International Longevity Centre - UK

The Audit Commission has published a report entitled “Under Pressure” which looks at the way local authorities are preparing to adapt to an increasingly ageing population. The report reveals that most local authorities are failing to prepare services for an increased number of older users and the majority do not know the future financial impact that demographic change will bring. Given looming cuts in public spending, councils clearly need to do more to avoid serious problems in the future. 

Just over half the local authorities examined by the Audit Commission had any reference to demographic change in their financial plans and only one in ten had tried to calculate the potential financial impact of an ageing population on service provision and budgets. Even those authorities who had made some attempt to factor ageing into their planning had focused almost exclusively on social services and transport and not taken services such as housing and leisure into consideration. 

The report suggests that the biggest financial impact of an ageing population is likely to be social care spending, which already increased by 46% between 2000-2001 and 2007-2008. The Audit Commission recommends that local authorities invest in early intervention and prevention measures that can reduce demand or delay social care, mainly by supporting people to stay in their own homes, which is far less costly than residential care. Measures here should tackle problems such as housing, health, social isolation and informal care breakdown, all of which can increase demand for social care. 

In addition, local authorities can take advantage of technology, for example the use of telephone helplines, to provide better services and save money. The Audit Commission also advises authorities to work with older people and relevant partners to get vital on the ground input to help them better plan and deliver services that meet the needs of older residents.

Rebecca Taylor

Baroness Greengross has written for ePolitix.com ahead of her question on the extension of the job guarantees available to young unemployed people to those aged over 50.

Although I believe the government has rightly concentrated its efforts on the young, we are approaching the tipping point of claimants entering long-term unemployment, and should ensure that the economy doesn’t lose out on the skills and experience of an older generation. That is why I am calling on government to extend the job guarantee, currently available for unemployed 18-24 year-olds who have been in receipt of Jobseeker’s Allowance (JSA) for nine months, to claimants aged 50+.

For many older workers a premature exit from the job market will effectively force them into early retirement, as employers are reluctant to take them on for what they see as a short period before retirement, but can easily be for five or ten years – longer than many younger employees will remain in one job.

A recent CIPD report, Our Employee Outlook, Autumn 2009, showed that nearly three-quarters of over-55s need to work past the state pension age as the recession hits their pension. There is a worry that older people, although more likely to keep their jobs in the downturn, are finding it harder to get jobs if they do end up unemployed, and thus may drift into long-term joblessness.

Unfortunately this concern has now been vindicated by recent ONS statistics which show that the number of over-50s who have been unemployed for six to twelve months increased by 136 per cent in the year to October 2009, around double the rate of increase for young people. Furthermore, one in three unemployed over-50s have been unemployed for more than 12 months, which is the highest percentage of all of the age groups and higher than the overall average (25 per cent).

Six months is clearly a tipping point when people need to move back into the labour market or risk remaining unemployed for 12 months or more, and the government’s move to reduce the qualifying period for the job guarantee from 12 months to 6 months shows that this is a critical juncture for unemployed people.

If the 100,000 older workers who have been unemployed for 6-12 months are not helped back into work in the coming months, they will be more likely to remain on benefits until retirement. With large numbers of older workers in this unemployment bracket, I am very concerned that long-term unemployment will condemn many people to an uncomfortable retirement and force them to rely on state benefits – an additional burden on the wider economy as well as a blow to their self-esteem and sense of worth.

This article was published on 22nd February at http://www.epolitix.com/latestnews/article-detail/newsarticle/government-should-extend-job-guarantees-to-over-50s/

The Labour government came to power aiming to tackle health inequalities and committed itself in 2003 to reducing inequalities by 10% by 2010, (measured by infant mortality and life expectancy at birth). While overall life expectancy has increased, the health gap between the rich and the poor has actually increased according to “Fair Society, Healthy Lives”, a strategic review of health inequalities in England, published earlier this month. 

The review, which was led by Professor Sir Michael Marmot, says that reducing health inequalities is not only a matter of fairness and social justice, but is also vital for the economy. The cost of health inequalities leads not only to additional strain on NHS resources, but also results in lost productivity, lower tax revenues and higher benefit payments. 

Highlighted is what the review calls “the social gradient in health” - a strong correlation between health status and social circumstances such as level of education, occupation, employment status, and housing conditions. This social gradient does not just affect life expectancy, which results in an average difference of 7 years between the poorest and richest in society, but also affects disability free life expectancy, which is the number of years a person can expect to be in good health. The review reveals that people living in the poorest neighbourhoods in England can expect 17 fewer years of good health than their wealthy counterparts. 

The health inequalities arising from this social gradient cannot be satisfactorily explained by lifestyle or problems in accessing healthcare services. The review therefore recommends that health inequalities are tackled by action on a number of non health-related fronts such as early years education, employment and skills, tax and benefits, public transport, green spaces and energy efficient housing. 

The report also backs the idea of establishing a “Minimum Income for Healthy Living” (MIHL), which would provide people with the income needed for proper housing, good nutrition, transport, healthcare and physical activity. 

Despite government initiatives such as Sure Start, tax credits and pension credits having made some progress in reducing health inequalities, there is still room for significant further improvement. Any action taken needs to be across society, not just aimed at the most needy, and will requires a life course response beginning with early years initiatives and continuing through to retirement. 

The Marmot report also highlights potential fairness issues for future governments which are likely to be minded to increase the state pension age to 68 or beyond. If, as the review suggests, 75% of the population will not be in good enough health to work until that age, further action will be required to ensure that reducing social inequalities in later life. To enable people to work longer, for example, more comprehensive preventative healthcare services for the over 50s will be necessary. 

Rebecca Taylor 

David Sinclair

http://www.ucl.ac.uk/gheg/marmotreview  

Gordon Brown has this week pledged to introduce a personalised approach to social care. Dubbed the National Care Service, it could see 350,000[1] of the nation’s elderly gain greater control over how and where they are cared for. The scheme would allow the most frail or in-need to be looked after in their own homes for free. “Too good to be true”, I hear you cry. But what may seem an ambitious plan makes a lot of sense, both for the older population and the public purse.

Many of the UK’s elderly reluctantly go into care homes when they would rather stay at home. Despite the standard of care being much higher here than elsewhere in Europe, for some, it’s a matter of independence, dignity and the social ties with neighbours, family and friends.
What made a scheme of this kind unrealistic in the past is the cost of managing older people’s health needs remotely. The outcome of a lapse in care can have an expensive impact on hospital admissions and individuals’ long-term health. And with elderly patients taking an average of five prescriptions each[2], managing medication at home can create a further burden on the public budget. Whether patients don’t take medication as prescribed, or it doesn’t have the desired effect, it equates to pouring a significant portion of the NHS’ multi-billion pound drug budget down the drain. In the financial battle between care homes and home care, the residential option has traditionally come out on top.

So the question remains: how to afford the unaffordable. How to trim the cost of caring for our elderly in their own homes. Organisation is the answer. The technology and resources now exist to make this an affordable alternative to the much-travelled route from own home to care home.
Inventions like e-health and intelligent packaging make it easy for medical professionals to monitor remotely when patients take their medication. Automatic alerts sent from drug packaging to mobile phone to PC, make communication between carer, GP and family more seamless and cost effective. Plus, the expertise of local pharmacists is a largely untapped resource that could make high levels of compliance, care and recovery an achievable prospect.

We’re no longer a nation that trusts its government implicitly to look after us at all stages of life. We’re as discerning about how our share of public funds is spent, as we are our own income. That’s why Gordon Brown’s proposition to give older people more control over their care options is a step in the right direction. A move to closely monitored home care will improve health outcomes and free up space in care homes and hospitals. The savings this generates will help offset the cost of in-home care, making it a feasible and sustainable solution to the elderly’s care conundrum.

Norman Niven, CEO, Protomed

Over recent decades, rates of childlessness have increased substantially in many European countries, including the UK.  The percentage of British women remaining childless has risen since it was at its lowest level for women born in 1945 (9%), doubling to approximately 18% for women who are currently completing their childbearing years. 

Most studies of the consequences of this phenomenon have tended to focus on the psychological effects for the individual of having no children, on levels of life satisfaction, the risk of social isolation and the potential shortfall in informal care and support.  However, an important area of research recently examined in a series of journal articles[1] considers the issue of intergenerational transfers: what childless people give to their families and to society, both through transfers to next-of-kin relatives and investments in non-family networks and voluntary and charitable organisations.

Clearly, social and psychological consequences of childlessness will depend upon its causes.  For example, voluntary childlessness has very different outcomes than not being able to find a partner, infertility, surviving the death of one’s children, or being socially childless through divorce. Marital status and gender tend to mediate the consequences of childlessness, as does education, income and health.  Nevertheless, this group is often viewed as homogenous and, from the point of view of policy-makers, as a cause for concern.

In England, most informal care for older people is provided by spouses or adult children (Pickard et al. 2007).  Current policy recognises the role of the family and explicitly relies on its continuance.  A decrease in informal care provided by either of these two groups is likely to result in increases in formal care and consequently large rises in expenditure on long-term social care.  Projections indicate that care by spouses will probably increase in the future, predominantly because improvements in male mortality will mean that there will be a fall in widows (ONS 2005).  However, there are a number of reasons why care by children may decline in future years, including rising levels of childlessness.

Conversely, Kohli & Albertini (2009) looked at the flow of giving not in the form of care from children to parents, but considered how childlessness may affect intergenerational wealth transfers from the older to the younger generation.  For obvious reasons, most of the large studies of intergenerational transfers have focused on those with children, and there is a paucity of detailed information about transfers to other family members and to friends, neighbours or charitable associations.  There are also issues about levels of consumption amongst childless older people compared to those with children: are childless individuals less likely to save in their lifetime (or retirement) and therefore have less (as a proportion of lifetime wealth) to pass on to the next generation?

In ‘traditional’ family systems, childless adults usually passed on any wealth to next-of-kin – nephews, nieces or other relatives.  More recently, however, evidence suggests that giving to public or semi-public welfare organisations is increasingly important amongst the childless population.  And the church, traditionally the beneficiary of many of these donations, has now been joined by many other favoured institutional recipients.  Many of these provide a service specifically for children or young adults, and so giving to them can be seen as a specific form of intergenerational wealth transfer and optimisation of the donation environment through policies may help to foster people’s charitable giving and civic engagement.

There is no consensus on forecasting trends in future childlessness, although it seems unlikely that there will be a dramatic decrease in levels.  However, childless people are a heterogeneous group, and policies for long-term care or wealth transfers should reflect the changing demographics of our older population.

The issue of increasing levels of childlessness raises more questions than answers. And there is certainly a need for more research into the impact of childlessness in an ageing society, both for childless older people and for society at large. Looking to the future, this is an issue which policymakers must begin to engage with.
 

Laura Stoll, January 2010.
Researcher in Demography at the London School of Economics

The earthquake which struck Haiti last week has been devastating for all Haitians, but has had an especially severe impact on the older population. In this initial response phase the priority has been efforts to rescue trapped people and emergency aid to the injured. However it is also urgent to reach the most vulnerable – children, people with disabilities and older people - who need immediate help. You may have seen news reports of older people in nursing homes in desperate need. We are concerned for the immediate welfare of the residents of the Port-au-Prince Municipal Nursing Home, and have alerted the Mayor of Port-au-Prince to their plight as well as doing our utmost to get emergency supplies there immediately.

However other residential homes have also been severely affected, and HelpAge International is working to support the older residents in these homes too. Over the coming days, our local partner NGO is providing two doctors and four nurses to all the residential homes most in need in Port au Prince. We will also supply much-needed transport to get sick older people into the nearest available hospitals. 

Our partners in Haiti have been working with older people for many years, but they themselves have been severely affected by the earthquake. However some are starting to work again, and in one case have received support from the HelpAge partner in the Dominican Republic, which is sending to mobile medical units to Haiti. In addition to supporting our own partners, in the we are also be working with the major humanitarian organisations and other NGOs to ensure that they also make the protection of the most vulnerable older people a priority.

HelpAge International will also be providing direct assistance. The emergencies teams from the UK and Jamaica have had difficulties getting here, but have now arrived. They are assisting those desperately in need immediately. More of our team are coming in from the Dominican Republic, bringing emergency supplies of food, water and basic items, which are going directly to the residential care homes.

In disasters like this, but also in political emergencies, it can be a struggle to get the needs of older people recognised and response is therefore inadequate. “Time and time again, HelpAge sees this awful situation repeated. Those who are most vulnerable are last to receive aid,” says HelpAge Haiti Emergency Programme Officer, Bertin Meance. “They cannot queue for hours for food and emergency items. Nor are they the loudest demanding to know when aid will come”.

HelpAge therefore takes on a dual role – working with our partner NGOs to deliver immediate aid on the ground, but also drawing the attention of other agencies to the situation of older people. Their needs may range from appropriate food to medications for chronic conditions, and agency staff  need to be responsive and sensitive. Shock and mental trauma  are also likely to have a huge impact on older people. However over time experience shows that older people can be very resilient too, and as the rehabilitation effort gets underway can be invaluable community resources.

That though is for the future. The immediate need remains to identify and reach out to the vulnerable older people in this disaster.

Mark Gorman HelpAge International, Director of Strategic Development

If you want to support the work of HelpAge International in Haiti you can donate to the Disasters Emergency Committee appeal by clicking on the link on the HelpAge International website www.helpage.org.

Today (14 January 2010) saw the launch of the Kids In Museums Manifesto (http://www.kidsinmuseums.org.uk/our-manifesto/) which sets out 20 ways to make a visit to a museum family friendly. Amongst other things, they talk about the importance of a friendly welcome, the need to reach out to communities, and that the sector should engage younger people in the design of the services provided.

Almost all of the calls in the Manifesto would also benefit older people. In 2008, Help the Aged published Lost in the Money Maze (http://bit.ly/8MhLe0). The report set out a checklist for advice agencies and credit unions to help make themselves more accessible to older people. Whilst this report was aimed at providers of financial advice, the checklist is relevant for other services targeted at older people. Amongst other things the checklist highlighted a similar list to the Kids In Museums Manifesto: including the provision of toilets; the need for a friendly welcome; the design of promotional material; the accessibility of the building; and the importance of outreach.

Speaking at the launch Secretary of State for Children, Schools and Families, Ed Balls MP, emphasized the benefit to all ages, noting that adults would also benefit from the proposals in the Manifesto.

One of the most common observations when I’ve spoken to people about older people in museums is “We don’t need to worry. Our museums are full of older people”. But the reality is that (as the DCMS Taking Part Survey shows) there is a big drop off in participation in the cultural and heritage sector when we reach.

There is some great practice out there. A Manchester museum, for example, recently decided to introduce portable lightweight chairs which people could carry around and rest on when they needed. They found that older people (and other ages) stayed in the museum for longer. But despite the increasing recognition of the ageing of our society, it seems that the sector has been (in the main) slow to respond.

But even those museums who are active in terms of outreach for older people, few would claim to be taking a strategic approach. There must be a bigger role for Government (particularly DCMS) and the Non-Departmental Public Bodies to encourage the cultural sector to take a strategic approach to an ageing society.

This isn’t and shouldn’t be about one age group verses another. As the Manifesto shows, some basic initiatives can make museums more accessible for all.

To be fair, we have over the years seen significant progress with accessibility of museums. Speaking at the launch, Mariella Frostrup argued that it wasn’t long ago that taking kids to museums was akin to a trip to the dentist (painful).

It does however, remain sad that such basic (not even good!) practice is not widespread and that we need Manifestos to push private, public and voluntary sector organisations to deliver even the simplest of improvements to accessibility. Let’s hope that the 2011 Manifesto highlights further progress!

David Sinclair

Since the 1990’s many advanced welfare states have moved away from the delivery of home care services and towards alternative ‘cash-for-care’ schemes. This move towards self-directed care has formed the heart of the Government’s personalisation agenda and has become emblematic of Labour’s restructuring of the relationship between the citizen and the state in respect of welfare services and support. More recently the Government has also contemplated the potential of personal health budgets, which would permit individuals to buy their own health care.

Direct payments and personal budgets are viewed by many as a panacea for delivering greater choice for social care users, while at the same time containing the costs of long term care and chimes with private and third sectors expansion in developing markets in care services. Self-directed support heralds a significant shift in service provision, but also necessitates establishing a culture, support structures and processes to support it.

This new paradigmatic shift in social care has prompted concern and questions across the health and social care arena. Self directed support per se is a relatively new concept and as yet the long term implications and potential benefits/disadvantages have yet to be fully explored. The move to extend this form of self-directed support to people, who were previously not considered suitable, also merits greater attention. In particular there is a significant absence of research examining the potential challenges and consequences for people with dementia.

With the ageing of the UK population and the demand for all forms of personal long-term care in the UK expected to rise, it is imperative policy-makers have a clear understanding of the effect and consequences of extending direct payments to older people. This is particularly pertinent with regard to people with dementia given the specific issues and challenges in respect of consent, mental capacity and safeguarding. While there seems to be broad support for the proposal to extend direct payments to people with dementia from health and social care professionals, and third sector bodies and user groups, there must be clearer evidence, information and support on how self-directed support can work more generally for people with dementia and their families.

Until relatively recently, few people with dementia were eligible for direct payments. According to a NAO report in 2007 (http://www.nao.org.uk/publications/0607/support_for_people_with_dement.aspx), this was partly due to barriers within the system and the inherent complexities embedded within it.  Implicit within this are the attitudes and culture of social care professionals, who are considered by some to be reluctant to explore how direct payments can work for people who lack capacity. It is not only a question of education and training to support professionals, but how the system can be adapted and modified to respond to the needs of this specific cohort of users.

If we are to impose such a radical vision for social care, it will also be necessary to engender a sea change in thinking amongst older people and their families. As a SCIE report (2004) pointed out, it cannot be assumed that older people and their families will automatically consider autonomy, choice and control an attractive proposition.

There are also a number of wider questions that need to be addressed, namely: How would direct payments need to be adapted to be suitable for use by individuals with dementia? What are the barriers and challenges that hamper individuals with dementia using direct payments? And what criteria would need to be adopted to facilitate people with dementia using direct payments? Unless we answer such questions we are in danger of following a path with no real understanding of just where it may lead…

Sally-Marie Bamford

If two hands are better than one, how about four paws? Such an opening gambit may seem nonsensical, but the psychological, social and functional benefits of canine-human interaction are slowly being acknowledged in the health and social care arena. Across the generations, the therapeutic value of man’s best friend is well attested, with a notable emphasis on the emotional and positive aspects of this interplay. Today, however canine and more generally animal interaction is perceived to yield wider benefits not only for the individual, but potentially for the public purse.

The benefits of ‘animal interaction’ for more vulnerable sectors of the populace has been the subject of academic exploration for over 20 years and pet ownership in particular has been perceived to be important for older people (See McNicholas et al, 2005). The psychological advantages are numerous, including: providing companionship; facilitating social interactions and providing a sense of routine and purpose.  Pets can also promote physical activity. Geriatric researchers from the University of Guelph in Ontario, Canada, demonstrated that older people who own pets are more active than those who do not, scoring higher in their ability to carry out normal daily activities.

Furthermore pet therapy has proven to be effective for older people suffering from some forms of dementia. Interaction with the animals has shown to reduce behavioural disturbances like agitation and aggression and inflections of mood like anxiety, apathy and depression (See Colombo et al, 2006). Furthermore it has also been suggested pet therapy can stimulate psychological and mental residual functions like long-term memory (through the evocation of memories related to past pets) and non-verbal and verbal communication.

The introduction of pets in residential care has also proven psychological, emotional and physical benefits, a report by the Joseph Rowntree Foundation in 1993 found that pet ownership was largely neglected by policy makers and managers of care facilities, with many older people being forced to give up their much loved pets. Approximately 2.75 million older people currently requiring residential care are pet owners and yet over 60% of care facilities for older people require them to give up their pets. The consequent distress caused by the loss of a pet is evident, with several surveys of care homes reporting older people suffering from depression and grief as a result.

However beyond the associated health benefits, dogs in particular can also provide invaluable functional support for disabled and vulnerable people in their everyday lives’. Assistance dogs have thus not only been shown to enhance the confidence and general social interaction of the owner, but have served to act as social catalysts and facilitators. Indie, a Labrador from Surrey, provides daily support to Wendy Plus from Surrey, who pays for Indie through direct payments. Until recently, Surrey County Council along with other councils refused to recognise dogs as carers. However Surrey Council relented and now Indie is part of Wendy’s official care package, with the estimated potential savings to Surrey Social Services to be as much as £23,000 a year (this includes the £8.50 a week in food and vet bills!)[i].

So if the Government continues to move towards self-directed care in the form of direct payments and individual budgets, will there be a demand for more assistance dogs to offer support and independence to not only disabled people but perhaps older people as well? Assistance dogs can not only carry out and assist with everyday living - their skills include: loading and unloading washing machines, picking up items on command and paying for shopping - but also and critically for older people aid and promote confidence and social interaction. A study of fifty seven recipients of ‘Dogs for the Disabled’ (Lane et al 1998) reported almost all owners, over ninety two percent, experienced substantial improvement in integration as a result of being with their assistance dog. Furthermore owners reported that the increased interactions differed qualitatively from those experienced when not with their dog. Overall over a third felt their social life had developed as a direct result.

Evidently pet therapy, pets in general and assistance dogs are not a panacea for the wider perennial problems experienced by disabled or older people. Nevertheless for certain individuals in certain circumstances their role can be truly transformative and may in the process, even save a few coffers for the public purse…

 Sally Marie Bamford

We all know the population is shifting, with older people forming a significant proportion of the population.  But there is more than one type of change happening.  The phenomenon of increasing obesity levels in the UK has led to a raft of public health initiatives aimed at tackling the diet, health and well being of people of all ages.  It is well documented that changes in behaviour can be slow to happen and at the moment most initiatives appear to be stemming the tide rather than turning it, but there is no doubt that people’s body shapes are changing.  Less well documented are changes in height; Europeans are on average getting taller and the universal approved heights for everything from beds to transport is increasingly too small or short.

So, if the age, size and shape making up the average person in the UK is changing, how do we address the needs of this new society?  Design has a key role to play and the Crucible team at University College London are keen to explore this area.  Crucible is a multi-disciplinary project joint funded by the UK Research Councils, which aims to encourage research to meet the challenges of lifelong health and well being.

A one day event held in London on the 26^th November 2009 examined the issue of transport and how it can be adapted to better meet the changing needs (and size) of its users.  The challenge is in creating a new public transport scheme within the confines of the current system and in a way which ensures accessibility for all.  A part of developing new transport is understanding the different needs of transport users, whether for commuting or leisure, in rural or urban centres.  

Passenger surveys and market research have identified that people are willing to be flexible with regard to their requirements.  This is particularly true for commuters who report that space is of the greatest importance and people would rather stand than be squashed into seats which are small and cramped.  There appears to be a space vs standing trade off which could support designers in making more functional and accessible services.  In addition issues of culture, attitudes and preferences also play a role e.g. attitudes to personal space, music, eating, mobility aids etc.  The key is building in flexibility which allows for these issues, particularly in terms of older users, given the strong links between age and disability (two thirds of disabled people are over the state retirement age). 

For older people, seats are of vital importance as are access to doors and fear of falling.   Whilst being aware of these issues, it can be hard for designers to put themselves in other’s shoes and develop new systems which reflect the needs of a range of consumers.  One solution is to get the passenger involved in the design process.  This has worked well in Barcelona where designers invited blind passengers to design the ticket machines for the metro system.  This method ensured universal design, easy access and met the needs of all users.  Similarly passengers find the poor provision of information frustrating and should be involved in the development of new systems. 

Underpinning all of these issues is law, namely entitlement, anti-discrimination law and the Disability Discrimination Act (DDA).  There is much discussion over whether those with a very high Body Mass Index should qualify as disabled under the DDA, but this currently must be linked to a health condition.  Similarly an individual, who is becoming less mobile in older age, does not necessarily qualify as registered disabled.  Forward thinking companies are beginning to consider how best to address these issues, but that attitude is by no means universal.

Transport affects us all.  Regardless of our needs and requirements, we all have to get around.  However it is not an issue that can be solved in a day.  It must take into account: design, passenger perception and attitudes, the needs of all groups, age related issues, the changing size and shape of the population it supports and current legislation and law.  Those companies who are addressing these issues now are ahead of the game and the people we all want to be travelling with, but despite vast improvements, until we work out a way of ensuring universal access for all, transport will continue to be a challenge for many.

Lisa Wilson