Türkiye's population is rapidly aging, with the latest data from the Turkish Statistical Institute (TurkStat) indicating a critical juncture for the country.

In 2023, the proportion of the child-age population decreased from 26.4% to 21.4%, while the proportion of those aged 65 and over increased from 7.1% to 10.2%. The median age of the country reached 35 in 2023, a historical record. The fertility rate, which stood at 2.1 in 2017, has declined to a historic low of 1.97 as of 2022. These figures underscore Türkiye's demographic challenges on the horizon, particularly in addressing the needs of its aging population. Apparently, managing the aging population will pose significant policy challenges in the coming decade as Türkiye becomes an elderly populated country. Understanding the current situation and expectations of the elderly population is therefore crucial.

A crucial recent report on this issue is the Turkish Elderly Profile Research. This pioneering study, conducted in the final months of 2023, involved interviews with approximately 29,000 individuals aged 50 and over from 22,640 households across the nation. The research, conducted in collaboration with the Ministry of Family and Social Services and TurkStat, provides valuable insights into the necessary policies for addressing the needs of senior citizens, highlighting the urgent requirement for establishing an elderly care insurance model in the country.

Health care and well-being of elderly

First, let’s look at the health conditions of the Turkish elderly. According to the report, 78 out of every 100 people over the age of 65 have a chronic disease.

It is no surprise that being healthy is the biggest source of happiness for people in this age group, similar to global examples.

According to the results of the research, 78.7% of people aged 65 have chronic diseases such as hypertension, diabetes, cardiovascular diseases, cancer, kidney failure, stroke, hepatitis and asthma. Of the elderly people who have a disability health board report, 77.6% have a disability report due to chronic diseases, 48.7% have an orthopedic disability report and 23% have a disability report due to visual impairment.

As an important indicator, the rate of those who stated that their chronic disease limits their daily activities is 32.3%. Furthermore, only two out of 10 elderly individuals over 65 report being in good health, while this proportion rises to three out of 10 among those aged 50 and older.

When elderly who had other health issues were examined, it was seen that the rate of people who had difficulty in seeing was 10.1%, the rate of those who had difficulty hearing was 10.6% and the rate of those who had difficulty speaking was 2.2%. The rate of those who had difficulty in walking, climbing or descending stairs was 27.1%, the rate of those who had difficulty in carrying or holding things was 29.7% and the rate of those who had difficulty in learning, performing four simple operations, remembering or concentrating compared to their peers was 13.8%.

When looking at the general psychology of the seniors in Türkiye, the rate of people over 65 who declared that they were generally happy was 64.1%, according to the research. As an important marker, the biggest source of happiness for 82% of people over the age of 65 is being healthy. According to the research, the rate of people who declared that they were unhappy was 8.0%. Additionally, the rate of people aged 65 and over who look at their past with happiness was 71.1%.

Increased care needs

An important aspect of the study is the growing need for care in Türkiye. According to the research, more than half of the elderly over the age of 50 state that they will receive home care services in the future. In detail, in the advanced age period, 54.6% prefer to stay at home by receiving home care/daycare services. Some 24.2% of participants prefer to stay with their son/daughter, and only 5.9% stated that they would prefer a nursing home.

When looking at the current situation, among those aged 65 needing home care support was 16.4%. This rate was 10.5% for people aged 65-74 and 26.9% for people aged 75. Yet, in contrast, the rate of people aged 65 and over who received home care support in the last 12 months is only 2.5%.

On the other hand, the proportion of those in need of care is expected to increase. According to the research, while the rate of people aged 50 who fell inside or outside the house in the last 12 months is 17.5%, this rate is 24.0% for the 65 age group. It seems that orthopedic problems, in particular, cause significant obstructions in terms of maintaining daily lives and participating in society.

When the ability of people to perform daily activities within the scope of the components included in the Lawton-Brody Instrumental Activities of Daily Living Scale is examined, it is seen that 85.7% of people aged 65 can use their phones and 55.1% can do their own shopping. It was observed that 76.6% of them could prepare their own meals and clean the house, 72.8% of the people could do laundry, 76.3% could travel, 85.5% could use their medications on their own and 74.0% could deal with their financial affairs.

When the ability of people to perform daily activities within the scope of the components included in the Katz Activities of Daily Living (ADL) scale is examined, it is seen that 86.5% of people aged 65 and over can bathe on their own, 89.5% can dress on their own and 92.1% can do go to the toilet on their own. It was observed that 92.1% of the people could move from bed to sofa on their own, 83.1% could manage their toilet needs and 95.2% could eat on their own. Figures show that the majority of Turkish seniors are in good condition in terms of living on their own without being dependent for their daily activities, yet it also shows a growing need for care.

Home care as primary preference

The study also shows that a major portion of the Turkish elderly prefer home care rather than institutionalized care. When the lifestyle preferences of those aged 65 are examined, 51.9% prefer to stay at home by receiving home care service/daycare service, 29.6% prefer to stay with their son/daughter and 5.1% seek institutionalized care in their later years.

Among men aged 65 and over, 55.7% preferred receiving home care or daycare services, 23.2% preferred staying with their son or daughter and 6.4% preferred going to a nursing home. For women, these rates were 48.8%, 34.8% and 4.1%, respectively.

Of those aged 50 and over who expressed a preference for staying in a nursing home in their later years, 41.3% cited not wanting to burden their children, 26.5% mentioned better facilities in nursing homes and 10.6% stated having no one to care for them.

The preference for nursing homes among the elderly is notably low, reflecting a cultural norm. In Turkish society, there's a longstanding tradition of families sheltering and caring for their elderly members, ensuring they remain within their social circles. Furthermore, entrusting elderly parents to nursing homes is widely regarded as socially shameful.

However, due to reasons such as the disintegration of the traditional family structure, young individuals leaving their hometowns and migrating to metropolitan cities, the increase in the number of divorces and young people moving away from traditional family values, more and more elderly are becoming in need of institutional care one way or another. The deep transformations that Turkish society is passing through are resulting in novel requirements in terms of the Turkish welfare state.

When the current situation is checked, according to the research, the rate of people aged 65 living alone is 20.4%, while the rate of people living with their spouse is 35.8%, the rate of people living with their son/daughter-in-law, daughter/son-in-law and grandchildren is 17.0%, and the rate of people living with their spouse and children is 10%. These rates show that informal social care systems are still working in Türkiye. However, it is seen that 13.3% of the elderly whose opinions were consulted said that there was no one they could ask for help in an emergency. This rate is alarming, and it will significantly increase in the forthcoming decades.

A pressing need: Long-term care insurance

The data presented clearly indicates the acute increase of elderly needing care in Turkish society. Additionally, the number of individuals living alone in Türkiye is rapidly increasing. More critically, informal family care arrangements, currently in place, are projected to become chronically inadequate within the next decade.

The solution is clear: Türkiye requires premium-based elderly care insurance immediately. The country has two decades of window of opportunity. If not established, after the aging crisis hits, care would be a great challenge that could threaten to collapse the current welfare system. Moreover, the elderly care insurance system is also a requirement for Türkiye in terms of International Labour Organisation (ILO) standards. Medical care insurance is one of the principal branches of social security offered by the ILO as a minimum standard, which is missing in Türkiye with the family insurance.

Türkiye’s need for a pay-as-you-go model elderly care insurance is not just a policy problem but also a macro-economic stability problem. The fund to be collected by the care insurance system would be a great fund for contributing to closing the savings deficit of the country. If started today, the first expenses are expected to be made within 10 years and the system will require significant spending only 20 years later. Until then, the system will be a net fund collector.

As Türkiye still has a young population compared to its European peers, and as the young will be net contributors, the system will be collecting for almost two decades, without any significant expense. The system has the potential to create a fund more than the successful Private Retirement Fund (BES) and the Unemployment Insurance Fund, with approximately $10 billion (TL 325.48 billion) within a decade. This fund, if used wisely, would help clear the burden of the current social security system as well.

In sum, Türkiye is required to step up for the long-term care insurance system immediately, for a healthy welfare state and to avoid an unbearable load on the shoulders of future generations.