An ageing population affects a broad range of critical issues including health, work, immigration, education, housing, and transportation.

Bermuda is already facing major challenges in caring for a burgeoning elderly population that requires support in the home, in the community, in our hospitals and in our care facilities. In Bermuda especially, all these issues are critical as we attempt to meet the demand for care workers by bringing in people from overseas.

At the same time, more and more research institutes are describing a looming 'crisis of care' as the gap between supply of, and demand for, care workers widens. This is supported by information from the American Paraprofessional Healthcare Institute (PGI) that identifies a massive shortfall of workers in the health care industry by 2016.

An example of this shortfall is the alarming statistic released by the US Bureau of Labor Statistics describing another one million direct-care workers needed in the USA alone by the year 2016, for a total of four million. This means that the total number of direct-care workers in the USA will exceed the number of all kindergarten through high school teachers (3.8 million), as well as all fast-food workers (3.5 million) and cashiers (3.4 million).

In addition, the need to support family caregivers is a key recommendation of the Fordham report "Ageing in Bermuda: meeting the needs of seniors" (2004).

Family members cannot care for the growing number of seniors in need without support from care providers and care workers, yet direct-care workers are in short supply. They are also very often under-paid and over-worked. And not only is there a shortage of workers, how do we know if they are qualified to care for our frail and vulnerable loved ones? How do we make care-related jobs more attractive? How can we attract more dedicated workers into the caring professions?

We are looking at a yawning chasm, whereby the number of women in the age group 25 to 54 forms an almost flat line in growth between now and the year 2030, while the number of people aged 65 and over will double. Women in this age group also form the majority of family caregivers AND direct-care workers. As a result, we urgently need to find ways of supporting our family caregivers while also attracting dedicated people to care-related jobs and professions.

According to PHI, direct-care workers – including home health aides, personal care aides and certified nurse aides, among others, are the "frontline" paid caregivers, most of whom serve the elderly and people with disabilities. PHI believes that, in order to raise the quality of care, the profile of direct-care workers must be raised through policy and advocacy. Their President, Steven Dawson, says "Like the rest of us, these workers want training, a decent wage, and a full-time job". But, he says, "Everyone on the long-term care team is undervalued, all along the line, from health aides and personal attendants to geriatricians and social workers".

The US Institute of Medicine, in its report "Retooling for an Aging America: Building the Health Care Workforce", concludes that "the nation is woefully unprepared to meet the social and health care needs of the burgeoning older population".

High on their list of recommendations is an increase in training opportunities for health workers who encounter older adults, with financial incentives for social workers, nurses, pharmacists, and others to meet the growing demand. This requires political will and collaborative action among policy makers, educators, and employers.

An example of collaborative action is the "CADENZA" project in Hong Kong. With a US$48 million grant from the Hong Kong Jockey Club Charities Trust, over the next five years this project will provide public education in ageing, training for informal family caregivers, support for scholarship and professional education in gerontology and geriatrics, and models of innovative care and evaluation. Also needed is urgent, collaborative action among professional bodies, unions and advocates of good employment practices around basic issues such as fair wage and benefits, health insurance, permanent employment, and standards of excellence and certification for all direct-care workers. Together with political will to make institutional change, the "CADENZA" project may prove to be a model of best practice for closing the growing gap in care for an ageing population.

Marian Sherratt is Executive Director, Bermuda Council on Ageing. She writes on issues concerning our ageing population each month in The Royal Gazette. Send email responses to info@bdaca.org