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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

RT @shirleyayres: I'm impressed by the membership offer from @CollegeofSW http://bit.ly/uvTXe4 & continued discu… http://ping.fm/SPcx1

RT @shirleyayres: I'm impressed by the membership offer from @CollegeofSW http://bit.ly/uvTXe4 & continued discussions with @BASW_UK...

The Care of Older People in Norfolk Conference Report

“The Care of Older People in Norfolk” Conference Report

A conference on ‘The Care of Older People in Norfolk: Experiences of social engagement, informal care and volunteering’ was held in the Assembly Rooms Norwich on the 16^th September 2011.

The conference was organised by Mayumi Hayashi from the University of East Anglia. There were delegates from Norfolk, Cambridgeshire, London and Japan. The aim of the conference was to present the findings of a piece of research by Mayumi Hayashi, looking at community care and social engagement for older people and their carers. The research has received international recognition and looked at 21^st century care of elderly people in both the UK and Japan.

The event was held in association with CUE East (Community University Engagement) at the University of East Anglia which supports community-university engagement across all disciplines and is funded by the UK Higher Education Funding Councils, Research Councils UK and the Wellcome Trust. CUE East helped with the funding of the research. The interviews for the research are being turned into a sound archive. 

The research emphasised older people are undervalued in policy terms. The informal and the voluntary sector are very important to the care of older people. The research showed the importance and benefits of social engagement for older people, and the existence of unknown numbers of excluded older people, left isolated and struggling financially, physically and emotionally. There is a clear need to enhance services for older people to meet further demands and to compensate for the loss of public provision despite challenging circumstances. There is a mutual help network among older people. Considerable care is given by older people to other older people and care is also provided by other family members. However funding from the public sector is seen as vital. One contributor said that the Big Society cannot be funded on the cheap. There is a need for enhanced services for older people. The good practice identified has been fed into engagement activities and one-to-one befriending of isolated older people. The ‘voices’ collected have been shared through public talks, local carers’ meetings and school visits, enhancing links between the community and UEA and reaching a wide audience.  

In Norfolk people are consulted via the Older People’s Forums across the county and there is the Norfolk Older People’s Strategic Partnership Board. This is a multi agency group with a third older people’s representatives. There is a need to plan for 20 years ahead and the projected increase in older people. The government says that being an “older person” starts at 50. The implications of this are that with people living longer they could spend most of their lives as an “older person”. However most people who are 50 do not see themselves as old. There is an Action Plan which aims to help people to live independently for as long as possible. The Action Plan is for 2011 to 2014, however its implementation has been delayed because the cuts have to be factored in. In Norfolk the budget of adult social care has to be reduced by £16 million which is on top of a £11 million cut last year. Research is needed to see if older people are still able to live tolerably well after the first year of cuts.

The speaker from Age UK reported that there is considerable activity by many groups but it is fragmented and there are few links between different groups. They are also indentifying groups to work in partnership with. 

Age UK splits older people into four groups. The first group are fit and healthy, with a pension and they tend to be self sufficient. Age UK could not function without the help of this group as they are the bulk of their volunteers. At the other end of the spectrum are older people who are in need of 24 hour care and they tend to be in residential care or possibly being cared for at home. 

In between these two groups are those who are living on their own and are beginning to need some support and the other group are those who are less affluent but are surviving. Age UK has decided that they are going to focus their attention on these two middle groups to keep people out of the most needy category for as long as possible.

The Age UK review highlighted two key groups of excluded older people. The first group is Lesbian, Gay, Bi-sexual and Transgender people (LGBT). They may be resistant to speak up because of past laws. Age UK found that residential care providers are only now becoming aware that there are now older LGBT people.

The other notable excluded group is offenders and ex offenders. There is an increasing percentage of older people in prison. There are now units in the prison estate that are designed for older people. There are a number of older ex offenders of working age with limited legitimate work experience which hinders them from finding employment.

It was pointed out that as some men do not feel comfortable going to day centres it is sometimes better to have a meeting with men in a pub as there are opportunities to socialise and there is food available. It is also important to get young people and older people together. There is less contact in comparison to previous generations. There is also less contact between grandparents and grand children for a variety of reasons.

In Norfolk there are transport issues. How do you move people, especially those who are in wheelchairs, around the county in a cost efficient and sustainable way?

The Carers Forum has found that caring has an impact on the mental wellbeing of the carer. Many carers are over 65, with a substantial number over 75. Many provide over 50 hours of care a week, with some on call 24 hours a day, and consequently suffer from a lack of sleep. 81,000 people in Norfolk were identified as carers in the census. 11.6% of carers experience more ill health than would be expected. As well as providing care the carer also has to deal with other roles that they may not be used to such as finance and paying bills which can also increase stress. Carers can be fiercely independent and can refuse external help. There is a change in the relationship with the person cared for and carers have to cope with loss. There is an extended grieving process for the loss of the other person’s old persona. There is also grieving for the plans and hopes that are gone. The biggest step is making the decision that you cannot care for the person anymore. This often triggers more grieving. After the time of caring, there is stress caused by the loss of the person as well as the loss of a ‘job’. There is more psychological distress the closer the carer is to the person cared for. Support is needed at an early stage. 

Three points made in the discussions were:

Those supported by Social Services have an average age of 84 years. How do you help those who are aged 50 to 84 to age well?

How do you increase the quality of life for people in care homes? They are ‘paying customers’ and have a right to quality services.

It is important not to lose sight of preventative services as they will save money in the long run.

This event had a live twitter feed with #copn in the tweets. Thanks to all those who responded and sent retweets.

Changing The Shape Of Conferences

The influence of new media is changing the shape of conferences. The National Children and Adult Services Conference was held over 3 days in October. The twitter hash tag of #ncasc was used and over the 3 days of the conference 115,000 tweets were sent reporting on and commenting on the conference.

Following from the conference a blog was set up Connecting Social Care and Social Media blog http://bit.ly/pRKAtO with a hashtag #cscsm to follow. One of the early posts is called ‘5 reasons why social workers should use social media. http://bit.ly/qe9G2K

Using different methods of communicating

The SSRG executive committee have been looking at ways of cutting costs. One of the first results of this is that the newsletter is now delivered to your inbox. This is saving the cost of printing and postage. The same will happen to Research Policy and Planning.

Unfortunately not everyone can attend conferences. There are now ways to find out what is happening using the web. SSRGEC and careknowledge do live twitter feeds when there is a conference that they are attending. They use #hastags to help filter the input from a specific event.

SSRG has a facebook page. Please 'like' the page.

There is an SSRG group on Linkedin.

Which method of getting in touch suites you best? do follow like or join.