The progressive increase in the number of elderly and the longer life spans being attained by a greater proportion of them havereated problems in care and service delivery. Care of the elderly requires a partnership between various sectors of government, the health and community development professions and voluntary agencies.

Acute and long term care
Acute care of the elderly is largely provided by institutions like hospitals and clinics staffed with appropriate staff. It is the long-term care of the elderly that has posed the most problems in many countries, including Anguilla.
Long-term care of the elderly is primarily concerned with maintaining and improving the ability of elderly people with disabilities to function independently as possible for as long as possible.
Long-term care for the elderly covers a broad range of activities. These include assistance with basic activities of daily living such as bathing, dressing and eating, life management activities like money management, medication management and transportation, assistive devices like canes and walkers and home modification like building ramps and installation of grab bars and door handles, that are easy to use, and human support services.

Family care
Contrary to popular belief, most elderly people in Anguilla are not disabled or dependent. They live in their own homes or in the houses of relatives and require mainly primary health care. Most of the care at home is provided by females. These include daughters, daughters-in law, sisters and other relatives. Many of these individuals work long hours with little financial reward and are often not appreciated by other members of the community. In the last few decades some family members in Anguilla have abandoned their role to take care of their elderly but it is hope that the tradition for family members to take care of their elderly will be maintained in Anguilla despite the many challenges.

Geriatric services
Geriatrics services in most countries focused on the clinical, preventive, remedial and social aspects of illness in the elderly. These services include home visiting, outpatient clinics, day hospitals and long-stay rehabilitation and acute assessment facilities. In Anguilla, community members, nurses and other personnel within the existing primary health care system provide care to the elderly when required. While there may not be a need for a specialist in geriatrics in Anguilla, more physicians should receive training in geriatric and receive gerontological information.

Institutional care
Although care by family is preferred by the elderly in most cases, it is a mistake to view all institutional care for long-term care as inappropriate. Caring for the elderly can pose severe hardship for some family members. A comprehensive assessment is needed to determine the most appropriate location for care of the elderly. Careful attention is needed to avoid maintaining an elderly person in the community when this is not in the best interest of either the person or the support system.
The Miriam Gumbs Senior Citizen Home in Anguilla provides many services to the elderly including food, shelter, recreation and personal assistance. Care is provided in as homely an environment as possible.

Home-care services
Home-care services are crucial for care of the elderly. A coordinated home-care programme is one that provides medical, nursing, social and related services in an elderly person’s own home, and also helps with the household chores. It is hoped that the home-care services in Anguilla will be strengthened in the very near future.

Challenges for the care of the elderly
There are many areas for improvement in the care of the elderly in Anguilla.
There are many caregivers working, in Anguilla, in various households. Several of them are either untrained or poorly trained in the needs and demands of the elderly and how to care for them. This area needs to be addressed urgently.
Special programmes should be developed to assist the family in its traditional role of supporting older members.
Older persons should have an active voice in decisions concerning services provided for them.
Prompt medical care and treatment should be available to the elderly at all times.
There should be stringent entry requirements and rigorous quality control of long term care in residential institutions.
Provision of a range of concessions is recommended for the elderly in such areas as medications and laboratory investigations at government health institutions.
Promotion of income-generating projects involving the aged and their families to enable them to achieve some degree of self-sufficiency is urgently needed.

Conclusion
The long-term care of the elderly is a challenge for many countries, including Anguilla. There are significantly more people living beyond the age of 65 years due to many factors including advances in medicine. The challenge for us is maintaining the quality of life of the elderly and reducing the burden of disability and illness to a very low level. There is need for a national comprehensive plan and programmes that coordinates all aspects of the care of the elderly in Anguilla. This plan should involve all stakeholders including elderly citizens as well.

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