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A Quality of Life Strategy for Older People

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    APPENDIX 2

    The Future is Ours

    A Quality of Life Strategy for Older People

    2006 2013

    Culture Housing Enough to Learning & the Live on

    & Leisure Home

    Older Making Diversity People’s Choices & Quality of Have a say Equalities Life

    Personal Views, Safe & Care, Health Expectations Strong

    & Support & Evidence Communities

    PART TWO APPENDICES

    THE FUTURE IS OURS

    A Quality of Life Strategy

    Older People

    The Future is Ours, A Quality of Life Strategy for Older People 2006-2013 Part Two, May 2006 1

    - 2013 2006

    For Discussion

    PART TWO - APPENDICES

    Appendix Page

Views, Needs and Expectations of Older People 3 A

    Older People‟s Voices 9 B

Background to the Vision and Action Priorities 11 C

    Social and Demographic Data 23 D

    Health Inequalities 30 E

Bibliography sources used to prepare this strategy 32 F

    May 2006

    The Future is Ours, A Quality of Life Strategy for Older People 2006-2013 Part Two, May 2006 2

APPENDIX A - VIEWS, NEEDS AND EXPECTATIONS OF OLDER PEOPLE

    Older people are citizens with a diverse range of interests and concerns. Building on their views, needs and expectations is a vital element in making sure the end result of what we are attempting is responsive and relevant both now and in the future.

    Older people say that independence is about more than being able to do things for themselves. It is equally about choice, control and fulfilling lives. The information we have suggests we need to move from the traditional agenda of prevention and support associated with health and social care to a much broader approach. This needs to focus on well being and building social capital through interdependence and engagement.

[A] Evidence from local studies and surveys

    In 1999 the Council undertook a consultation with people aged 50 plus. This involved a large postal survey and a day conference. Key messages from this exercise were:

Community Safety

    ; People felt generally safe in their home and in their area but there were local

    variations. Concerns covered:

    o Lack of visible police presence

    o Young people as a potential source of trouble

    o Bogus callers and rogue traders

    o Victim support

    ; There was a general lack of awareness about neighbourhood watch

    ; A need to communicate concerns between generations was identified

     The scope for individuals to reduce risk of becoming a victim of crime ;

Attitudes

    ; Only 2 in 5 people under 50 saw older people in a positive light

    ; Perceived discrimination in employment

    ; Perceived negative attitudes and stereotyping of older people was a concern

    ; Contribution made by older people often not recognised

Having a Say

    ; More older people tended to vote

    ; Overall people felt they had a limited voice in local matters

    ; More could be done on involvement

    ; Around a third were involved in voluntary or community groups

Getting Out and About Transport

    ; Not everyone used public transport buses most commonly used

    ; Poor waiting facilities and information about services inhibited take up

    ; Safety was an issue especially during evening s and when dark

The Future is Ours, A Quality of Life Strategy for Older People 2006-2013 Part Two, May 2006 3

Leisure & Learning

    ; Good leisure facilities were important

    ; Need to be at reasonable cost

     For some people there were access and parking issues. ;

Enough to Live On

    ; Concern about lack of take up about benefits issues of awareness, availability

    of advice and complexity.

    ; Need for more information

    ; CABx seen as doing a good job

    ; Earnings link for pensions

Making Informed Choices

    ; Need for useful information relevant to area interested in

    ; Ability to talk to people locally

    ; Complex language within leaflets

    ; Value of “testing” publications with older people before printing them

Health & Healthy Living

    ; Maintaining mobility and independence within the home and outside

    ; Improved hospital transport

    ; Ease of access to local health facilities

    ; Shared pathways with cyclists

In 2004/05, as part of the arrangements for consultation on “All our Tomorrows”

    Age Concern organised a telephone survey with a sample of residents aged 65+ across

    the borough. This covered two main areas: housing and the home and getting out and

    about. The key results are:

Housing and the Home

The responses suggested that there was:

     A lack of awareness about what the council was doing on accommodation ;

    issues

    ; Strong support for the view that better care and support should be offered to

    extend independent living and for

    o People being able to chose where they live

    o People being able to live as independently as possible

    ; Limited knowledge of how improvements to existing accommodation could be

    used to lengthen the period of independence but that certain things would help

    o Help with cleaning

    o Adaptations

    o Equipment

    o General help, odd jobs and maintenance

    The Future is Ours, A Quality of Life Strategy for Older People 2006-2013 Part Two, May 2006 4

    ; A view that care homes were for people who required 24 hour care

    ; Extra care housing was seen as an alternative to a care home by nearly all

    respondents with ability to maintain independence a key consideration

    ; Care and support in their own home was the priority for the majority

Getting Out and about

In terms of getting out and about

    ; just over half used a car to get to local places such as the shops, doctor or post

    office/bank

    ; Nearly two in five relied on transport that is not their own to get about. Access

    ; A higher proportion of people 75+ rely on others to get out and about with car

    driving of own car falling considerably.

    ; Only around a third of those 75+ found it easy to get out and about and do

    things.

Crime and Fear of Crime

A third study “What Matters to you, Matters to Us” was undertaken in 2004. The

    outputs have been used in preparing the 2005 Crime and Disorder Strategy. The survey is important because safety and security are key issues at almost any age. This survey was concerned with crime and fear of crime. Issues for older people were a specific focus within the overall survey. The key messages from this research were:

    ; Worries about vandalism to the home and bogus callers increase with age with

    around a quarter of over 60s not opening their door to strangers

    ; People 75+ were more likely to ask for identification, slightly less likely to

    purchase at the door and more likely to feel taken advantage of where they do

    ; Concerns about being burgled while at home existed at similar levels across all

    age groups

    ; People over 75 tended to be rather more fearful of being a victim of crime

    when out and about and concerned about the lack of a visible policing presence

    ; Having someone to call for help, advice and help with home security and how

    to deal with people at the door as a means of reducing concerns when at home

    all rose with age with positive responses to possible initiatives in these areas.

    ; The importance of better public transport/ring and ride in terms of reducing

    concerns when out and about rose with age as did

    o Street lighting

    o Dog fouling

    o Litter removal

    o Graffiti removal

    o Keeping greenery under control

[B] Evidence from National Studies and Surveys

    The ability to benchmark information has particular value in setting local experience into context . There is a growing body of literature in this area which can usefully be put alongside the demographic information to help form a view about what older people are seeking both now and in the future. The issues are very similar. The Future is Ours, A Quality of Life Strategy for Older People 2006-2013 Part Two, May 2006 5

1. Anchor/Mori

    An Anchor/Mori survey in 1996 confirmed that independence was fundamental to older people as were control and choice about where and how one lived. In terms of their sense of security the following were important

    Issue Percentage reporting

    Losing Physical Health 47%

    Losing my independence 32%

    More police on the streets 26%

    Seeing my Family regularly 22%

    Having a secure financial future 14%

     Growing Older in the 21 Century 2. ESRC

    The Economic and Social Research Council [ESRC] has had an ongoing programme of work on extending the quality of life in later years. The key outputs of this work are st Century and covers issues of diversity, inclusion, set out in Growing Older in the 21

    and social support [includes transport, lifelong learning and care]. The key messages from this series of studies are:

    ; Older people are even more diverse than younger groups and experience more

    inequality and differences in quality of life

    ; Factors relevant to quality of life were family, health and home; together with

    independence, emotional well being and mobility.

    ; Social environment was the most important predictive factor for individual

    quality of life: home, safety, finance, services, leisure and transport.

    ; Drivers of quality of life include standards of comparison, expectations, health

    and functioning, feeling supported, having activities and feeling safe in the

    community.

    ; Less high profile service such as post offices, street lighting, refuse collection,

    street cleansing, local police officers and access to transport all helped to create

    a sense of a good quality of life.

    ; Gender and class differences were often significant

    ; Many older people did not want to continue in work although some did

    ; In terms of inequalities in early old age [65-74] people under 70 had a

    pronounced higher quality of life than those over 70

    ; Within disadvantaged areas older people were more likely to be

    o Socially isolated

    o Poor and have inadequate income

    o A victim of crime

    o Uninvolved in community groups

    ; Car ownership and access to transport were key elements in the quality of life The Future is Ours, A Quality of Life Strategy for Older People 2006-2013 Part Two, May 2006 6

    ; Barriers to public transport use included waiting, reliability, security and

    accessibility when carrying things

    ; Being alone has to be seen as one of the main challenges of later life ; Social isolation and loneliness are factors for some older people ; The therapeutic value of learning was a way of ensuring good health

3. Public Services for Tomorrow’s Older Citizens

    This paper, produced and agreed by key organisations concerned with the commissioning, provision and performance review of public services for older people, brings together the research messages from a number of sources. This identified eight building blocks to meet the challenge an ageing population presents:

    ; Vision and culture to underpin a quality of life and well being approach ; Addressing ageism and discrimination

    ; Addressing poverty and the legal and financial architecture that underpins

    income in retirement

    ; Information and resources for choice and control

    ; Addressing the failure of the market to deliver the type of products and services

    that older people want

    ; Promoting a quality of life and well being approach

    ; Developing a broader set of housing and support options

    ; A stronger and more comprehensive strategic, resourcing and commissioning

    framework.

4. Kings Fund 2004

    The findings from this study in London suggest that the following issues meant something to a group of people in their 50s:

    ; Care provision was seen as a right that had been earned and expectation of

    services was higher.

    ; Age discrimination and ageism were seen as impeding access to good quality

    services for older people.

    ; Choice and maintaining independence were key aspects of quality services and

    respecting individuality.

    ; Ability to secure assistance that helped sustain independence, social contact

    and involved them rather than did things for them.

    ; Staying in one‟s own home was generally desired as was the ability to keep up

    social networks, interests.

    ; Access to information for decision making and choice.

    ; Information, advice and advocacy services were seen as important. ; Services should be dependable, reliable, offer continuity, be safe, and

    undertaken by competent staff who were valued and in turn displayed positive

    attitudes towards older people.

    ; Security

    ; Transport

    ; Prospect of residential care was disliked in terms of loss of independence and

    perceived quality of what was available now.

    The Future is Ours, A Quality of Life Strategy for Older People 2006-2013 Part Two, May 2006 7

    5. Commission for Social Care Inspection [CSCI]

    “When I get older” was published by the Commission for Social Care Inspection in 2004. It contains a number of important messages some of them similar to those elicited by the Kings Fund:

    ; People under 60 would prefer to stay in their own homes as they get older. ; Two thirds would prefer to receive care and support in their own home

    from friends and family.

    ; Just under two thirds would stay in their own home with help from trained

    carers.

    ; Moving to a smaller home to retain independence was seen as an option by

    two in five respondents under 60 with a quarter being prepared to consider

    some form of supported/sheltered housing.

    ; Few would choose to live in a residential care home.

    ; Most prefer to be able to make decisions about the care they receive and

    who it is from.

    ; There is powerful public support for rigorous inspection and for

    involvement of service users within that process.

    6. Caring for Carers

The Government published “Caring for Carers” in 1999. It identified six key

    issues for carers. They were:

    ; The well being of the person they cared for.

    ; A short break from the caring role

    ; Freedom to have a life of their own

    ; Maintenance of their own health

    ; Confidence in services

    ; A say in service provision

    Information for carers was a key element along with support and caring for carers. The local strategy on meeting the needs of carers takes up these themes. The “Carers Speak Out Project” report, produced by the Princess Royal Trust

    for carers looks at the ongoing need for information and involvement.

    For many the health service is an important source of information about the health needs and treatment of the person they care for but this was not always shared. Health organisations were significantly less successful in seeking carers‟ views. Carers also wanted agencies to work together better and some were uncertain whether agencies really understood their role. Assessments of needs were not always seen as leading to change and sometimes not offered.

    Appendix “B” includes examples of carer‟s voices from work undertaken by the Princess Royal Trust for Carers since 2000.

    The Future is Ours, A Quality of Life Strategy for Older People 2006-2013 Part Two, May 2006 8

    APPENDIX B - OLDER PEOPLE’S & CARER’S VOICES

It is important that we hear the voices of older people when reviewing what we

    have now and what we might want to see in the future.

    Here is a selection of comments from “All Our Tomorrows” [Solihull MBC] and “Independence & Well-Being” Audit Commission, 2005.

    [A] All Our Tomorrows Survey through Age Concern, 2005.

“I would fight to keep my independence for as long as possible”

“I would dread going into a home”

“Keep elderly independent as long as possible”

“Most people are happiest in their own homes with old familiar things around

    them”

“More freedom of choice and living at home”

“For me to be able to ring Age Concern… is so helpful”

“More domestic and practical help, more advice on services available”

    it‟s frightening sometimes on your own” “Security is very important –

“To remain independent, peace of mind that help is at hand”

“Daily contact with someone – even if only by phone”

    help with the garden” “Help with shopping –

“I don‟t drive but am able to use the buses”

“I can‟t get out at all”

“I don‟t go out at night. It‟s too dark now and I‟m frightened”

“Help with transport – mainly for shopping”

“Transport to enable older people to have some social life”

“I think everyone has a right to remain a person in their own right unless unable to

    cope, with access to all facilities”

    The Future is Ours, A Quality of Life Strategy for Older People 2006-2013 Part Two, May 2006 9

[b] Audit Commission Older People Independence and Well-Being” [2005]

“There‟s a lot of older people in our road – we look after one another”

“It‟s about older people as contributors rather than takers”

“[seen as]… independent, not a liability, treated with respect, treated as an asset”

“You don‟t want other people to do everything, to think for you.”

“Getting out amongst people is the best thing”

“Pursuing interests keeps us out of the doctor‟s waiting room”

“If someone takes you, you worry… are you holding them up?”

“My income is ?91a week… my rent is half of this!”

“You need independent finances for true independence”

“I can‟t afford it. I have to watch everything I do.

“It‟s such rigmarole to make a claim. It puts you off”

    “The biggest difficulty is if you don‟t know the system, you don‟t where to go and who to ask”

    “There doesn‟t seem to be any connection between government services… you are saying the same thing to them over and over again.”

    [c] Carer’s Voices - Carers Speak Out Project [2003] & Primary Carers [2003]

    “There seems to be a gap between NHS/Social Services and myself that needs

    to be bridged”

    “Views are asked but are certainly not taken into account”

    “My mother refuses to go anywhere…she depends on me for everything”

    “Age is catching up on me, I run out of steam more quickly than I used to.”

    “More money would make life easier, or more information as to how to get it”

    “More facilities for the person cared for in leisure and other activities

    independent of the carer.”

    “There was nothing from the GP practice, all information came from the

    Carers‟ Centre”

    “The district nurses come on visits … but I feel invisible. No one says: “How

    are you coping?

    “I had a phone call out of the blue… to check up if everything was OK”

    The Future is Ours, A Quality of Life Strategy for Older People 2006-2013 Part Two, May 2006 10

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