Guest blog: What burden of ageing?

This guest blog was contributed by Rob Greig, Chief Executive at the National Development Team for Inclusion (NDTi)

The area of government policy that has continually depressed me the most (and I’m talking successive governments here) is that around older people and ageing. What we at NDTi call the ‘demographic dialogue’ of public policy and the media creates a culture whereby older people are seen as a problem and a burden on society.

Read almost anything from government policy, think tanks or the national press and you will see older people being described negatively. They are ‘bed blockers’ in hospitals, creating a ‘financial precipice’ in public finances and the cause of a pension system crisis that means younger people will have to work longer. Older people are portrayed as being the cause of problems that government and society have to address.

I beg to differ.  There are 3 fundamental flaws in this perception of older citizens:

  • It sees older people as primarily passive recipients of services provided by the state or wider society, denying or even discouraging their capacity to continue to give to the communities around them.
  • The service and cost modelling is substantially based on an assumption that we will do the same in the future as we have done in the past – rather than explore more innovative options that could change the financial parameters
  • It conveniently appears to forget the contributions that people have made to society, through their work, taxes, caring and creativity. Is it too old-fashioned to still think that society may have some obligation in the form of ‘pay-back’ time that should argue against using the language of burden?

I will put the third point to one side as it is primarily influenced by values and opinions and instead focus on the first two – and tell you about Ted.

Continue reading “Guest blog: What burden of ageing?”

Sheltered and retirement housing – ‘Making it Work for Us’

Age UK has launched a new report on sheltered and retirement housing ‘Making it Work for Us’, coinciding with a meeting of MPs and Peers to discuss reforms to leasehold housing. The complexity of leasehold agreements in retirement housing makes some older people vulnerable to financial exploitation – an issue we address in our report. Older residents tell us they are increasingly concerned about lack of transparency in leasehold contracts, particular in regard to service charges.

To produce the report Age UK supported a panel of older residents to look at how sheltered and retirement housing could be improved. Most of the residents were positive about what retirement housing could offer, but had concerns about a failure to address issues around bad practice.

Why is this so important? Currently only a very small percentage of older people actually live in retirement housing; the vast majority live in ordinary mainstream housing. Yet there is a growing interest in the role of retirement housing in freeing up larger family homes for younger people.  Achieving this is difficult when there just isn’t enough affordable, well designed retirement housing in the right locations to make a real difference. Continue reading “Sheltered and retirement housing – ‘Making it Work for Us’”

Why we must celebrate – not ignore – ageing

 This guest blog was contributed by Julia Unwin, Chief Executive of the Joseph Rowntree Foundation. This forms part of our Expert Series which highlights the work of those influencing, designing, commissioning and delivering services for people in later life.

This decade is one of transition – transition as we adapt to our economic circumstances, transition as we try to reduce the impact of climate change, and

Julia Unwin, Chief Executive, Joseph Rowntree Foundation

transition as we conserve resources of all kinds. But it is also a time of transition in terms of demography.

We are an ageing society. This is a cause for great celebration, and one of the triumphs of our time. But it does also represent a transition, as we get used to the fact that we are indeed all ageing and this has implications for us personally, and for policy-makers. We can bury our heads in the sand and pretend this is not really happening. We can hide behind jokes about getting older, behave as if ‘it won’t happen to us’ and allow policy-makers to ignore this major challenge to the ways in which we organise ourselves. We can collude with the view that once we are no longer economically active, we are no longer worthy of consideration. That way we will never have a sensible settlement for meeting the real costs of long term care. We will never resolve a better way for providing pensions. We will continue to think that more of the same will provide answers, even though we know it won’t. And we will continue to treat residential care as a dread destination, rather than a place of opportunity and growth.

The alternative is to embrace this change, and recognise the great prize of a longer life, seize the opportunities that it offers and stop being scared. To do this we need to hear from people who are themselves older, understand their very different experiences, and start to think much more honestly, and much more creatively, about the ways in which we want to shape a good old age, both for ourselves as individuals and as society. An ageing society can be one that values difference, and recognises the very rich and different contribution that we will all be able to make. An ageing society can be one that uses all the skills, experience and talents of all of us as we age. It would recognise that older age is not only about loss, there are rewards and excitement too. It would therefore be a society that is better for all of us. It would be one in which frailty is no longer equated with powerlessness, dependence no longer seen as weakness.

 If we start to see growing old as an important and natural transition in our own lives, we will also be able to build a society that makes this transition in a just, considered and creative way. Such a society will be able to respond to the changing needs of all parts of its population, without hiding behind lazy stereotypes and prejudice. It will structure policies and practice that meet the needs of real people, not just imagined nightmares. 

In a good society, ageing will be seen as an inevitable and important part of life’s journey. Older people themselves will shape, design and provide the services they want. Policy-makers, practitioners and older people together will develop activities and services that meet our very different needs. Services and activities for older people will be at the heart of communities meeting the needs of all generations, shaped by the needs, aspirations and desires of older people but meeting all our needs. Intergenerational activity benefits us all. It allows us to share scarce resources, but also share the joys, and the pains of ageing. Our changing demography provides us with a golden opportunity to re-shape dramatically our attitudes to ageing, and to engage in that great transition with creativity and with courage. Failing to take that opportunity means that the lives of all of us will be considerably poorer.

The Joseph Rowntree Foundation’s ‘A Better Life’ programme aims to hear from older people about what they want and value in life, and help bring their words and images to a wider range of people.

Find out more about the ‘A Better Life’ programme

Find out more about Age UK’s Expert Series

Read the latest blog posts from the Joseph Rowntree Foundation

The Future of Care Homes?

This blog was contributed by David Richardson, Strategic Programmes Delivery Manager for Age UK. David develops and tests innovative services that address the needs of older people.

There’s an expectation, almost a mantra, that the future of caring for individuals with increasing support needs lies in their own homes. Tailored care packages will be delivered seamlessly and altered to meet changing individual need and preference. Care homes are redundant. Does it not sound a little utopian?

What does this mean for real people living in real communities?

Most domiciliary care packages address physical needs, although of varying quality and quantity. They are less successful in meeting psychological and social needs. Being at home all day with a succession of “help” is still a lonely and isolating experience with long term consequences for wellbeing. We are very good a deciding what is best for older people (that is those at least 20 years older than one’s self). But do we really know? The recent Joseph Rowntree Foundation (JRF) report A Better Life – what older people with high support needs value casts some much needed light on this neglected area.  

Is the move to providing yet more care in a person’s own home possibly driven by other considerations, perhaps the often expressed guilt of “have to put mother in a care home?”

There is another way. Residential care homes have provided safe havens for those with high support needs for many years. A few, rightly vilified by the tabloid press, have produced appalling experiences for their residents. Rather more provide a “satisfactory” level of care while a minority provide exemplary support. What defines satisfactory I don’t propose to unpack here – not least since it depends on your perspective.  There is another way.  The other way is emerging from the collaboration between City University and Age UK which is My Home Life.

My Home Life works towards just that – where living in a community is the chosen home for each individual, in the same way that they might have chosen to move house. Hence this initiative. In their new home residents are able to express voice, choice and control over their care and support. Still too utopian? Over 4,000 registered home managers, the National Care Forum together with other key care home organisations and regulators don’t agree.

Over the last four years My Home Life has developed an extensive evidence base of existing best practice in care homes. It promotes care homes as a positive accommodation option for older people where resident centred care delivers profound improvements to the quality of life experienced by care home residents. The chosen agent for change is care home managers themselves.

Care home managers undertake a structured leadership and management training programme which helps them to take a different view of their own domain. A common thread from their action learning groups is their identification that task-based approaches to delivering care are restrictive, not just for residents but actually for their staff; tasks become activities.

Typically, it takes two years to change the philosophy and practices of care delivery in a care home. Philosophy? Empowering care staff to think about what they need to do rather than processing tasks takes time. Adopting best practise over ‘drugs rounds’; embracing risk-taking for residents and opening the doors to the wider community also take time and challenges “but we’ve always done it this way”.

Putting residents firmly at the centre of all activities is empowering for the whole care home community – residents and their families, care staff, visiting health and social care professionals, regulators and commissioners.

The nagging utopian theme is still there, especially for care home operators and owners who have to get a return on their investment. There is strong anecdotal evidence that My Home Life has a positive impact on the ‘bottom line’. Staff turnover reduces, retention improves, sickness absence reduces. Void rates improve. This combination has a strong effect on margins and encourages investment in the training.

Commissioners in a number of local authorities have identified this collaborative programme as a powerful tool to improve safeguarding in care homes by driving up positive practice. Effectively, every member of the care team becomes a champion for residents who also have their own voice heard.

Improving the lives of some of the most frail and vulnerable older people approaching the end of their life is challenging. My Home Life provides a gateway to doing that. The future needs for those with increasing physical and emotional needs can be met in their own home – a home in the community where others are on hand to provide support.

Age UK are calling on the Government to reform the social care system. Find out more about Age UK’s Care in Crisis campaign and how to sign up to our petition.  

Read more about the My Home Life programme

View a presentation about My Home Life

Citizens or consumers? How older people can influence care and support services

About fifteen years ago I worked for a local authority developing a ‘user involvement’ strategy for social services. It wasn’t an authority noted for gung ho radicalism, so I had to put my disability rights background on one side and adopt a ‘total quality’ approach focussed on how user empowerment could be part of a wider quality system.  I was then completely wrong footed when the Director of Housing and Social Services pointed out that in housing the local authority had been much more radical than anything I had advocated and were putting real power in the hands of residents by transferring all housing stock to a tenant management co-operative. The co-operative would take decisions about resource allocation including potentially sensitive issues such as which housing stock would be refurbished first.

So, fifteen years later, how far have we moved on? Are people who use social services in control of how those services are planned, managed and commissioned? The Joseph Rowntree Foundation published a new report ‘Involving Older People in Service Commissioning – more power to their elbow’’ last week.  (http://www.jrf.org.uk/publications/involving-older-people-more-power-to-their-elbow). The report concludes that, despite increased policy emphasis on user voice and choice, there are few examples of older people having a real say in commissioning or service planning.

Perhaps the most interesting part of the report is it’s analysis of how local authorities are involving older people. This analysis argues that, broadly speaking, local authorities take one of two approaches, viewing older people either as citizens or as consumers. Citizen involvement seeks to involve the whole community, including older people who are now in good health and might find it difficult to anticipate future needs. It is not focussed on services but on how councils can promote continued independence and wellbeing. In contrast consumer involvement is more limited. It seeks to involve existing service users and the focus is on improving the quality of services. Consumer user involvement is usually initiated and led by service providers.

Current government policy does indeed seem to reflect a dichotomy between ‘democratic’ involvement. Involving the community (citizens) in decision making as part of the localism agenda and a ‘consumerist’ approach to personalisation, turning ‘service users’ into ‘budget holders’ who will be able to exercise power as customers. Reliance on the latter approach alone has been criticised by some, including Age UK, for failing to take account of the imperfections of social care markets or the barriers to service users acting as empowered consumers. It’s also a far cry from the emphasis on mutual and peer support which underpinned the philosophy of ‘independent living’ developed by disabled people from the 1960’s onwards.

The other problem with this dual approach, based on wide democratic involvement and consumerism is that it leaves out a third group – people who do not meet eligibility criteria for local authority care but who need support to remain independent or know that they are likely to in the near future. This group do not qualify as ‘service users’ but neither is their perspective that of the general citizen – the availability of good social care services is a much more important and pressing issue.

The Rowntree report includes in depth studies of two local authorities, Salford and Dorset, who are seen as models of good practice. In both cases one of the keys to bridging the gap between ‘citizens’ and ‘service users’ seems to be the involvement of Older People’s forums and of organisations arising from the ‘POPPS’  (Partnerships with Older People Programme) projects. Older people were involved  influencing the planning and development of extra care housing, helping to redesign older people’s mental health services, and redesigning hospital and community services.

So there are a whole range of ways in which older people can take control of services. Rights, democratic control, involvement of service users and of groups representing a broader range of older people, personal budgets, good quality systems,  with effective mechanisms for giving a voice to service users, mutual and peer support, and outright service user control should all be on the agenda.