A better life: valuing our later years
By Reports & Resources,

What can help older people with high support needs to improve their quality of life? This research rounds-up JRF’s A Better Life programme of work and presents a vision of what life can, and should, be like for all of us as we get older. The following challenges emerged from this work and we hope they will form the bedrock on which joint solutions can be developed:

  •     We all need positive images and balanced narratives to challenge ageist assumptions. Old age is not about ‘them’, it is about all of us.
  •     We all need to make the effort to see and hear the individual behind the label or diagnosis, taking into account the increasing diversity of older people as a demographic group.
  •     We must ensure that all support is founded in, and reflects, meaningful and rewarding relationships. Connecting with others is a fundamental human need, whatever our age or support needs.
  •     We need to use the many assets, strengths and resources of older people with high support needs through recognising and creating opportunities for them to both give and receive support.
  •     We must all be treated as citizens: equal stakeholders with both rights and responsibilities, not only as passive recipients of care. We must also have clarity on what we can reasonably expect from publicly-funded services and what we will need to take responsibility for ourselves.
  •     The individual and collective voices of older people with high support needs should be heard and given power. We must use a much wider range of approaches to enable this.
  •     We need to be open to radical and innovative approaches; but we also need to consider how, often simple, changes can improve lives within existing models.

These challenges are not specific to a particular sector, service or profession: a key message is that these apply in care homes, health services, voluntary sector organisations and older peoples’ lives.

Key points:

  •     We all need positive images and balanced narratives to challenge ageist assumptions. Old age is not about ‘them’, it is about all of us.
  •     We all need to make the effort to see and hear the individual behind the label or diagnosis, taking into account the increasing diversity of older people as a demographic group.
  •     We must ensure that all support is founded in, and reflects, meaningful and rewarding relationships. Connecting with others is a fundamental human need whatever our age or support needs.
  •     We need to use the many assets, strengths and resources of older people with high support needs through recognising and creating opportunities for them to both give and receive support.
  •     We must all be treated as citizens: equal stakeholders with both rights and responsibilities, not only as passive recipients of care. We must also have clarity on what we can reasonably expect from publicly-funded services and what we will need to take responsibility for ourselves.
  •     The individual and collective voices of older people with high support needs should be heard and given power. We must use a much wider range of approaches to enable this.
  •     We need to be open to radical and innovative approaches; but we also need to consider how, often simple, changes can improve lives within existing models.

Background

The world has changed since this work began. We are facing a major crisis in the funding of public sector services, particularly in social care, with successive rounds of cuts forcing the withdrawal of services and tightening of eligibility criteria in many areas. Recent scandals in health and social care suggest that some over-stretched services are failing to provide older people with basic dignity and nutrition. Many of the voluntary sector organisations on which older people depended for practical, social and emotional support, transport and activities have reduced services or closed. Meanwhile, cuts are threatening the local infrastructure – community buildings, libraries and parks – which promotes the wellbeing of older people and those who support them.

Yet our population is continuing to age at a dramatic rate. The number of people aged 85 and over in the UK (1.4 million in 2012) is predicted to double in the next 20 years and nearly treble in the next 30. As this age group grows, it seems likely that the proportion with chronic conditions and (often multiple) disabilities will also increase. Around 40% of people aged 85 and over already have a severe disability that makes it difficult for them to carry out daily activities (Falkingham, 2010).

Public services in their current state cannot keep up with growing demand. The private sector plays a key role (particularly in England, though increasingly in Scotland, Wales and Northern Ireland), providing care homes, retirement housing and home-based care services. Much private provision is simply contracted out local authority provision (and therefore subject to the same challenges of limited public funding) or, where it is a pure private exchange between provider and customer, is not affordable for significant swathes of the population. There is poor practice in parts of the private sector, where compassion seems to have been squeezed out to maximise profit, but as our evidence shows there is also plenty of excellent and creative practice here – driven by a real focus on what older people want (Owen 2012).

To date, most of the political debate on ageing has focused on the ‘demographic time bomb’ and on what the state can (or cannot) afford, specifically in relation to the funding of long-term social care for those individuals who need it. The A Better Life work has sought to widen the parameters of the discussion and to assert that a good life goes beyond just what the state can afford. It is also not just about social care or even wider services, and does not only concern individuals.