For the past several years many of the conversations I have had with colleagues and members of the public have been about the state of health and social care services for older people. Hardly anyone I know in my age group – mid 50’s has not been affected personally. The old adage – you don’t really know what something is like until you experience it seems to apply. Stories of poor care and frustration with systems abide. Those of us who have been able to “buy” our way out of trouble have fared no better than those reliant on the state. Indeed the problems of trying to purchase care and the lack of advice if one does not fit the financial eligibility criteria can make it worse. If you chuck personalisation aka direct payments and individual budgets and there is a toxic mix.
Another factor that people my age are more than aware of is that it will soon be our turn. Discussions turn not only to services now but also the future and this includes the thorny issue of the right to die. We are clueing ourselves up on the Mental Capacity Act, “living wills” etc. (A British Social Attitudes Survey in 2010 found more than 80% of people support assisted dying). We are also very conscious of the importance of safeguards and how acutely difficult it is when one has to have the discussion with doctors about loved ones and “give permission” for the only intervention to be TLC. (And yes those decisions go on in thousands of families each year now, uncomfortably grafted into discussions about “End of Life Care”).
Social workers working with older people are deeply frustrated with the current systems. They rarely have time to assess and support people properly and detest the tick box mentality of the systems that they have to work within. Yet we know that frequently older people and their families want to talk through their concerns and worries and that the oft neglected psycho-social interventions are not only valued but they also lead to better decisions in terms of cost.
Home care services used to be the eyes and ears of social workers, but now that they have nearly all been privatised that relationship has been lost at great cost both financially and in terms of good practice. Increasingly residential care is a dominated by accountants and shareholders. In my view nobody should go into care without the option of trying to return home, but which manager of a residential home is allowed to encourage that?
As those of us who have had first-hand experience of hospitals and older people’s services there is the major issue of institutional ageism. Not that there are not bad staff, but in our experience it is so often the system that is at fault and it is very difficult to make any progress if a complaint is about a general issue – older people not being given help to eat for example. Safeguarding doesn’t seem to get institutional age discrimination. If you add on discrimination about people who work with older people – nearly all low paid and part time the picture gets worse.
There have been so many inquiries, reports, pending reports and recommendations that it is impossible to keep abreast of them all. None of the findings were a shock to social workers. The following are just a few:
- November 2011 “Close to home: older people and human rights in home care”. The report cites disturbing evidence that the poor treatment of many older people is breaching their human rights and too many are struggling to voice their concerns about their care or be listened to about what kind of support they want.
- We are waiting the promised White Paper on care reform in the spring. I can guarantee there will be a late spring this year
- There are calls for an international human rights convention to recognise specifically that age discrimination should not be allowed. (See Age UK).
- Last week there was a call for the new Dignity Code to prevent abuse. This was made in a letter to The Daily Telegraph signed by the care minister Paul Burstow and his Labour shadow, Liz Kendall. The signatories are backing a new “Dignity Code”
- We are awaiting information about the latest enquiry into the Mid Staffordshire Hospital Scandal
- Today heard that the Government has decided to delay a decision on implementation of its proposed ban on age discrimination in the provision of services, which it had envisaged bringing into force in April 2012. This means that any ban is unlikely to come into effect before October 2012
- And finally “The Best Exotic Marigold Hotel” was launched this week. It is well worth a trip to the cinema. A group of older people, with diverse reasons, have signed up to live in a “Paradise for older people in India”. Maggie Smith is brilliant “Plan ahead! These days I don’t even purchase green bananas”. On leaving the cinema members of the audience were overheard seriously planning to set up their own communes.
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