Need A New Approach To Elderly Care To Tackle Social Isolation - Especially In London
There has been a lot of discussions about our ageing society but social isolation of older people has not been addressed. How do we care for the increasingly socially isolated elderly?
With the number of people aged over 80 set to double over the next twenty years, a serious debate about ageing has finally begun in Britain. Social care, pensions and healthcare have all been the subject of major policy reviews in recent months. But an issue that has received less political attention is the social isolation of older people.
Too many people face later life cut off from society, lacking the friendships and access to basic services that so many of us take for granted. Research published last week by IPPR, and funded by the City Bridge Trust, highlights the scale of the challenge. One in ten people over the age of 65 are socially isolated in England, and this figure increases sharply amongst the oldest age groups. There is a big difference between ‘early retirement’ and those over the age of 75, with the latter group being at a far greater risk of living alone, not having access to transport and being lonely than 65–74-year-olds.
So why does any of this matter? At their most fundamental, social ties are important for building an inclusive society -enabling people to enjoy each other’s company and navigate life’s events. At a more practical level, social ties can provide access to transport, informal care and information about services, as friends and family members give help with these tasks. It is not surprising, therefore, that social isolation is linked to higher rates of depression and earlier rates of entry to care homes.
The causes of social isolation lie beyond the traditional realm of ‘ageing policy’ - which has generally been concerned with issues such as pensions and healthcare.They can be found in wider changes to family, society, technology, culture and economy over the past fifty years. For example a reliance on the car and the withdrawal of local shops and services has reduced the number of chance encounters that older people have in their neighbourhoods. And the decline of formal membership organisations and the shift to online services has reduced the number of institutions in which people interact. This hits older people especially hard because they spend more time in their local neighbourhoods and are less likely to use online services than the rest of the population.
The state is not well equipped to deal with these challenges. It is more used to delivering services that are designed to tackle acute problems requiring one-off solutions, such as providing a house, prescribing medication and so on.It doesn’t have the tools to help build relationships between older people and the communities where they live.
Nowhere is this more obvious than in the way we care for our elderly. We rely on caring for older people in hospitals – something which is often unnecessary and inappropriate. Across England, older people with dementia occupy 20 per cent of acute hospital beds, when around 70 per cent of these people may be medically fit to be discharged. Most dementia patients do not need a hospital bed, but require decent quality home care. Sadly on this front, too, our system is failing. A relentless focus on efficiency, accountability and targets has created a dehumanised home care service – a series of standardised tasks to be delivered as quickly and cheaply as possible. The result is reports of older people having a constant cycle of different care workers, with just fifteen minutes to get their clients washed, dressed, and fed.
It is impossible in a system designed according to this ‘transactional mindset’ to build social contacts between people. The result will always be impersonal services that isolate older people. So what can be done? First, the health service must pool its budget with local authorities in order to shift resources from hospitals into properly funded home care. Second, town planners must ensure there are places for older people to interact –making it harder for local services such as pubs, post offices and banks to withdraw from the high streets. Third, frontline staff in a range of services – from firemen fitting smoke detectors to mobile librarians – should be involved in referring older people to other services. Fourth, we will all have to take our obligations towards older people more seriously - changing the way we live so that regular social contacts are maintained. Tackling social isolation will therefore require both the state, and families, to organise themselves in new ways.