It's a problem around the world that has been caused by the drop in the birth rates. Around the world young people are having far fewer children than they used to have. So there is a much smaller supply of family to provide for older people. If anything, that says to us that there needs to be investment, there needs to be development of the home support industry. If we don't have a daughter, a son, or grandchildren to look after us, then we hope there will be a supply of paid labour to look after us.
Much of the home care around the world is being provided by immigrants. In the Pacific Rim countries Filipino nurses have played a major role in support of older people. We certainly want to make sure that people who are coming into the country and who are engaging in this kind of work have the right kind of training and the right kind of personality. In general, we have been blessed by some very good immigrant workers who have come in and taken on the role.
We need to think about the quality of home care. We began to look at the quality of hospital care, but there has been less attention paid to the quality of home care. Some research has been done in that area on how to monitor home care and how to ensure there is a sufficient amount of supervision. Training is one thing; the second is the degree of supervision and oversight. Whether the government is paying for the service for those who cannot afford it or the individual is purchasing it in the marketplace, we still need to make sure there is sufficient oversight and regulation that the service is provided at a proper level of quality.