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Addressing Equalities in Older People’s Social Care.

Addressing Equalities in Older People’s Social Care.

This conference was held in January 2012. It was organised and sponsored by the Social Care Workforce Research Unit of King’s College London (which is part of the National Institute for Health Research, School for Social Care), the University of Bedfordshire, Making Research Count and Age UK London. This was their fourth joint conference.

Professor Jill Manthorpe, from King’s College London, welcomed everybody to the conference. She noted that in 2012 there will be a national celebration of ageing with the Queen’s Diamond Jubilee. This would be a welcome change from older people, ageing and an ageing population being seen as problems and a drain on the nation’s resources.

Dr Helen Carr, from the Law school of the University of Kent, looked at a specific case (McDonald vs. Kensington & Chelsea) that had gone to the Supreme Court. The case was about a decision on the needs of the elderly. This was the first time that the Supreme Court had looked at the cuts in social care in relation to the Human Rights Act and other legislation in relation to vulnerable groups. The case looked at what a council could legally do when an assessment highlighted a ‘substantial need’ but then changed the care package to fit the budget that was available. The case involved changing the provision of a night carer to assist with toileting to the use of incontinence pads for someone who was not actually incontinent. As a result of the case, the verdict made it acceptable to review an assessment in the light of the resources that are available. As long as the right procedures are followed then it does not have to consider the dignity of the individual. There was a dissenting voice which came from the only woman on the Supreme Court, Baroness Hale. Unusually, she received a considerable amount of criticism from her colleagues. As a result of the court ruling managing scarce resources is seen to be more important than meeting social needs and human dignity. During the questions and answers the question was raised of what is the definition of dignity? Is it the same for each individual or is it specific to each person?

Laura Ferguson, Director of the Campaign to End Loneliness, looked at the need to create vital connections with older people. Isolation is objectively measurable, whereas loneliness is subjective to the person, and only you can say if you are lonely. Isolation can lead to loneliness. In 2003 just under half of older people are sometimes or always lonely, with 10% saying they always feel lonely. These numbers are growing slightly. One of the key ways to combat loneliness is to give older people information. This should be accessible in ways that they find easy to access, and the internet should not be relied upon. Preventing loneliness is key to good health in later life, even more so than smoking cessation.

Dr Kritika Samsi, Research Associate at the Social Care Workforce Unit, King’s College London, looked at Championing Dementia. The initial research was looking at the Mental Capacity Act. The research into dementia was an additional part of the research. The development of the National Dementia Strategy in 2009 is linked to the Mental Capacity Act of 2005, which was launched in 2007. If the person with dementia is also isolated this can lead to additional abuse, especially financial abuse. One of the things that people with dementia face is that if they admit to being scared it could change their relationship with the carer. The Alzheimer’s Society has found two common situations where people can be open to financial abuse. Firstly is the loss of the ability to guess the cost of things and secondly there is isolation when the family carers are living a long way away. With a move to Direct Payments and Personal Budgets the potential for grooming and befriending a vulnerable person in order to abuse them has to be guarded against.

After a networking lunch Dr Elizabeth Price, the Deputy Director of Social Work, University of Hull, talked on improving social care service delivery for older lesbian, gay and bisexual people (LGB). The research found that there was a heterosexual assumption in health and social care provision. There is a legislative framework consisting of the Mental Capacity Act, The Equality Act which includes private health care provision, the Civil Partnership Act and the Equality Act (Sexual Orientation Regulations). The personalisation agenda should allow for sexually sensitive care. It was only in 1973 that homosexuality was no longer regarded as a mental health problem. Even people who have been ‘out’ for many years may become fearful in older age that remaining ‘out’ will affect their care. The needs of LGB people tend to be ignored and there is limited awareness in residential care homes. Dementia amongst LGB people may need very specific care. There are some examples of good practice but they tend to be in small pockets. The LGB community did well with the AIDS crisis. They now need to do as well with old age issues. If you do things well for minority groups, such as LGB people, then you will be likely to be getting it right for the rest of the population.

The final speaker was Gerry Zarb, Head of Human Rights in the Public Sector, at the Equality and Human Rights Commission. He presented the findings from the EHRC inquiry on human rights and home care for older people. Good practice and a human rights approach tend to come from clear leadership from the top. The risk to human rights comes when services are provided behind a closed door, as in your own home. One in five, or half a million people, have home care services. One of the key findings was that having a conversation with the person receiving care was almost more important than completing the tasks. It is the small things that tend to make a difference. As packages and care plans are trimmed to the bone as it is, any skipping of tasks would count as neglect. Care Plans rarely include social provision. For some people there was a lack of general care and dignity provided. Where time and tasks were key issues for the staff, the person receiving the care felt like a task or object. Where there are price and cost pressures, then there is increased risk to the older person. Other contributing factors include the lack of age appropriate brokerage and support. During the questions and answers a number of points were made from the floor. If care workers are treated with respect, then they are more likely to treat the older people with respect. Pressure needs to be kept up to include travelling time in the paid hours of work, so that workers are paid at least the minimum wage.

Copies of the PowerPoint presentations are available on: KCL Website 

Mark Barton, Research Plus+

www.research-plus.co.uk

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