A progress report on the implementation of measures for older persons in the Caribbean, 2022 to 2024

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Teaser:

The 27 Caribbean[1] member and associate member countries of ECLAC had a total population of 12.4 million persons in 2023, of whom 1.8 million were aged 65 and over. The population of older persons has increased rapidly from less than 1 million in 2000 and is projected to reach 2.5 million by 2040. An increasing number of countries and territories are also starting to see declining working-age populations.

Ten Caribbean countries had falling working-age populations (persons aged 20 to 64) in 2023: Aruba, Barbados, Bermuda, Dominica, Guadeloupe, Martinique, Montserrat, Saint Kitts and Nevis, Saint Vincent and the Grenadines, and United States Virgin Islands. A smaller working-age population makes it even more difficult for these countries to adequately fund pensions, health and social care for older persons. The total population in these countries is also falling or will soon start to fall. This population decline is due, firstly, to sub replacement levels of fertility and, secondly, to net out-migration (for the majority of countries with falling populations, net migration is also negative). 

The international community’s primary policy framework for ageing and older persons is the Madrid International Plan of Action on Ageing, 2002. Since the adoption of the Madrid Plan, Caribbean governments and civil society organizations have worked within this framework to develop policies and programmes for older persons. To mark the 20-year anniversary of the Madrid Plan, a Caribbean subregional review of its implementation was carried out in 2022, identifying areas of progress and outstanding challenges (see Quashie and Jones, 2023 and ECLAC, 2023). 

The years 2021-2030 have also been declared as the Decade of Healthy Ageing by the United Nations General Assembly (United Nations, 2020). This is a call for concerted collaboration to improve the lives of older persons, aligned with the Madrid Plan and with the Sustainable Development Goals (SDGs). The Plan of Action for the Decade of Healthy Ageing focuses on changing attitudes towards older persons; realizing the potential of older persons; age-friendly healthcare; and long-term care (WHO, 2020). In support of this, the Pan American Health Organization (PAHO) in collaboration with other United Nations agencies have prepared a series of publications to inform interventions on a range of topics including visual and hearing health, dementia, long-term care, and the role of digital technologies in health care (PAHO, 2024).

This article looks at the most recent initiatives undertaken in Caribbean countries, over the last two years, within the framework of these aligned policy agendas, to promote healthy ageing and the rights of older persons.

Ageing policies 

Countries with falling working-age populations are starting to develop policies and strategies to address, in a holistic way, the challenges associated with demographic ageing and population decline. To address the fiscal implications of ageing, and boost the labour force, the Barbados Population Policy (BPC, 2024) incorporates measures to support families, the care economy, reproductive rights, healthy lifestyles, and managed migration. The Government of Bermuda has similar concerns which were set out in a strategic policy paper on “Addressing the Challenge of an Ageing Population” (GoB, 2022). This calls for measures to encourage labour market participation and manage migration in order to help close the gap between the demand and supply of labour.

In Barbados, the Ministry of People Empowerment and Elder Affairs’ National Policy on Ageing (2023 – 2028) was approved by Cabinet and presented to parliament. The policy aims to “enable and promote healthy and active ageing as a way of life for all Barbadians” and “ensure that the fundamental rights and freedoms of older persons are fully recognised and vigorously defended” (Barbados Today, 2024a). Legislation is also being drafted to protect older persons and this will address elder abuse and the rights of caregivers (Loop, 2024). 

In 2023, the Government of Saint Vincent and the Grenadines held a series of public consultations as part of the development of draft legislation on elderly care and protection (MoNM, 2023). Also in 2023, the Government of Aruba held a National Forum for Older Persons at which 26 stakeholder organizations signed a national agreement for older persons which will provide a foundation for future cooperation and action aimed at improving the quality of life for the elderly (MTINO, 2024).

Bermuda’s Ministry of Youth, Social Development and Seniors recently shared, for public consultation, a copy of its “National Seniors Strategy, 2024-2030 – Celebrating Life and Ageing Well!” (GoB, 2024b). The draft strategy is designed to address the many challenges faced by Bermuda’s ageing population such as dementia, affordable housing, long-term care, safety, transportation, and accessing health care.

In 2023, Suriname acceded to the Inter-American Convention on Protecting the Human Rights of Older Persons, becoming the first Caribbean State to accede to this treaty. In 2024, the Cabinet of Belize granted approval for accession to the same convention which will now be subject to parliamentary approval.

Belize’s Ministry of Human Development organized the first ever National Summit for Older Persons to gather input from key stakeholders to inform the government’s policy development for older persons (News 5, 2023). In the Cayman Islands, the Council of Older Persons held its first ever public forum “Ageing in the Cayman Islands,” with attendees discussing topics including care planning, mental health, financial wellness, dementia and other health conditions, and active ageing (COP, 2024b).

Bermuda’s Ministry of Social Development and Seniors has created an Ageing Well Committee, the appointments to which were recently announced (GoB, 2024a). The Ageing Well Committee will be an advisory board that focuses on recommendations for older persons, including areas of best practice, policies, procedures, and services. In the United States Virgin Islands, the Government’s new advisory and advocacy group for older persons, the Commission on Ageing, recently held its first meeting (GoUSVI, 2024)

Pension reform

With increasing numbers of older persons, all Caribbean countries and territories are having to consider the need for reforms to restore the sustainability of contributory public pension schemes. If not done in a timely manner, this will lead to more abrupt adjustments and generational inequities in the future. A recent International Monetary Fund review of pension schemes in the countries of the Eastern Caribbean Currency Union recommended a number of measures. These included increasing employer and employee contribution rates, rationalising pension calculations to make them fairer, and making contributions mandatory for self-employed workers (IMF, 2024). The National Insurance Scheme of Grenada will increase the contribution rate from 12% to 16% (split between employers and employees), over the period 2023 to 2031 (NIS, 2023), while the Social Security Board of Anguilla will increase the contribution rate from 10% to 12%, between 2024 and 2027 (SSB, 2023). 

Many Caribbean countries have increased (or are in the process of increasing) the retirement age for social security pensions from 60 to 65. In Barbados, the retirement age is already 67 with plans to raise it to 68, by 2034. Grenada is the most recent country to increase the social security retirement age from 60 to 65, which will be implemented over the period from 2024 to 2029. The only other Caribbean member States which still have retirement ages of 60 are Trinidad and Tobago (where the Government is expected to increase it to 65) and Belize, Guyana and Suriname, where demographic ageing is relatively less advanced.

The Turks and Caicos Islands Government is introducing a Senior Citizens Financial Assistance Programme which is designed to provide persons aged 70 and over with a minimum pension income of 1,000 dollars per month. The Government of Dominica reduced the age of eligibility for its non-contributory pension from 70 to 65, so the pension of 315 EC$ (117 US$) per month is now available to those 65 and over with no other pension income. In Guyana, the old age pension was increased from 28,000 to 36,000 GYD$ (172 US$) in 2024.

Affordable health and social care services

The 2022 review of the Madrid Plan highlighted how older persons can face great difficulty in accessing affordable health care, long-term care, day care and respite care services. Several countries have since implemented measures which seek to address some of these issues. In 2023, the Government of Anguilla introduced a free medical care programme for Anguillans aged 70 and over called Senior Shield. This programme means that seniors will no longer have to pay for care and medication at government health facilities. In the same year, Saint Lucia’s Ministry of Health, Wellness and Elderly Affairs implemented the Golden 80 Plus Health Care Package which provides free medication, hearing and eye care services to citizens aged 80 and over at community wellness centres. The Cayman Island’s Health Services Authority (HSA) recruited its first specialist geriatrician to provide care for conditions including multiple chronic conditions, functional decline, dementia and frailty (HSA, 2024).

A report on ageing and long-term care in Jamaica (Ashby-Mitchell and others, 2022) presented a comprehensive analysis of long-term care services in the country. It noted that long-term care services were not widely available, especially in rural areas; that the limited public provision that is available is targeted at the poorest segments of the population; and that standards and regulations are not adequately enforced. It emphasized the importance of a continuum of care services and how investment in home and community care services can support older persons to continue living in their own homes.  

A report on residential care facilities in Bermuda analysed the current demand for residential care facilities across the territory and made projections of future demand based on anticipated increases in the number of older persons, emphasizing the need for additional beds. It also described how residential homes are regulated, including annual inspections and complaints procedures; drew attention to the high cost of care and the need for affordable options; and highlighted the need to improve care for persons with dementia (BHC, 2023).

Aruba’s Minister of Elderly Affairs recently announced the decision to open 10 “Pasadia” day care centres for seniors across the island (GoA, 2024b). The programme is designed to help vulnerable older persons lead independent lives, strengthen their social contacts, and alleviate the pressure on informal carers (GoA, 2024a). There will be five new dedicated Pasadia centres, while five will utilise pre-existing facilities and services operated by third parties that will be integrated into the programme. The Government of Barbados also recently approved financing for the construction of a new day care and respite facility for the elderly (Barbados Today, 2024b).

A Technical Note published recently by the Inter-American Development Bank (IDB, 2024) analyzed day centres in the Latin America and Caribbean region and globally, including their multiple benefits for users, family caregivers and the role they play in relieving pressure on the social and healthcare system. The Note also presents guidelines for the design, implementation and day-to-day management of day care centres, using a person-centred approach.

In October 2023, the Geriatric Society of Trinidad and Tobago (GSTT) was established. This is a non-government organization that aims to provide care for older adults in the community and advocate for policies, programmes, activities, and education in order to enhance the quality of life, health, and independence of older persons (GSTT, 2024).

Promoting social inclusion of older persons

Promoting the active participation of older persons in all aspects of society is an antidote to age discrimination, exclusion, isolation and loneliness. In a notable example of such participation in community life, a group of older persons in Martinique created their own online television channel called Ti Gran Moun TV. It began in 2021, when a group of seniors began producing a programme InterMag, acquiring journalistic and technical skills along the way. The programme addresses topical issues from artificial intelligence to fishing, biodiversity and football, and is aimed at audiences of all age groups, incorporating intergenerational perspectives (Age Village, 2024). The group have since expanded their output which is disseminated through a YouTube channel. The name of the channel is a play on the French Creole expressions “gran moun” (older person) and “ti moun” (children), which is intended to capture the idea of building connections between generations.

In Belize, digital skills training has been provided to older persons across the country. The Senior Citizen Digital Skills Training Programme, organized by the Nаtіоnаl Соunсіl оf Аgеіng, thе Міnіѕtrу оf Нumаn Dеvеlорmеnt, Fаmіlіеѕ, аnd Іndіgеnоuѕ Реорlеѕ Аffаіrѕ, аnd thе Unіtеd Nаtіоnѕ Dеvеlорmеnt Рrоgrаmmе (UNDР), brought together older persons with students from the University of Belize who guided the seniors through the latest technologies (BBN, 2024).

The Government of Aruba worked together with the non-profit organization Club Kibrahacha to re-launch a telephone helpline for older persons in 2023. In 2024, the Ministry provided additional funds to extend the hours of operation (GoA, 2024c).

In order to promote a positive attitude towards older persons and to dispel stereotypes, the Council of Older Persons of the Cayman Islands ran a public education and awareness campaign. Taking inspiration from the “Age Proud” campaigns that have been run in other countries, they used the hashtag #AgeProudCayman to promote and celebrate the stories of local older persons and highlight their knowledge, skills, achievements and passion (COP, 2024a).

Conclusion

Realizing the rights of older persons depends on achieving the goals contained in the Madrid Plan, the Plan of Action for the Decade of Healthy Ageing, and the SDGs. These include universal and sustainable pension and social protection systems, universal health and social care, and protection against discrimination and abuse. This article presents ample evidence of the ongoing commitment of Caribbean governments to develop policies and programmes for older persons and strengthen protection for their rights. Nevertheless, the restrictive fiscal situation in many Caribbean countries continues to mean that these interventions and social programmes for older persons are often not able to meet the demands that exist, whether in terms of reach, affordability or quality. In addition, the demographic changes which are taking place ensure that there are ever increasing numbers of older persons experiencing economic insecurity, premature morbidity and mortality, and social exclusion. In the years leading up to 2030, concerted action, therefore, is needed, within these aligned policy agendas, to close this implementation gap and improve the lives of older persons across the Caribbean.

References

Age Village (2024), “A la Martinique, les seniors lancent leur web TV”, [online] Paris, France [date of reference: 15 October 2024] https://www.agevillage.com/actualites/a-la-martinique-les-seniors-lance….

Ashby-Mitchell, K. and others (2022), “Aging and Long-Term Care in Jamaica”, Kingston, Jamaica, April.

Barbados Today (2024a), “Humphrey tables national policy as country grapples with rapidly ageing population”, Bridgetown, St. Michael, 10 August.

Barbados Today (2024b), “New elderly care facility coming to St Philip”, Bridgetown, St. Michael, 18 September.

BBN (Breaking Belize News) (2024), “University of Belize’s Senior Digital Literacy Program helps 400 seniors use digital devices effectively”, Belmopan, Belize, 2 October.

BHC (Bermuda Health Council) (2024), “Residential Care Facilities - A Data Report”, Hamilton, Bermuda, July.

BPC (Barbados Population Commission) (2024), “Barbados Population Policy”, February.

COP (Council of Older Persons) (2024a), “Age Proud” [online] Grand Cayman. Cayman Islands [date of reference: 15 October 2024] https://www.gov.ky/olderpersonscouncil/ageproud.

COP (Council of Older Persons) (2024b), “Council of Older Persons: Ageing In The Cayman Islands Forum” [online] Grand Cayman. Cayman Islands [date of reference: 14 October 2024] https://www.gov.ky/olderpersonscouncil/OPC/Forums.

ECLAC (Economic Commission for Latin America and the Caribbean) (2023), “Report of the expert group meeting on the ageing Caribbean: 20 years of the Madrid Plan of Action”, Port of Spain, Trinidad and Tobago, January

GoA (Government of Aruba) (2024a), “Launch Project PASADIA”, Oranjestad, Aruba, 9 July.

GoA (Government of Aruba) (2024b), “Project DAYCARE will have ten operational facilities this year”, Oranjestad, Aruba, 10 July.

GoA (Government of Aruba) (2024c), “Telephone for Elderly celebrates its first anniversary.”, Oranjestad, Aruba, 11 April.

GoB (Government of Bermuda) (2024a), “Board Ageing Well Committee, 2024-2030”, Government Notice, Hamilton, Bermuda, August.

GoB (Government of Bermuda) (2024b), “Public Consultation National Seniors Strategy, 2024-2030”, Hamilton, Bermuda, September.

GoB (Government of Bermuda) (2022), “Addressing the Challenge of an Ageing Population in Bermuda”, Ministry of Economy and Labour, Hamilton, Bermuda, September.

GoUSVI (Government of United States Virgin Islands) (2024), “Governor Bryan Convenes First Meeting of Commission on Aging, Strengthening Advocacy for Seniors in the Territory”, Recent News, St. Thomas, United States Virgin Islands, 11 October.

GSTT (Geriatric Society of Trinidad and Tobago) (2024), “Geriatric Society of Trinidad and Tobago” [online] Port of Spain, Trinidad and Tobago [date of reference: 13 October 2024] https://ttgeriatrics.org/.

HSA (Health Services Authority) (2023), “HSA offers new geriatric service for patients 60 and over”, Press Release, Grand Cayman. Cayman Islands, 20 July.

IMF (International Monetary Fund) (2024), “Eastern Caribbean Currency Union - Selected Issues”, IMF Country Report No. 24/94, Washington D.C., April.

IDB (Inter-American Development Bank) (2024), “Why and how to develop day centers: Putting the well-being of older people and caregivers first”, Technical Note No. IDB-TN-2924, Social Protection and Health Division, Washington D.C., April.

Loop (2024) “Legislation to protect the elderly coming soon”, Barbados, 26 March.

MoNM (Ministry of National Mobilisation, Social Development, Family, Gender Affairs and Persons with Disabilities) (2023), “Saint Vincent And The Grenadines Holds Consultation On Legislation On The Elderly Care And Protection”, Kingstown, April.

MTINO (Ministerie van Transport, Integriteit, Natuur en Ouderenzaken) (2024), “Rapport – Foro Nacional Pa Adulto Mayor”, Oranjestad, Aruba, March.

NIS (National Insurance Scheme) (2023), “Adjustments to Pensionable Age and Contribution Rates”, [online] Saint George's, Grenada [date of reference: 14 October 2024] https://www.nisgrenada.org/2023-adjustments/.

News 5 (2023), “National Summit for Older Persons 2023”, [online] Belize City, Belize [date of reference: 14 October 2024] https://archive.channel5belize.com/archives/259709.

PAHO (Pan American Health Organization) (2024), “Series - The Decade of Healthy Aging in the Americas: situation and challenges” [online] Washington D.C. [date of reference: 18 October 2024] https://www.paho.org/en/series-decade-healthy-aging-americas-situation-….

Quashie, N. and F. Jones (2023), “The ageing Caribbean: 20 years of the Madrid Plan of Action”, Studies and Perspectives series-ECLAC Subregional Headquarters for the Caribbean, No. 111 (LC/TS.2022/225-LC/CAR/TS.2022/5), Santiago, Economic Commission for Latin America and the Caribbean (ECLAC).

SSB (Social Security Board) (2023), “The Social Security Board informs you of an important change to the Contributions Regulations”, Public Notice, The Valley, Anguilla, 21 August.

United Nations (2020), “United Nations Decade of Healthy Ageing (2021–2030)”, General Assembly resolution 75/131, December.

World Health Organization (2020), “Decade of Healthy Ageing: Plan of Action”, Washington D.C., December.

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[1] Anguilla, Antigua and Barbuda, Aruba, Bahamas, Barbados, Belize, Bermuda, British Virgin Islands, Cayman Islands, Curaçao, Dominica, French Guiana, Grenada, Guadeloupe, Guyana, Jamaica, Martinique, Montserrat, Puerto Rico, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Sint Maarten, Suriname, Trinidad and Tobago, Turks and Caicos Islands, and United States Virgin Islands.

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