Expanding community care will help Bermuda cope with its burgeoning elderly population, says elderly specialist Dr. Khin Myint.

And he said the proposals, put forward by consultants Arthur Andersen, would mean one-to-one treatment for many elderly citizens.

Dr. Myint, who is head of the continuing care unit at King Edward VII Memorial Hospital, said if Bermuda went the route of institutionalising older people rising life expectancy would mean around five to ten percent of the population would end up being admitted.

"That's why we are keen to take services to the community -- if old people are really very ill they can come to the hospital and then go to the homes.

"The system of health care now is very much hospital-based but it's moving towards care in the community.

"Health screening is a very important step. The Department of Health is going to undertake a pilot project. I've proposed a figure of 2,000.

"To transfer care from the hospital to the community we will need to know how many people are living in what sort of condition and we will need to know what sort of services are needed, how many can afford to have treatment.

"Care in the community is a better option because you don't want to take anyone into hospital for minor ailments.'' However, he said care in the community wasn't necessarily the cheaper option.

"If you have 100 patients scattered around you need more manpower and time to reach them.

"The provider will have to spend more but, on the other hand, the patient will get a one-to-one based service and they can stay in the comfort of their own home.'' And he said patients could then avoid the trauma of sharing accommodation with incontinent and mentally ill patients.

"At the moment the hospital has the home care system,'' said Dr. Myint.

"People go to the doctor and treatment follows but there is no mechanism for early detection of disease.'' "We are working towards early risk intervention on medical and mental risk.'' He said care workers would know who had what disease under their care and could assess if they were getting the necessary treatment.

"From a preventative aspect we could say who has high blood pressure, who are we treating and who are we not treating? Are they getting the proper treatment?'' Opposition Health spokesman Kim Young said more needed to be done with community care to help people live in their own homes. She said: "We need more people to do that, to help do their shopping or help them get dressed in the morning or dress a wound.

"If we are going to do that we also need social workers to go out and make sure these people are OK.

"Maybe we need a geriatric psychiatrist to assess if these people are showing signs of Alzheimer's, they need to be assessed in the community to find out if they need to be moved, or can stay on their own or they need more care. We need more aids. Some people don't need full-time care, just someone to check on them to see they are OK and give them a hand.

"Sometimes just opening a jar can be very difficult and frustrating.

Mrs. Young said the health care system needed to adjust to changing lifestyles.

She said: "The women used to look after the grandparents but now 78 percent of women in Bermuda who can work do so. We need to do more. We were very good with our elderly people in the days when not so many people were working. Now they have to work because of the high cost of living.'' Dr. Khin Myint