Transcript Excluded Older People Luke O’Shea

Excluded Older People: New
Policy Approaches
David Bartram
Social Exclusion Unit
W. and SW. Regional Housing LIN
Weston-Super-Mare 21st July 2005
What is social exclusion?
We have used a wide definition of social exclusion
to include not just those living in poverty, but
people excluded by reason of chronic ill health,
caring responsibilities etc.
“An experience characterised by poverty
and the lack of access to social networks,
activities and services that results in a poor
quality of life”
The policy shortcut – Celebrity as a driver of change
Eleanor Rigby was isolated and excluded:
- Waits at the window, wearing the face that she keeps in a
jar by the door, who is it for? – wearing make-up even
though no-one visits.
- She died in the church and was buried along with her
name, nobody came. – No friends, relatives or carers
attended the funeral. No-one will remember her.
Do overall resources reflect the scale of the problem?
…many older people experience exclusion affecting their everyday lives...
There is significant public spending on older people, but not just health, social care and
pensions. However there is significant unmet need and inequity with other age groups
in some areas.
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2.1 million people of pension age live in
poverty. 50% is due to benefits take-up;
Around 30% of people over 65 do not see
any friends at least once a week;
1 in 6 people aged 65 and over are affected
by depression.
60% of people aged 65 and over have a
long-standing illness.
Approximately one-third of people living in
“non-decent” homes are 60 or over.
Every year there are more than 20,000
excess winter deaths amongst older people.
Limiting illness
MULTIPLE
EXCLUSION
Poor
housing
Poverty
Where do excluded older people live?
…excluded older people do not just live in areas of deprivation ...
Patterns of Poverty
There are higher proportions of people above
state pension age in some areas, including
rural and coastal areas where isolation and
exclusion from services is a key issue.
There are high concentrations of
older people on low incomes in
some areas including the North
East, North West, West Midlands
and Greater London
Source: Office for National Statistics and NRU
...But services in these areas are sometimes worse.
And the picture does not ch ange when th e tim e
frame is expanded to 6 weeks!
120
120
100
100
80
80
%ageof assessmentscompleted
within 2weeksof first contact
%age of assessments completed
within 2 weeks of first contact
new clients in more deprived areas find that th ey
are less likely to have their assessments d one
quickly. This chart shows %age done in 2wks
60
40
20
0
0
20
40
60
80
100
Falling deprivation
120
140
60
40
20
0
0
20
40
60
80
100
120
140
Fallingdeprivation
-1-
Housing Issues and Older People
The majority of older people are owner
occupiers, although this proportion
decreases with age.
Overall 15% of older people live in poor housing
(housing that is unfit, in serious disrepair or in
need of essential modernisation)
In 2001 80% of older people aged 50-64 living
in private households in Great Britain were
owner-occupiers. This compares to 72% of
people aged 65 to 84 and 61% of people aged
85 and over
And over 50% over non-decent homes are lived in
by older people. (Pie chart shows those living in non-decent
Percentage of households by tenure who are 45 and
over
40
35
30
25
20
15
10
5
0
45 to 64
65 to 74
home by age of oldest member)
85 and over
16-24
25
75-84
75 and over
Rented from Rented from
council
RSL
Rented
privately
furnished
Rented
private
unfurinished
60-74
85 and over
15
10
35-49
Buying w ith
mortgage
50-59
75-84
20
25-34
60-74
Ow ned
outright
Percentage of people who are over 50
in non-decent homes by tenure, 2001
5
0
50-59
Ow ner occupiers
Private tenants
Local Authority
tenants
RSL tenants
Percentage of households, by age of oldest
person, that failed on the compenents of decent
homes, 2001
25
50-59
60-74
75-84
85 and over
20
By 2011, estimates suggest there will be
around 6m owner occupiers who are 60+,
compared with 4.5m in 1997/98.
15
10
5
0
Fitness
Disrepair
Modernisation
Thermal comfort
Are we planning ahead to predict future patterns?
…the population is getting older and this will affect exclusion and public
spending. A positive response is needed...
Economic challenges and new opportunities
•
Public spending will be affected by an ageing population.
For example the JRF calculated social care costs could double in 25 years.
Many excluded older people require intensive services and support.
An ageing population with high levels of exclusion will have considerable
economic and social consequences.
BUT exclusion, loss of function and acute needs are not an inevitable
consequence of ageing.
Preventative services and a positive approach to ageing would result in
improved quality of life and reduced demand for expensive services.
•
•
•
•
All ages
2002-2012
2002-2022
0-14
This map shows the change
in numbers over state
pension age by area (1991 2001).
15-29
30-44
45-59
Some parts of the country
will have greater costs than
others.
60-74
75+
-20%
% Change
-10%
0%
10%
20%
30%
40%
50%
60%
Over 50’s make up 33% of the population and the number is projected to increase
by 37% by 2031 bringing the number of people aged 50+ close to 27m.
Source: Office for National Statistics
What research is needed?
…funding streams and provision of services can changed to better fit these patterns...
Further exploitation of existing
data is needed to understand
basic geographical and
demographic patterns of current
and future need and ensure
funding formula reflect this.
Service providers, local and
central government need to know
how to find the most excluded.
Map of loneliness!
Some Consultation Responses
“Quality of life is
about having choices.
Services for older
people are still often
designed to suit the
provider and lack
flexibility.”
“Social networks suffer as
people get older and it
becomes harder to make
new friends. Social
isolation leads to
depression, loneliness,
anxiety which in turn stop
people from interacting
with their local community
and accessing the services
they need.”
“It’s OK to know you can do this, do that,
and do the other thing but if you can’t get
out and about you’re trapped, you’re just
unable to socialise.”
“…you want to feel that you are of
some use to society… that you’re not
just shoved on the scrapheap and
that nobody you know, that nobody
cares about you or the things that
you’ve done in your life, the
experiences that could be useful to
other people”
When I came here first (
to this group ), I was
absolutely terrified. I
did’nt really want to
come that morning…she
was so kind ( the
organiser )…I thought I
can’t do this, but I did
and I’ve never looked
back.”
“The decline of community life and
the break up of the traditional family
model, can leave older people with
few, if any, opportunities for social
interaction”
Consultation said exclusion is a result of…
Lack of access
to leisure
Poverty
Age
Discrimination
Services not
joined-up
Poor health
Bureaucracy
Together these result in
multiple disadvantage
Inappropriate
services
Lack of lower
level services
Services not
responsive to
needs of users
Social isolation
Fear of crime
Lack of
appropriate
transport
Lack of
information
Three priorities for improving services
The views expressed by respondents distil down to three key themes
for how services for excluded older people should be delivered in the
future. Keele research also supports this approach: to deliver
coordinated solutions that address but also go beyond poverty and
preventative policies to support people at key turning points in their
lives.
1 - Early intervention
and low level
services
2 - Promoting user
involvement, choice
and control
3 - Joined
up and co-ordinated
services
1 - Early intervention and low-level services
Early intervention
and low level
services
•The current provision of services for excluded older people is focused on providing
intensive, costly services once problems arise.
•Shifting the emphasis to providing lower level services, earlier - before people
develop intensive needs - means there will be less need for intensive services in the
future. This is better for individuals and less costly.
Improved access to “universal” services.
Better “joined up” rehabilitation
services.
Relatively
small numbers
of people with
high levels of
need receiving care.
Larger numbers of people who fall
outside eligibility criteria for services
but may benefit from lower level services.
Lower levels of
high cost
intensive
care
services.
Adapted from ADSS/LGA All our tomorrows
The right bit of help, for the right person…
...the same services will affect people differently...
Home
Physical
and
Practical
Personal
and
Social
Early intervention
and low level
services
External Environment
Heating/insulation, Home
safety/security, Cleaning,
Shopping, Gardening, Equipment,
Adaptations, Home Improvement
Agencies, Community Alarms, Use
of Technology,
Handyperson/repairs, Lifetime
Housing, Specialist Housing,
benefit Take-up, Equity Release
Transport, Personal safety, street
lighting, built environment
(pavements, dropped kerbs, disabled
access), traffic management,
community centres, advice centres
and one stop shops, accessible shops
with affordable products.
Befriending, Bathing, Meals
service, Hairdressing, Carers
support, Range of personal care
including nursing, intensive home
support, resettlement into
sheltered housing, floating support,
rapid response, rehabilitation,
advocacy
Leisure, Primary Health care,
Chiropody, Lifelong learning, libraries,
employment, volunteering, day care,
luncheon clubs, rehabilitation, step-up
schemes, step-down schemes,
engagement in priority setting,
community development, healthy living
schemes, peer support
...at the right time – early intervention is critical
...services are most effective if delivered at key points where risk
of decline is high...
Early intervention
and low level
services
What does the Keele research identify as key risk points in a person’s life?
•
Major risk points include the death of a carer or relative dies, loss of employment, being a victim of crime and ill
health. Vulnerability is increased when living alone and when social contact declines
Younger Adult Life
Maintaining highest
possible level of function
Functional Capacity
Childhood
Growth and
development
Older Adult Life
Maintaining independence
and preventing disability
Preventative, lowlevel services and a
positive approach to
ageing would
maintain function
across the life-course.
“Enabling
environments” such a
accessible transport,
home adaptations)
can reduce the
disability threshold
(Kalache and
Kickbush, 1997)
Disability threshold
Age
Low level services can have a
strong preventative effect if
the timing is right. At these
times services must join-up to
meet multiple needs.
Change of
role (loss of
job, family
move away)
Drop in
income
Decline
in
heath,
falls etc
Death
of a
carer or
relative
2 - Control and choice
Promoting user
involvement, choice
and control
• Excluded older people are diverse. Tailored services are needed to
reflect different people’s circumstances, preferences and cultural
backgrounds.
• Involving excluded older people in decisions and providing choice
can empower people who may feel powerless. If people can take greater
ownership of services the services become less stigmatised and more
attractive.
• User involvement and choice can also lead to more efficient services,
because individuals have a good understanding of what will work for them.
Giving people more control - for example through direct payments - has also
often reduced costs, because far from trying to ‘milk the system’, most
people take only what they need.
“Quality of life is about having choices” Consultation respondent.
Empowering older people and tackling discrimination
Promoting user
involvement, choice
and control
•Empowerment of older people and promotion of interdependence models.
“…you want to feel that you are of some use to society…that you’re
not just shoved on the scrapheap …that nobody cares about you or
the things that you’ve done in your life, the experiences that could be
useful to other people…”
•Tackling discrimination is necessary to promote empowerment and
interdependence.
•Changing the culture of society and people who provide goods and
services to older people. Workforce reform and training should be
considered.
“One thing I could still say about discrimination against older people
is in clothing. Clothing its all midriff, all these blouses just reach
below our bosoms and its all hipsters, trousers.”
A Positive Approach to Ageing
Exclusion, loss of function and acute needs are not an inevitable
consequence of ageing.
More positive images of older people – challenge age
discrimination.
With the right early intervention in later life older people can
continue to learn and develop, and to contribute,
“Enabling environments,” such as accessible transport and
home adaptations to make it easier for older people to live
independent lives – people with needs are not the problem !!
Not just a focus on public services.
Joined
up and co-ordinated
services
3 - Joining up
...older people’s services are currently too disjointed with multiple access points ...
Joined up services are
desirable for people of all ages
and from all backgrounds.
Joined up services are even
more important for excluded
older people, who may have
limited additional contact with
mainstream service providers
and lack the confidence and
social capital to seek out the
services that they need.
This means that outreach, and
proactive services, as well as
joining-up are important for
excluded older people.
Supporting People
- providing an alarm
and advice
Local Age Concern
- befriending, lunch
club and home visiting
Disabled Facilities Grant
- ramp and walk-in shower
Warm Front central heating
Housing Department
- kitchen repair
Primary Care Trust
- community nurse
Social Services home carer and shopping
Example of different agencies and funding sources
supporting a person to remain in their own home
Principles of service delivery
…people commented that Sure Start model, for services for young
children, could work equally well for older people…..
Joined
up and co-ordinated
services
1. Working with older people
Every older person should get access to a range of services that will deliver better outcomes, meeting their needs and
stretching their aspirations.
2. Services for everyone
But not the same service for everyone. Older people have distinctly different needs. Needs are different in different areas and
a person’s needs also change over time. Services should recognise and respond to these varying needs.
3. Flexible at point of delivery
All services should be designed to encourage access. For example, opening hours, location, transport, mobility and caring
issues need to be considered. Where possible we must enable older people to get the health, advice and support services
they need through a single point of contact.
4. Promoting independence and well-being
Services for older people should be preventative in approach, accessible earlier to promote independence and well-being and
halt decline. This means not only health, housing and social care services but also advice and support with transport,
mobility, leisure and employment.
5. Respectful and transparent
Services should be customer driven, whether or not the service is free.
6. Community driven and professionally co-ordinated
All professionals with an interest in older people should be sharing expertise and listening to local people on service priorities.
This should be done through consultation and by day to day listening to older people.
7. Outcome driven
All services for older people need to have as their core purpose better outcomes for older people. We need to reduce
bureaucracy and simplifying funding to ensure a joined up approach with partners.
Joined
up and co-ordinated
services
What future services might look like for an excluded older person?
A ‘SURE START ‘model would
enable a person entering at any
place in the system to receive a
seamless service.
Finance &
benefits
Key features:
•As access to services is critical for
excluded older people - this could be
via an outreach service, or via the
voluntary sector.
•The services available would not be
limited to core statutory services.
The voluntary and community
sector would be fully involved and
‘low level’ would be part of the
provision.
•There would be local involvement in
the ‘direction’ of the service.
Advocacy &
specialist
advice
Safety &
environment
Excluded
older person
Housing
Transport
Social
activities
Social care
Health
How will social change occur for excluded older people?
Government policy makers do not exist in a vacuum sifting through
evidence. Ask yourself who cares and why? Are all the pieces in
place?
- Wide academic and intellectual outrage?
- Broad voluntary sector outrage?
- Older people demanding much more?
- Public informed e.g. press representation?
- High profile cases – lonely deaths, elder abuse?
Often necessary before:
- Senior political leadership and championing
- Legislative change
- Additional commitment of resources
- Machinery of government changes
Where might we offer new leadership?
Gives a clearer voice to
excluded older people who
experience poverty and the lack
of access to social networks,
activities and services that
results in a poor quality of life.
Renewed tackling of poverty and
better services important but not
enough to end exclusion. We
need a new policy push on
isolation and poverty of social
relations.
www.socialexclusion.gov.uk
Interim report published on 15th March 2005 contains initial
findings – we see that as a second stage of consultation.
Further in depth consultation particularly with excluded older
people themselves.
Develop work on the themes referred to earlier.
Develop an agreed set of actions across Government for
Excluded Older People.
Final report out by January.
www.socialexclusion.gov.uk
Some possible questions:
1. What are your top three policy priorities?
2. Are our themes broadly right? What should central government,
local government and individual providers do?
3. When are low level services most effective? What low level
services are most effective and what evidence is there?
4. How can user involvement in services be made more effective?
5. What services should be joined up at a neighbourhood level?
6. Should tackling poverty be prioritised over other areas?
7. How can social networks be best encouraged to develop?
8. How can research be exploited to meet governments needs?
9. What would a map of loneliness look like!?