Grey Area: Why Age Concerns Us All

Today one in 90 Scots suffers from dementia. By 2031 it will be one in 50. During the life of the next Scottish Parliament alone, the number of people living with the condition will climb by almost 4500. But the charity Alzheimer Scotland says the country is not coping.

Kate Fearnley, policy director, says: “We are not investing enough. Services for people with dementia are patchy: what you get depends on where you live. If you need overnight care at home, you may or may not get it as part of your package of care.”

Who cares for our ageing population is a vital part of the electoral battleground. Not only are there increasing numbers of senior citizens but older people are more likely to vote than any other demographic band. Not surprisingly, politicians spend a lot of effort trying to address their concerns.

Yet a survey by Alzheimer Scotland found more than half Scotland’s local authorities could not provide overnight support to sufferers in their own home. Furthermore, one in five were not using the template for looking after dementia patients published by the Scottish Executive in 2004.

Loved ones often rally, but the strain can take its toll. Nine out of 10 carers told Alzheimer Scotland last year that they had experienced their family member wandering off or behaving aggressively. As the illness progressed, most carers were spending more than 10 hours a day with the patient.

Gaps in services affect all those involved, says Fearnley. And it is not just when they are hidden behind their own front door that the needs of dementia patients go unmet: the attention patients can expect in hospitals and care homes is also variable. “There is insufficient staff training,” she says. “People may face malnutrition and dehydration because staff do not realise they need help to eat and drink. People get their meal plonked down in front of them and taken away 20 minutes later.”

This is a familiar story among the increasingly vocal organisations that represent Scotland’s elderly. While targets to cut waiting times for operations are met, there is a sense that aspects of treatment that cannot be measured – such as the help patients receive to use a knife and fork – drift unchecked. Similarly, while arguments about council-tax bills have dominated election debates, the less quantifiable but vital services they pay for, such as daycare centres, receive less scrutiny.

David Manion, chief executive of Age Concern Scotland, says: “There are a great many services out there at the soft end’ – that enable older people to stay mobile, stay in touch – and those are the first things that will go if there is a squeeze on local government. It seems the unspoken words throughout this election are local government.”

Holyrood’s landmark policy for the elderly is delivered through councils. Free personal care – the support package available to pensioners north of the border for no charge, no matter what their means – was one of the first dramatic gestures of the parliament. It means help with intimate jobs such as getting washed should be delivered to the elderly on the same principle as NHS treatment.

But while it is the envy of campaigners in England, controversy continues to surround the deal. One snapshot survey found 50% of councils were operating waiting lists for assessing people’s personal-care needs because of a lack of staff, and more than 500 elderly people were waiting longer than six weeks for their entitlement.

Manion says: “In one of the Lothian councils it takes 12 weeks to get an assessment for a care package. In Fife they seem to be delivered within a matter of days. Of course, there are questions of efficiency, but that sort of scale of difference cannot be simply explained by differences in efficiency.” Instead, he suggests, the way the money to fund free personal care has been divided among councils needs revisiting.

“The free personal care project was absolutely the right thing to do. It is just the implementation that has been poor,” he says. “It is not unfair to suggest that the speed at which the implementation took place has had something to do with the outcome.”

It might seem harsh to punish politicians in the polling booth for doing the right thing badly, but similar issues seem to permeate the elderly sector. Delays in putting the support package someone needs in place and problems keeping it at a consistent standard are reported by pensioners and their families. This all adds up to extra stress and frustration at a time when people are already coping with new disabilities, isolation even bereavement.

“It is life’s little difficulties that confront older people on a day-to-day basis and make the difference between them leading an independent and healthy life or being sucked into the social-care system,” says Manion. “It is about not getting the grass cut because you cannot do the mowing any more or trying some small home repair yourself which goes wrong. That is why things like local social networks are very important.”

Irene Sweeney, executive member of the Scottish Pensioners Forum, describes how one 90-year-old lady’s home-help service failed during Christmas. Not only did this disrupt the support she received, she had to pay for care that wasn’t being provided. “It is things like that,” says Sweeney. “If the service breaks down which bit has broken down? Is it the local authority bit or is the voluntary organisation providing the service?

“There’s also basic things like the hassle this lady had to get a zimmer frame. You would think that would be something quite simple, but she had to go through hoops. Technically people are meant to have a single person to contact, but it doesn’t happen. You have local authority services, NHS services and voluntary services. They are all separately funded, all under-funded and the older person is in the middle.”

Despite this Ms Sweeney says when pensioners were asked to name their top concern at a community meeting, crime received the most votes. “I was surprised,” she says, going on to suggest that fear rather than experience has informed this point of view. You hear about all these callers who come to the door,” she says. “There are old people’s handbags being snatched and things like that we would never have dreamt of years ago. As you get older you are more isolated as it is.”

Will different teams pull together as the proportion of elderly people living in Scotland reaches record levels or will more pensioners fall between the cracks? The number of people living beyond the age of 75 is projected to rise 75% by 2031. Consider this alongside the theory that while we are living longer we are not necessarily enjoying more years of good health, and there’s clear cause for concern.

But Sweeney, who has 11 grandchildren, is optimistic about their futures. She says emphatically: “Society will change and older people will change with it. I’m 67 and I am a different woman than my mother when she was 67. I am far fitter and I have had more opportunities. Each generation does that.”

She points to the efforts to promote healthy eating, all the sport young people are involved in, the ban on smoking in enclosed public spaces, medical advances and the technology which already helps ailing pensioners remain independent for longer.

“This idea all these older people are going to be stuck in hovels and there are not going to be people to take care of them,” she says. “I think it’s just rubbish. We are human beings and we adapt.”

The space dedicated to older people’s issues in the manifestos this election shows priorities are already shifting. Only time will tell if we are moving fast enough.