Elderly and housebound people dependent on home care in Central and Eastern Europe are being forgotten as economic constraints and cutbacks in state health and care programmes reduce the services to them.
Even Red Cross visiting nurses - for decades a lifeline for hundreds of thousands of people - have had their numbers slashed. Paid by the then communist governments to provide home care to the elderly and disabled, the Red Cross is today struggling to maintain services and acquire sustainable resources.
Meanwhile, the need for such services grows. Social safety nets are failing in many countries, the number of older people is increasing, and more and more pressure is placed on the Red Cross to bridge the gaps with less and less money.
A thin red lifeline becomes ever thinner. In Latvia, the number of Red Cross nurses has fallen by more than 60 per cent over the past five years. Valdis Nagobads, president of the Latvian Red Cross and Director of Riga's Welfare Department, is adamant the home-care programme should continue.
Pensioners make up a quarter of Latvia's 2.4 million population and the average pension is 56 lats a month (about US$90). "There is a big demand for this service, especially in Riga, and the best solution would be if municipalities bought the service from the Red Cross," Nagobads says. It makes economic sense as well - caring for people in institutions is more expensive than caring for them at home.
Finding new ways to cooperate with the state is key to the future. Some health professionals believe the role of the Red Cross will develop in fresh directions once the systems of family doctors and district nurses that health care reforms have introduced to the region are fully developed.
Rather than more nurses, the greatest need may be for trained volunteers to make home care viable. For the time being, however, both are needed.
The undoubted advantages of the Red Cross providing auxiliary community services are not lost on the authorities. The ability of its network of volunteers to assist the most vulnerable is second to none, and the impact is already visible in home care.
The Red Cross Society of Bosnia and Herzegovina, for example, has 2,000 trained volunteers caring for between 10,000 and 15,000 vulnerable elderly spread throughout the country who otherwise would be forgotten.
The importance of volunteers in maintaining home care services has been underlined by the Lithuanian Red Cross, which this past summer produced 300 graduates from a home-care training scheme funded by the European Union's Access Programme. Other donors are now being sought to continue with similar projects.
Lithuania, too, has a long tradition of Red Cross visiting nurses but due to economic constraints government support has been decreasing dramatically. Over the past five years it has dropped from an annual 1.5 million litas (about US$428,000) to 300,000. Where there were 110 nurses in 1994 helping 2,317 elderly, there are 20 today.
So 300 trained volunteers providing basic care services and psychological support to 1,500 lonely, elderly, socially vulnerable people across the country, are an enormous boost.
Secretary General Irena Bruziene says the project seeks to help socially vulnerable people otherwise left without care, to reintegrate lonely elderly into society by breaking their isolation, to raise public and state awareness of social problems, raise the prestige and authority of volunteers in society, and recruit more volunteers in the future.
"It makes plain Red Cross sense," says the Federation's regional health and care delegate, Annamari Raikkola. "We are, after all, the world's largest volunteer network, and the Red Cross is well placed to get the needs of the most vulnerable on government agendas."
A pressing challenge is clear. A growing number of elderly people in a shrinking population spells problems. While economic and social development allows people to grow older, there will be fewer folk of working age to support them. Less money will be collected for public budgets on which health care depends.
A preference for smaller families, a reluctance to have children due to economic hardship and social insecurity, less time to raise a family among working women, and popular acceptance of contraception, have all contributed to falling birth rates.
Currently in the world's developed countries, there are between four and five people of working age to every person over the age of 65. Demographic predictions suggest that by 2050, this old-age dependency ration will have fallen to two to one.
The more elderly people there are, the more health care services will be called upon to cope with increased incidence of age-related diseases, such as cancer and cardiovascular problems, which are costly to treat. The elderly, too, are the least likely group to be able to afford private health-care insurance.
Alternative forms of care are being developed in many countries, and long-term homes and hospices are being upgraded. But care to help the elderly stay at home will be a vital part of the equation.
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April 2002 - Second World Assembly on Ageing