work on health promotion with older people was undertaken by the Department of Health from . While the Ministry of Health considers that many of the programmes will be continued under the current structure, the focus on older people’s issues in the short-term appears to have lost some momentum.

Many government agencies have a potential policy role in health promotion. The housing issue, in particular, is one that can be directly linked to health. For frail older people, unsatisfactory accommodation can mean increased likelihood of moving into residential care rather than remaining in the community. While government health policies encourage older people remain in their own homes, there are few specific housing policies which support this objective. Such in congruencies in government policies need to be addressed.

While the notes that it is possible the baby boom generation may reach old age in far better health than did their predecessors, as a result of their better education and information about healthy life-styles, this is nevertheless dependent on sustained investment in educational programmes and preventative measures.

• Health Services

Since , health services for older people have been delivered through two systems; personal health services and disability support services. If an older person has an illness requiring acute care, their needs are addressed through personal health services, but if their condition has stabilized and is expected to continue for at least six months, services are provided through disability support services.

Disability support services

Access to disability support services is largely controlled by way of an assessment protocol. In order to receive disability support services, older people must be assessed by Assessment, Treatment and Rehabilitation Units, of which there are in the country, to determine the level of care and the services they need. Disability support services purchased through can also be subject to income and/or asset testing.

The continued viability of needs assessment-based disability support services is dependent on adequate resources being available to ensure that older people receive the services they are assessed as requiring. Comments frequently made by older people and health professionals indicate that service delivery is not consistent throughout the country.

Residential care

These figures support the analysis, which identifies expenditure on residential care as the major contributor to the increased cost of health care for older people. Residential care as the major contributor to the increased cost of health cares for older people. Residential care services have an important place in the overall health framework providing intensive, specialized services to those older people experiencing chronic ill-health in their latter years. Given the British Virgin Islands’ aging population and, in particular, the forecast growth in the over 80’s age group, the demand for residential care services is likely to increase.

Home-based services

Current government policy is to promote community care which will assist older people to remain living in their own homes for as long as possible., this policy is in line with a general desire among older people to remain living in the community. Hone-based services currently funded by include meals on wheels, cleaning and personal care services for bathing, dressing, and feeding. The provision of home-based support services for older people with a significant disability is not only desirable from a social perspective, it is also attractive in economic terms.

With the growth of the British Virgin Islands’ older population and the increased geographical spread and mobility of families, the requirement for home-based services is expected to further increase. An adequate level of funding for these services is therefore essential.

Personal health services

Personal health services received by older people are essentially the same as those provided to the general population. The main issue of concern to older people is the waiting times, particularly for elective surgery such as cataract and hip replacement operations.

While the Department is not aware of any data on the opportunity cost of delayed surgery, it is reasonable to assume that such costs would be considerable, and could include items such as income support, home care services, hospital care, residential care and other health and social services. There are also social costs as older people in this situation would have less opportunity to continue to contribute to their community and family.

• Future Directions

The forecast increases in older British Virgin Islanders, in particular those aged 80 and over, will have a major impact on the country’s health services. Early co-ordinate planning is needed to determine how best to cope with this demographic change.

Health promotion strategies, implemented throughout the life stages, will have an important role in improving the health status of future generations of older people. Health promotion policies need to recognize the multiple determinants of health status and a co-ordinate approach should be adopted across a broad range of government agencies.

A co-ordinate inter-agency approach is also essential to the development of broader positive aging strategies. For instance, if health policies are promoting aging in place, then housing policies need to be congruent with this objective. The need for better co-ordination between government and non-government agencies has been raised at consultations undertaken by the on Positive Aging. Any recommendations that the may make in response to this concern will be particularly pertinent to health issues.

More immediately, current tensions in health service delivery, apparently caused by the separate funding streams for disability support services and personal health services, should also be addressed. Greater co-ordination of service delivery in these areas is essential for the well being of older people.

While high levels of expenditure on residential care are expected to remain a feature of disability support services for older people, it is essential that funding for home-based services is sufficient to meet the needs of an increased number of older people who will live longer, and to mitigate against the use of residential care in circumstances where community support could sustain living in the community.

Advancing technology, medical knowledge and pharmacology continue to increase the range of procedures and medications that can improve the quality and length of life in older age. The expectation of many older people, as with other sectors of the population, is that they will have access to publicly funded health services as they need them. It is anticipated that despite the work in defining core health services, public debate will continue on priority areas for health expenditure. Ultimately, public opinion will influence decisions on the level of resources allocated to health.

Positive Aging

This strategy involves a new approach to the development of policies for older Australians, based on a recognition of the important roles played by older people in the community – in family life, in provision of services and in promoting harmony between generations. Policies, which promote people remaining active and involved members of society, will also help people maintain independence and dignity.

The Department is working to the government outcome “that social welfare policies and practices support older people to live independently and facilitate the participation and contribution of older people in community life”.

Positive Aging Strategy

The Department is developing a Positive Aging Strategy in conjunction with, the complementary to, the broader government-wide positive aging strategy. The Vision for the Department’s Positive Aging Strategy is:

“That older people are encouraged and supported to remain self reliant, and that they continue to participate and contribute to the well-being of themselves, their families, and the wider British Virgin Islands community.”

Key strategies for moving toward the vision are:

• Encouraging British Virgin Islanders to plan for a positive and self reliant retirement;
  
• Encouraging and supporting older people to stay independent for as long as they are able;
  
• Encouraging and supporting older people to participate in the contribute to the wider community; and
  
• Promoting positive attitudes to aging throughout the British Virgin Islands society.

While the actions below these strategies and measurable goals have yet to be fully developed, the Department is already involved in activities that support them.

These include:

Super Centres

Income Support has developed the concept of “Super Centres” to provide a specialized client-focused service for older people, who comprise over half of its client base. The establishment of 38 Super Centres over the next four years is planned and it is envisaged that Super Centres will expand beyond their income support service role to provide information on a range of issues and local services available to older people.

• Senior Citizens Unit Initiatives
  
• Celebrating the diversity of older people;
  
• Encouraging the development of intergenerational activities between older and younger people;
  
• Promoting well-being in older age; and
  
• Promoting full participation of older people in community life.
  
• Non-Government Organizations

Age Concern New Zealand Age Concern New Zealand is a non-governmental organization, which aims to promote the rights and well being of older people and those who care for them. Its missions “to work together to promote quality of life for older people” and its key objectives are to:

• Empower older people to achieve equality and quality of life;
  
• Ensure the availability of services and opportunities to meet the needs and aspirations of older people;
  
• Promote understanding and positive attitudes towards older people and the aging process; and
  
• Foster an age-integrated society in which adults acknowledge a shared responsibility for the welfare of people of all ages and work together to achieve that objective.

Age Concern New Zealand comprises 38 Age Concern Councils, which provide a range of services to older people and their careers. Each week, about 4,000 Age Concern volunteers provide services for over 12,000 older people. The councils also raise awareness about positive aging and the needs of older people.

• Future Directions

The growth in the older population has significant policy implications for all nations throughout the world. In developed nations in particular, there is widespread concern about expected increases in health and retirement income expenditure due to the aging population. However, improved health status of older people and increased life expectancies means that they are able to continue to contribute to society in ways which may not have been possible for previous older cohorts. It is important that government policies across the range of issues, including employment, health, housing and income support, allow and encourage older people to experience aging as a positive and productive phenomenon.

The twin concepts of positive aging and productive aging are closely inter-related. The benefits of positive aging for individuals are obvious; good health, independence, intellectual stimulation, self-fulfillment and friendship are just some of the valued outcomes of positive aging. Society as a whole also has a lot to gain from these outcomes: a healthy, happy, aging population places less demands on social services; contributes a wealth of expertise and skills to the community and the workforce, and provides positive role models for younger generations.

Changing media images of older people is an important strategy to break down barriers, which restrict older people’s abilities to continue to contribute to society. The development of intergenerational programmes is essential to dispel the negative myths and stereotypes of aging.

A stable and secure income in retirement is recognized as an essential prerequisite for people to be able to age in a positive and productive way. A lack of adequate income has negative effects on health and on the ability of older people to remain active participants in society. In the British Virgin Islands, the Accord on Retirement Income Policies aims to provide this security and encourage future generations of older people to prepare for their retirement so that they are able maintain a reasonable and secure standard of living.

Employment and labor reforms are another necessary component to encouraging continued contributions of older people in society. From 1 February 1999, compulsory retirement on the basis of age will be prohibited in terms of the Human Rights Act. This change in legislation signals the reforms, which are necessary in order to achieve an environment where contributions of older people in the workplace, are valued. The choice to work later in life, using flexible part-time arrangements is of central importance to meeting the active aging challenge. The evidence suggests that those who work longer enjoy better health in their old age. The policy conclusion is clear: it is imperative to maintain people in gainful activity longer. In order to achieve this objective, it will be necessary to ensure that education and training policies are adapted to the specific needs of older workers.

The OEC notes that aging populations create four fundamental challenges for public policy:

1. Fiscal. Changes are required to fiscal policy to prevent the need for large increases in 
   government spending.
   
2. Market responsiveness. The need to create a policy framework within which labor and capital markets can be responsive to changes resulting from shifting demographics.
   
3. Encouraging active aging. Helping people to stay active, flexible and self-reliant as they age.
   
4. Balancing collective and individual responsibilities.

These are major inter-related challenges. The Department of Social Welfare has taken a lead in meeting these challenges through its Positive Aging Strategy. Because of its expertise and its position in the Department of Social Welfare, the Senior Citizens Unit will continue to play a significant role in the Department’s Positive Aging Strategy, which is being developed for the next ten years.

3.2 Key Points on Aging

Key Points on Aging and the Elderly

3.4 Demographic features on the current and future of Older Population

Population changes in the British Virgin Islands were extraordinary during the intercensoral period 1980-1991 and this lead to a technical co-operation study to attempt a prediction on the various population variables. The UNFPA, through the Country Support Team framework, visited the 1991 Population and Housing Census data to prepare population projections to assist with the explicit integration of population issues and concerns in the development planning process. The National Integrated Development Strategy (NIDS) is intended to develop inter-related policies and strategies deal with economic, fiscal, physical/spatial, environmental, social, population and human resources development matters.

The projections exercise consisted of in depth analysis of the 1991 Population and Housing Census with special focus on migratory patterns and it included areas such as fertility, nuptiality, education, economic activity, income etc. Special efforts were made to differentiate between belongers, long tenure migrants and migrants of recent tenure. The model predictions were based on scenarios of no increase, moderate and high growth in international immigration. For the purpose of the NIDS a professional internal decision was taken to base our population analysis on the moderate.

After reviewing the range of assumptions for the various scenarios the medium one was selected to represent the expected future demographic trends of the BVI. For the medium scenario, it is assumed that the fertility level will gradually increase from a TFR of 2.2 to 2.5 by the terminal year. This fertility assumption was maintained for the high scenario as it was deemed unrealistic to assume that the fertility level would exceed a TFR of 2.5. It was assumed that the positive net migration would increase by about 15% by the year 1996 and then remain constant thereafter until the terminal year.


Table 1
Population Change for Low, Medium and High Scenarios, 1991-2021

(1) AAGR - Average Annual Growth Rate

Source: Population Affairs and Social Statistics Division, Development Planning Unit

Growth Rates

All scenarios show that the population will continue to increase but at decreasing average annual rates of growth for each five year interval. The average annual rates of growth from the base to the terminal year were 1.60%, 1.95% and 2.20% for the low, medium and high scenarios respectively. These rates are to be compared with the average annual growth rate of 3.8% experienced for the period 1980 to 1991. However, by any comparison, these rates are considered very low, because even with the growth rate of 2.20% of the high scenario, the population of the British Virgin Islands will take about 35 years to double.

Sex Ratios

It is projected that the sex ratio in the medium scenario, the scenario selected to represent the BVI demographic trends, will decrease in the long run. These movements or lack thereof are direct consequences of the migration assumptions used in the projections. It was assumed that immigration will continue to display a male dominance in view of the construction and industry type service jobs which would be created as a result of gross capital formation envisaged in the Public Sector Investment Programme (PSIP) and the private investment according to our National Integrated Development Plan (NIDP), 1995 - 1999. The present sex ratio - the main factor of the sex composition of the population - of the migrants is very high 126 males per 100 females.

Age Composition and Dependency Ratios:

The medium scenario indicated that the under 15 years percentage of the population will fall from 27.2% to 23.7% of the population during the thirty year period 1991 to 2021. Indications are that the working age population percentage will not change due to aging and the assumptions of immigration. On the other hand, substantial increases are likely to occur with the population 65-and-over- years.

As a result of change in the population age structure there will be decreases in the young dependency (under 15 years) ratio and increases in the old dependency (65-and-older) ratios. While the increases in the young-dependency and the old dependency ratios are likely to fluctuate in the low scenario, the total dependency ratio (not including dependent residing abroad) is projected to increase from 48.8% in 1991 to 49.3% in 2021.

3.5 Issues of interest and concern to Older People

Portfolio of the Minister for Senior Citizens

• Key Points
  
• Issues in the portfolio of the Minster for Senior Citizens are becoming more prominent.
  
• The portfolio of Senior Citizens within Cabinet enhances its credibility with older people.
  
• There is a potential for the advocacy role of the Minister for Senior Citizens to conflict with other portfolio responsibilities.
  
• The effectiveness of the portfolio is dependent on the Minister receiving comprehensive advice on a wide range of issues quickly.
  
• The size of the Senior Citizens Unit limits the volume of policy advice provided to the Minister for Senior Citizens.
  
• History

Until the establishment of the portfolio of Minister for Senior Citizens, the needs and interests of older people were not consistently represented by any one Minister of Government. The increasing importance of senior citizens as a specific group to be considered in public policy formation is reflected in the fact that in 1990 both the National and Labor parties endorsed the principle of appointing a Minister for Senior Citizens.

• Roles and Responsibilities of the Minister for Senior Citizens

The role of the Minster for Senior Citizens is to advocate for older people at Cabinet and other government policy forums. The Minister for Senior Citizens works in the interests of older people, representing their views and concerns at government level. This has been greatly assisted by the fact that all but one of the portfolio holders have been Ministers inside Cabinet, and thus able to advocate at the highest level.

In order to advocate for older people, the Minister and his/her officials contribute to the policies affecting older people, which may be developed in a range of government agencies. The Minister for Senior Citizens is therefore required to maintain close relationship with other Ministers.

The advocacy function of the Minister for Senior Citizens is complicated by the fact that older people are not a homogeneous group. An issue such as income support, for example, gives rise to a range of viewpoints within the older population. Further, while the portfolio responsibility requires the Minister for Senior Citizens to represent the needs and expectations of older people, their needs must be balanced against the competing needs and expectations of other age groups in society.

The scope of the Senior citizens portfolio is very broad, incorporating issues such as health, income support, housing and transport. Services for the Minister are provided by the Senior Citizens Unit, which is part of the Social Policy Agency of the Department of Social Welfare. The work programme of the Senior Citizens Unit is negotiated with the Minister and formally agreed to on a quarterly basis. The focus of the portfolio varies and may be influenced by both changes in government policy and lobbying by older people’s interest groups. The Unit is proactive in identifying areas of current concern and relevance to older people. It also works closely with the Department of Social Welfare and non-government organizations in initiating new projects.

• Future Directions

The portfolio of the Minster for Senior Citizens is becoming more important as the population ages and the interests and needs of older people have a greater impact on the social structure of The British Virgin Islands. The effectiveness of the portfolio is dependent on the ability of the Minster to respond to issues raised by and affecting older people. The placement of the portfolio of Senior Citizens within the ranks of Cabinet has contributed to the effectiveness of the position of Minister for Senior Citizens and has greatly enhanced its credibility with older people.

Older people are a significant and growing proportion of the population and they are becoming more politically active. Over the past three years the Minister for Senior Citizens has been put under increasing pressure to use his advocacy function to challenge government policy, particularly on health and income support issues. It is therefore of increasing importance that the Minister is able to receive comprehensive advice on a wide range of issues quickly.

The Senior Citizens Unit is the primary source of advice to the Minister on issues affecting older people. These range across many portfolio areas. The small size of the Unit limits its ability to maintain expertise across the range of issues affecting older people. Also, the volume of policy advice provided to the Minister is affected. The continued effectiveness of the Senior Citizens portfolio is therefore dependent on the resources available to the Senior Citizens Unit to perform its policy advice function.

• Future Directions

The Advisory Council for Senior Citizens provides advice to the Minister for Senior Citizens on a wide range of policy issues. As noted, this is a particularly valuable stream of policy advice and is complementary to the advice delivered by the Senior citizens Unit. The Advisory Council members have close community involvement and so they can keep the Minister in touch with the range of views that older people have about current policies and issues. This makes their advice especially relevant in assisting the Minister’s advocacy role.

The Advisory Council reports in confidence to the Minister and at times members have been frustrated by this confidentiality obligation. This factor, coupled with the fact that the Council has not had a high profile, has resulted in some public criticism that the Advisory Council has not been effective. The confidentiality requirement is, however, an important means of ensuring that the advice members give can be free and frank and cannot be used by members as a political tool. The non-political status of the Advisory Council is important in maintaining its credibility.

The Advisory council is also a forum in which Senior Citizens Unit analysts can test their assumptions and ideas on older people’s issues. A strong working relationship has been developed between the two parties allowing for productive exchanges of information.

The Advisory Council is a reasonably cost-efficient body. The fees paid to members are moderate and travel costs are kept to a minimum by ensuring that the majority of members reside either in, or close to, the greater Wellington region. The servicing of the Advisory Council does, however, significantly increase its overall cost. As noted earlier, the allocated overall staff resource required to service the Advisory Council is one half-time staff equivalent. In reality, closer to one full-time equivalent is spent on servicing the Advisory Council, with analysts assisting with information provision and report preparation.

Time spent in servicing the Advisory council is not only costly in a monetary sense, but it also has an opportunity cost in terms of other project work that could be undertaken by analysts. As a result, the Senior Citizens Unit is limited in the extent of work in which it can engage. The cost of the Advisory Council needs to be balanced with the value of the advice it provides to the Minister. It is the Senior Citizens Unit’s view that it is important for the Minister to have advice provided from a community perspective and that the Advisory Council performs this function well. However, if the Minister wants an Advisory Council and a policy advice function, which can keep up with the increasing emphasis on older people’s policy, then an increase in Vote, will be essential.

• Elder Abuse and Neglect
  
• Key points
  
• There is no international standard definition of elder abuse and neglect.
  
• Increased awareness of elder abuse and neglect is needed.
  
• Data on elder abuse and neglect in New Zealand is inadequate.
  
• The incidence of elder abuse and neglect is expected to increase due to the projected increase of older people in the population.
  
• No government agency has policy and funding responsibility for elder abuse and neglect services in New Zealand.
  
• Introduction

Elder abuse and neglect may occur in a number of different settings, including private residences, rest homes and hospitals. There is no international standard definition of the term ‘elder abuse and neglect’. The definitions provided by Age Concern New Zealand in their elder abuse and neglect resource kit are good examples of what is generally meant by these terms, and these definitions will serve as the terms of reference for this paper.

Both elder abuse and neglect are distinguished from general criminal activity in that the person being abused knows the perpetrator of the abuse or neglect and the relationship is one of implied trust.

Categories of elder abuse may be identified as:

• Physical abuse – infliction of physical pain, injury or force;
  
• Psychological abuse – behaviour that causes mental or emotional anguish or fear;
  
• Sexual abuse – sexually abusive and exploitative behaviours involving threats, force, or the inability of a person to give consent; and 
  
• Material/Financial abuse – the illegal or improper exploitation and/or use of funds or other resources.

Types of neglect are further defined as:

• Active neglect – conscious and international deprivation by a career of basic necessities resulting in harmful effects.
  
• Passive neglect – refusal or failure by career, because of inadequate knowledge, infirmity or disputing the value of the prescribed service, to provide basic necessities resulting in harmful effects.

Causes of elder abuse and neglect

There is no simple explanation as to why elder abuse and neglect occurs. There are, however, several factors that are known to contribute to incidents of elder abuse and neglect:

• Dependency of the older person on others for all or part of their care;
  
• Career stress;
  
• Dysfunctional family dynamics, including a history of family violence and/or alcohol abuse;

•  Social isolation of both the older person and the abuser; and
  
• Psychological and social problems of the abuser.

The variation of these contributing factors reflect the complexity of elder abuse and neglect and the need to develop responses appropriate to the different causal factors and the particular needs of older victims.

• Extent of the problem

Elder abuse and neglect has only recently received recognition. It is therefore difficult to obtain accurate information about its prevalence in New Zealand or internationally. A preliminary examination of international research suggests that between 3% and 5% of older people be subject to abuse or neglect. However, the complexity of elder abuse lends itself to inconsistencies between research definitions, which make reliable comparisons of research findings difficult. Davies suggests that about 3% to 4% of older people in New Zealand are victims of elder abuse and neglect.

• Policy Issues
  
• Education

Elder abuse has not gained the same high profile as child abuse in the community, yet if overseas trends are followed, it will become more of an issue as public awareness is heightened. Currently there are not adequate resources to deal with the issue, and there is still a need for preventative measures in the form of public education.

Age Concern New Zealand has recognized the importance of education and has taken this educational role upon itself. The organization has been assisted by funding for the development of resources material from the former Public Health Commission. Education about elder abuse and neglect is regarded by the National Advisory Group as integral to the role of the pilot co-ordinators. In their work to raise awareness about elder abuse and neglect, pilot co-ordinators spend a significant time speaking to community and public groups, and to health professional students. The question of who is to take responsibility in the long-term for such education needs to be addressed. This issue is expected to be discussed in the National Advisory Group’s report to Ministers in early 1997.

• Effect of the Domestic Violence Act 1995

The first opportunity for legal protection of older people in a domestic relationship other than marriage is provided in the Domestic Violence Act, effective from 1 July 1996. Due to the personal relationship with their offenders, victims of elder abuse have tended not to want legal action to be taken against offenders. It is not clear whether the new legal provisions, which mean that most offenders could be dealt with in the Family Court rather than the District Court, will result in an increase in legal action being taken against perpetrators of elder abuse and neglect. The effect of publicity about the Act on the number of incidents reported is also unknown.

• Community cares

The link between care givers stress and the incidence of abuse and neglect has been well established. As government policies move progressively away from institutionalisation and towards community care, where increasing responsibilities are placed on family members in particular, it is imperative that appropriate support services are introduced. Unless adequate support services for family carers, including respite care, are available, the risk of elder abuse and neglect will increase.

• Mandatory reporting

As with child abuse, the issue of the mandatory reporting of elder abuse has been raised as an option for increasing awareness and increasing protection of those most vulnerable to abuse and neglect.

Mandatory reporting of elder abuse and neglect is seen as a potentially expensive option that may do little to improve the situation of older people, and in some cases could result in a worsened situation, for example, the inappropriate institutionalization of older people. In addition, mandatory reporting may inhibit the reporting of elder abuse by victims, thus compromising their autonomy, dignity, and self-esteem.

• Future Directions

The issue of elder abuse and neglect has only recently gained recognition in New Zealand. As public awareness of elder abuse and neglect grows, the demand for services to deal with the problem will intensify. Unless the Government, through one of its agencies, takes responsibility for service provision in this area, the problem is likely to remain largely hidden, to the detriment of older people, their families and their caregivers.

The collection of data on the actual incidence and types of elder abuse and neglect prevalent in New Zealand will provide a sound base form which government strategies and intervention and education programmes may be developed. Data is currently being collected from seven elder abuse and neglect programmes but further data and research on elder abuse in New Zealand will be required.

• Transport
  
• Key points
  
• Mobility is an important factor in enabling older people to remain healthy and active.
  
• Adequate and appropriate transport system are needed for older people to access services and facilities, take an active part in community activities and keep contact with friends and family.
  
• An older driver, passenger or pedestrian is more likely to be injured or killed in an accident than a younger person.
  
• The number of older drivers in New Zealand is expected to increase significantly over the next few decades.
  
• The requirement for people over the age of 70 to renew their driver’s license is currently under review.
  
• The needs of older pedestrians are often ignored in town and road planning and in the design of shopping centres and community facilities.
  
• Introduction

Mobility is an important factor in enabling older people to remain healthy and active. Adequate and appropriate transport is needed for older people to access services and facilities, take an active part in community activities and keep contact with friends and family. The loss of a driver’s license can have a major impact on an older person’s independence and can lead to feelings of loss of self-worth.

Accessible public transport is essential to assist older people to remain active and to enable them to travel to services and facilities. For this reason, it is important that those planning public transport systems consult with older people, as well as other client groups, about their requirements and preferences as part of the planning process. In addition, maintaining regular contact with users will enable planners to keep track of changing needs.

• Older Pedestrians

Walking is an important means of personal transport for older people. Older people are over-represented in pedestrian accident figures. In 1991, 20% of all pedestrians hospitalized following an accident with a motor vehicle and 34% of all pedestrians who died were aged 60 years or more. The high ratio of death to injuries reflects the increased fragility of older people who are much more likely to be seriously injured or killed if they are hit by a vehicle, than a younger person in the same circumstances.

Apart from injury caused by vehicles, hazards for older pedestrians include:

• Uneven or broken footpaths;
  
• Children riding bicycles or skateboards on footpaths;
  
• Poor street lighting; and
  
• Traffic signals at crossings often provide insufficient time for older people to cross an intersection safely.

In designing shopping centre parking areas, the needs of pedestrians are frequently forgotten. Reaching shops often requires walking around parking vehicles, crossing busy main roads and navigating obstacles such as speed bumps and low walls.

Good design and maintenance can eliminate many of the dangers for pedestrians. Provision of more public seats at bus stops, in parks and on the roadside would provide more places where older pedestrians could rest. Some of the requirements of older pedestrians may conflict with the interests of other road users. For instance, longer pedestrian signal crossing times create longer delays at read lights for motorists.

• National Land Transport Strategy

At present the Ministry of Transport is developing a National Land Transport Strategy. The purpose of this strategy is to develop long term land transport goals and policy objectives, and measurable targets for achieving these objectives. It will cover safety, transport disadvantage, economic sustainability and environmental factors. Consultation on the strategy began in July 1996 and the Ministry of Transport plans to release a draft for public discussion by 30 September 1997, with the final strategy being launched in May 1988.

• Future Directions

There is considerable policy work relevant to older people being undertaken in the transport area. The Land Transport Safety Authority has sought public comment on licensing provisions for older drivers and it is expected that it will decide to further relax these. The provisions of the Human Rights Act 1993 may have an impact on age restrictions for licenses. In addition, the Ministry of Transport is working on a National Land Transport Strategy, which it plans to complete by July 1997.

The Senior Citizens Unit liaises regularly with the Land Transport Safety Authority and Ministry of Transport and will have opportunities to comment on the development of relevant transport policies and rules. It is anticipated that the Advisory Council for Senior Citizens will continue its interest in this policy area and provide submissions.

Concerns regarding creating a safe environment for pedestrians are being acknowledged by many planners and providers. More positive attitudes about aging are likely to create greater awareness of this issue. The Prime Ministerial Task Force on Positive Aging has identified transport as one of the areas on which it will be providing recommendations to Government. This will reinforce the need for local authorities to plan responsive strategies, policies and services for older people in their communities.

• Community Support Services
  
• Key points
  
• The growing older population, in particular those aged 80 and over, requires community support services to enable older people to remain in their own homes.
  
• No government agency has responsibility for funding non-health related community support services for older people.
  
•  The Lottery Aged Distribution Committee is the major source of funding for non-government organizations providing community support services for older people.
  
• The level of Lottery Aged funding has decreased at the same time as the older population has increased
  
• Community support services require a permanent source of funding.
  
• Funding for non-health related community support services for older people should be the responsibility of the New Zealand Community funding Agency.
  
• Introduction

Home support services, such as meals on wheels, cleaning, and personal care services for bathing, dressing and feeding, are defined as core disability support services and are therefore funded through regional health authorities. These services enable older people to remain living in their own homes for as long as possible.

Community support services include lawn mowing, home maintenance, and assistance with shopping, social support, transport, outings and the provision of advice. These services are generally provided by volunteers working for community organizations. The services provide practical support to assist older people to remain active and independent. For this reason, they are just as important as health-related services.

Demand for community support services is steadily increasing. The growing pressure for these services is a result of:

• The growth in New Zealand’s older population, and in particular people aged 80 and over;
  
• Older people’s expectations that they should be able to live in their own homes for as long as possible;
  
• Recent government health policies which have encouraged and supported older people to live in their own homes, rather than moving into expensive residential care; and
  
• The geographical spread and mobility of families, which often prevents families from providing informal, care to their older members.

Because community support services are not defined as core health or disability support services, there is an expectation by the health sector that these services for older people are the responsibility of the non-government sector. However, many community organizations are reporting that they are finding it increasingly difficult to fund these services and to attract sufficient volunteers to provide them.

• Future Director

The demand for community support services for older people are increasing. Factors contributing to this demand are:

• New Zealand’s aging population, especially the projected increase in those aged 80 and over;
  
• The expectation that older people will live in their own homes most of their lifetime; and
  
• The reduced ability of family, particularly women, to provide support for older members due to changing employment patterns and increased geographical spread and mobility of families.

Community support services are mostly provided by non-government organizations, which are facing increasing difficulties, obtaining funding and attracting volunteers.

Funding for community support services for older people is inadequate, currently provided on an ad hoc basis through the Lottery Aged Distribution Committee. Lottery Aged has a significant role in funding older people’s organizations, but the funding of essential community support services is not its responsibility.

Although government policies encourage older people to remain in their own homes, there is no government agency responsible for funding non-health-related services to support this policy. Regional health authorities are responsible for funding core health and disability services, but these do not include community support services. However, community support services are just as important as health-related services in maintaining older people in their own homes.
Housing

• Key Points
  
• 93% of older people live in their own households and expect to remain there as long as possible.
  
• Government policies are needed to support older people to remain in their own homes or to move to more appropriate accommodation.
  
• Different groups of older people have specific housing needs.
  
• The cost of home maintenance and local authority rates can cause significant hardship for older homeowners.
  
• Older tenants are finding it difficult to afford market rents.
  
• Introduction

Most older people prefer to remain in their own homes rather than moving into residential care. Recent government health policies promoting home-based support services have responded to older people’s expectation that they will continue to live in their own homes for as long as possible. It is important that older people have appropriate housing to support this policy direction.

Older people’s housing needs include a safe and comfortable environment, low maintenance and well-sited dwellings with easy access to shopping, transport, recreational and community facilities. Among the most vulnerable groups in the housing market are frail older people, older women living alone, older Maori, older Pacific Islands people and those for whom is their only source of income.

• Housing Demographic Information
  
• Geographical location

People aged 65 and over made up 11.4% of the total population in the 1991 Census. This proportion was not evenly distributed between geographical districts. While some people retire in the community where they have been living, others move to areas that offer specific lifestyle options. Areas with a significant percentage of older people. In these regions, there is likely to be a greater demand for housing and other services that meet the needs of older people than in other regions.

• Dwelling type

In 1991, most people aged 65 years and over lived in private dwellings, with only seven percent living in rest homes, hospitals or similar accommodation. Those living in residential care were mostly aged 80 and over. Only 2% of people aged 65 to 69 lived in residential care compared with 13% of people aged 80 to 84 years and half of those aged 90 or older. Most older people in private dwellings live in separate houses, but older people are more likely to live in flats or houses that are attached to others.

Living arrangements in 1991, 50 percent of people aged 65 and over who were residing in private dwellings lived with a spouse or partner, and one third lived alone. A further 12 percent lived with their children or siblings. Of men aged 65 and over, 18% lived alone, whereas 44% of women lived by themselves. The likelihood of living alone increased with age; approximately half of all those 80 years and older were living alone. Older Maori and older Pacific Islands people were more likely to be living with their children or siblings than other ethnic groups.

• Issues Facing Older Home Owners

In 1991, 76% of those aged 65 and over lived in a mortgage-free private dwelling and a further 9% owned their home with a mortgage. The major housing issue facing older homeowners is meeting costs such as home maintenance, local authority rates and home alterations.

Older people who have lived in their own home for many years are often faced with major home maintenance. For frail older people or older women living alone, who are unable to do their own repairs, even small house maintenance tasks can be expensive. In some areas, non-governmental organizations, such as Age Concern Councils and the Retired Persons Association, operate volunteer schemes to assist older homeowners with minor home repairs and maintenance. However, such assistance is not available nationwide. The costs of or difficulties associated with, home maintenance can contribute to:

• Older people living in substandard or unsatisfactory accommodation; and
  
• The increased likelihood of a frail older person moving into residential cares rather than remaining in the community.

For some older homeowners, the values of their properties have increased dramatically over time, but with retirement their incomes have declined. This means that an older person’s annual rates bill may be a significant cost for them.

• Future Directions
  

The housing needs of older people are varied and depend on factors such as whether an older person owns their home or lives in rented accommodation and the person’s gender, ethnicity, level of income and health status.

Recent changes to housing policy which have seen the removal of government incentives for low income earners and subsidized home loans may result in a future generation of older people who do not have equity in a residential property.

Affordability of housing is a factor for older people on low incomes. Older people have higher costs in other areas, such as health expenses, when compared with younger age groups. In addition, people live on their retirement income for several decades with little opportunity to earn more income. Community organizations report that older people with high housing costs often reduce their expenditure on other essential items such as heating and food in order to meet fixed costs, such as rental payments. This is detrimental to their health and well being and often precipitates the need for expensive hospital or residential care services.

Older people have an expectation that they will continue to live in their home for as long as it is possible and home support services have been developed to support this expectation. There is an assumption that an older person’s home, in which they have lived during their life, will still be safe, affordable and appropriate as they get older.

Present government health policy promotes community care through the provision of home support services. Unless accommodation is appropriate, the provisions of home support services will not be enough to ensure a frail older person can remain in their own home. There is a need for other government policies to be developed to support older people to remain in their own home or to move into more appropriate accommodation.

In an aging society with increasing chronic illness and long-term care issues, and the steady advance of expensive medical technology that can always promise to improve quality of life and life expectancy at the margins, it is not possible to control health costs – and, in the U.S., probably not possible to achieve universality – through redistribution and administrative rationalization alone (Callahan 1993; Gaylin 1993; Kari, Boyte, and Jennings 1994.


4.3 Demographic and Population

Population issues, constraints and problems in the BVI are dominated by immigration affairs as they have impacted significantly on all demographic variables – especially so since the 1980 Housing and Population Census. The extraordinary growth in economic activity in a situation of limited indigenous human resources resulted in a sustained flow of immigrant labour to satisfy the growing demand for both skilled and unskilled labour.

The imported labour included a substantial share of unskilled or low skilled workers who were paid at the lowest possible wage level. This was essentially so given at the lowest possible wage level. This was essentially so given that the minimum wage level was fixed at $2.00 per hour for as many years as a decade before it was recently revised to $3.25 per hour. However, immigrant workers continued to enter into employment arrangements for the lower level wages virtual fixed over the decade while the cost of the basket of minimum goods and services went up as indicated by inflation according to the Consumer Price Index.

Chapter 2 indicated that, in 1980, 6.0% of the population were over 65 years of age. This dropped to 5.5% in 1991 despite the increased expectancy of life for this same time period. This was the case because of the dominance of the percentage share of the active segment of the population. Dependency ratios for the old, as a result, fell from 10.0 in 1980 to 8.2 elderly persons per 100 active persons in 1991. Of the elderly, 54.22% were males and 45.78% were females. It is only at the 85+ years age group that the perce