Many countries are coping with ageing populations, below-replacement birth rates, and the resulting economic and societal impacts. Among the responses, time-banking systems are increasingly popular, but cannot meet the challenges of elder care alone.
Time banking is a scheme by which volunteers who spend time assisting elderly people can later redeem these hours when they, in turn, seek help. Schemes like these are expanding in Europe and around the world, as citizen-led responses to the needs of greying populations.
In contrast, other countries have included non-health-related services for the elderly, such as help with grocery shopping and housework, within comprehensive government-led social and healthcare plans for all citizens.
Here, we look at two such contrasting programmes: a volunteer-based time-banking system in Austria, and a government mandated, long-term care insurance plan in Japan.
Zeitpolster, which translates as "Time Cushion", is Austria's time-banking system, through which people help the elderly or disabled with tasks like grocery shopping or gardening, and bank these volunteer hours to use when they require assistance themselves.
"Middle Europe is growing old," says Gernot Jochum-Müller, who founded Zeitpolster in 2018. "It's not only Austria; it's Switzerland, Germany, and all the countries around." In a nutshell, these populations are ageing, people are living longer, and there are fewer young people to help care for the elderly. "The total fertility rate is 1.7, so we're going backwards with the younger generation, and we're also getting older," adds Jochum-Müller.
Other demographic changes are in play as well. The number of retiring Baby Boomers is ballooning, and people tend to become parents in life, so when we get old, our children are fully employed and have no time to provide care. "Fifty years ago, children married and lived near their parents. Where do the children live now? Around the world," says Jochum-Müller. And the once-traditional situation where the daughter would care for ageing parents is now outdated.
Time banking is no substitute for a care system - but it helps to fill the gaps.
To be clear, Austria's healthcare programme includes a tax-funded long-term care system for senior citizens. However, time-banking helps to fill some gaps. "We are not nurses, we are volunteers," Jochum-Müller stresses. Zeitpolster works with volunteers to assist with basic tasks like shopping, helping in the home or garden, looking after children, and driving to the doctor or other appointments. "Help with easy things, to make every day a good day."
Loneliness and isolation are common among the elderly, but as Jochum-Müller notes, people are often reluctant to admit they are simply lonely when requesting help. "It's not easy; loneliness is tricky." Clients don't realise that they can ask for someone just to drink a cup of coffee and have a chat with. In such cases, volunteers often help with a specific task, like shopping, but also spend companionable time with the elderly person.
Zeitpolster builds small, local groups of 60 to 100 volunteers in a region, all of whom receive training, with three to five acting as leaders. There are currently 1,500 volunteers providing help, and 1,600 people who need care. Zeitpolster's 45 groups are active in seven of Austria's nine federal states, with plans for an additional 100 teams.
The goal is to have groups in every area of Austria. "We are growing every year, but it's a long-term vision," Jochum-Müller adds. It requires coordination with the government, local municipalities, and other organizations. "You have to engage with people in the community to build trust. It's a process."
Among the Zeitpolster volunteers, 60 % to 70 % have not done volunteer work before, and they are mostly over age 50. In general, volunteers are healthy, approaching retirement, or already retired - and becoming aware that they will need help when they become older.
Jochum-Müller and his team developed the Zeitpolster model as a "social franchise" that can be rolled out in different countries. They've already created a franchise in Liechtenstein, where they partner behind the scenes with the locals to run the system. In Liechtenstein, there are 310 people needing care at the moment, and 270 helpers. This is a sizable number considering that Liechtenstein is a small area with only 30,000 inhabitants.
Currently they are talking with potential partners in Germany to start the system there. And Zeitpolster regularly gets enquiries from other countries. "The demand is really big and we need new solutions in this care service area."
Japan has the oldest population in the world, which profoundly impacts the country's economy, workforce, and society. Almost a third of its population of 124.5 million people is over 65 - an estimated 36.23 million - and today more than one in ten Japanese is aged 80 or older.
As Japan takes the lead in becoming the world's oldest society, while also experiencing declining births and a shrinking population, the world is watching to see how it deals with these challenges. According to academics Yoshiko Someya and Cullen T. Hayashida in their 2022 paper, "The Past, Present and Future Direction of Government-Supported Active Aging Initiatives in Japan: A Work in Progress" Japan is at an existential crossroads.
Japan had a time-banking system in the past, called Fureai Kippu, which means "Ticket for a Caring Relationship". This started in 1973, and was targeted at providing care for older people through the exchange of time credits.
Such systems were widespread throughout the country, and varied in scope and size. Unfortunately, there are no formal studies or empirical data on the outcomes of using time-banking systems in Japan, so its direct impact is largely unknown, according to Mayumi Hayashi of King's College London.
While the Fureai Kippu concept was considered the first example of time banking, which changed and grew throughout the 1990s, it was supplanted by the government's Long Term Care Insurance (LTCI) established in 2000.
Despite being phased out, Fureai Kippu was highly influential and widely cited by other countries, including Britain, when creating their own time-banking programmes. In fact, in 2006, Gernot Jochum-Müller of Zeitpolster invited a trainer from the Sawayaka Foundation in Japan to give a workshop in Austria on the Fureai Kippu system.
Launched in 2000, Japan's Long Term Care Insurance (LTCI) system is a national programme crafted to support the long-term care of the elderly. It was set up to shift the burden of family caregiving to social solidarity, ensure cost-sharing through insurance premiums (the LTCI budget is covered 50 % by taxes, and 50 % by premiums), and integrate long-term medical care and welfare services.
Long Term Care Insurance is mandatory in Japan for everyone over age 40, and the municipalities operate as insurers. There are different rules for people under and over age 65. The over-65s must pay fees for services received, according to their income, starting at 10 %. The balance is covered by the government. The system is fairly generous in terms of the levels of coverage and benefits compared with those of other countries, and the scheme has been continuously updated over the years.
The world is watching Japan - how will it respond to ageing, declining births, and a shrinking population?
Services are provided based on an assessment of needs, and these include items not directly related to health, such as assistance with shopping, cleaning, cooking, and other types of housework. Some communities have services supplied by volunteers, like rides to hospitals, but time banking is not involved. "As far as I know, there are no time-banking programmes nowadays," says Yoshiko Someya, of the Health & Medicine Paradigm Shift Consortium (HMPSC) in Tokyo. She adds that if someone is willing to pay for these services, even if not assessed, it is possible to buy them from care agencies.
And how are the Japanese working to alleviate loneliness? The government has established nationwide ageing measures, such as senior centres and senior colleges, aimed at helping the elderly to remain engaged both physically and mentally.
As of March 2023, the number of people requiring long-term care or support in Japan reached approximately 6.9 million, up from about 5.8 million in 2014. This amounts to 5.5 % of the current population. It is projected that in 2040, there could be 10 million people aged 85 years or older, out of a total Japanese population of 110 million. This almost certainly means a further large increase in the numbers needing long-term care. Even with the government's LTCI system, the question is: will robotics, immigration, or even revived time-banking systems be needed to cope with the challenges this brings?
