Growing challenge of the rural elderly
One in five elderly people in the UK feels they have no-one to turn to, according to the Campaign to End Loneliness. So what can be done to tackle loneliness in older people in the countryside? Jessica Sellick investigates.
Back in 2013 Defra published its Rural Ageing Research Findings.This profiled how older people in the countryside use services and highlighted examples of good practice. The study found while 18% of people live in rural areas (compared to 82% in urban areas), there are proportionately more people aged 65 years and over in rural areas than in urban areas: 24% in rural compared to 76% in urban.
Between 2011 and 2021 the number of older people is forecast to increase by 29% in rural areas, compared to 20% in urban areas. While older people in rural areas were found to have some socio-demographic advantages over their urban counterparts (e.g. above average income and education levels) they were unlikely to be proactive in terms of arranging the support they needed to help them continue to live there.
Here, two of the key challenges around service delivery that are well-rehearsed among RSN members, namely (1) lower population densities impeding economies of scale resulting in higher unit costs and (2) the penalty of distance and higher travel costs now converge with another challenge (3) lack of ability to forward plan services as older people present at critical moments.
A landmark report is Ageing in the Twenty-First Century: A Celebration and A Challenge’ published by UNFPA and HelpAge. While the report celebrates the contributions of those aged 60 and over as caregivers, voters, volunteers and entrepreneurs; it also sets out a series of challenges facing older people, particularly around income security, access to services and affordable housing.
On 30 September 2015, the World Health Organisation (WHO) launched its world report on ageing and health. This uses the term ‘functional ability’ in calling for a transformation of health systems away from disease-based curative models to providing integrated care. The Global Age Watch Index 2015 ranks 96 countries, covering 91% of the world’s population aged 60 and over. In the overall ranking the UK is tenth – behind the United States, Japan, Iceland, Netherlands, Canada, Germany, Sweden, Norway and Switzerland (ranked first).
With nearly 24% of its population over 60 years, Switzerland has a range of policies and programmes on active ageing, promoting capability, health and the enabling environment for older people. At the other end of the scale, Afghanistan, with 4% of its population aged 60 years and over, has few local or national policies to promote the wellbeing of older people. HelpAge International has called on all Governments to redouble their efforts to make ageing visible and to listen to, include and hear the voices of older people.
With renewed international focus on ageing populations, are we asking and listening to the voices of older people in rural England? I offer three points.
First, while many people dream of a rural retirement, the reality can be one of isolation, loneliness, fuel poverty, limited incomes and falling through the cracks in Government policy.
Amid the Government agenda of productivity, jobs and growth much of the current dialogue is around modernising the State Pension as part of wider attempts to improve the income security of older people.
On one hand, having a larger proportion of older people could mean slower growth and (because older people need to draw down their wealth to live) less saving; leading to higher interest rates and companies disincentivised to invest. On the other hand, some older people are deciding to work for longer dispelling the myth that no one works after the age of 65 years.
The Government’s UK Advisory Forum on Ageing (UKAFA), using data from the Department for Work and Pensions (DWP), found one in six men and one in four women who had recently reached State Pension age hadn’t worked since at least age 55.
An average earner retiring ten years early could see their pension pot shrink by a third. For each extra year in work an average earner could have around £25,000 extra income and increase their pension pot by around £4,500 (or 4%).
Carried out by NIACE, research on the labour market found (i) most older people want to work for longer – for identity/status, intrinsic interest, social engagement and/or financial reasons; (ii) working longer is good for individuals, firms and the economy; and (iii) the labour market is much less efficient for people over 50 – from this ‘mid-life’ point age discrimination rises, health problems cause premature exit, caring responsibilities peak, career progression stops and retirement beckons.
In 2013 the Department for Business, Innovation and Skills (BIS) funded NIACE to run a Mid-Life Review Project to provide people aged 50+ with access to impartial, expert advice on work issues to prevent them from leaving the workplace early.
The pilot provided very local and specific practical careers sessions to older people, with 3,600 sessions delivered to 2,994 clients across England.
The pilot was welcomed by clients who rarely discussed careers issues with anyone and by providers / careers advisors who welcomed the opportunity to build up their offer and work in partnership with other agencies.
For NIACE, the project was seen as important in addressing four main policy changes around discouraging premature retirement, reducing underemployment in hours and use of skills, encouraging lifelong learning, and ensuring a well-managed retirement.
In a recent article for the New York Times, sociologist Anne Karpf described how older people are more likely to be seen as a burden and drain on resources rather than a resource in themselves. She argues terms such as ‘dependency ration’, ‘agequake’ and ‘demographic time bomb’ enshrine dubious assumptions about who will be financially dependent on whom.
In current policy discussions around productivity and growth I do not think older people – as rural entrepreneurs, caregivers and volunteers, who remain vital and present and make a contribution to local economies – are always recognised.
In rural areas there are relatively lower levels of benefit claimants despite low wages.
This suggests the operation of a more informal economy with people undertaking a variety of activities to ‘get by’. People of all ages in rural communities often juggle more than one job to generate an income for their household.
The Rural Productivity Plan, with its welcome focus on education and training, apprenticeships, enterprise zones, planning, housing and availability of childcare often attends to fulfilling the economic potential of younger people in the countryside.
We need to fully consider how ageing influences the economy – the workforce, productivity/growth, savings and investments – and how this differs in a rural context (where the proportion of older people will increase more than in urban places). How can we then use these insights to ensure economic independence and reduce poverty in old age?
Secondly access to services. Many older people are lonely as a result of a partner’s death, disability, chronic illness, reduced or unstable income, and loss of vision or hearing, frailty, fear of falling and/or fear of forgetting.
How can we ensure older people in rural areas can access preventive, curative and long-term health and care? And encourage ageing in place by enabling older people to maintain their independence and social networks, such as transport and technology?
Much of the current discussion tends to be around the funding and criteria used to determine ‘from whom’ and ‘what’ health and care is provided for older people.
Care is funded through Government funds allocated to local councils, council tax revenues, individuals’ contributions to their local authority care package, and/or to services arranged independently.
The voluntary and community sector also provide and subsidise a range of care services. Health is funded directly from taxation. We are consistently informed that the health and care delivery systems have not kept pace with the needs of an ageing population.
And while much has been made around partnerships between NHS bodies and local authorities, vanguards for the development of new care models, person centred integrated care remains under-development.
At the same time, local authorities are calling for sustained and substantial extra funds to help older people. In its ‘don’t cut care’ campaign, Age UK argues the Government should invest £1 in social care for every £27 spent on the NHS.
RSN members clearly recognise the challenges of rurality with regard to providing services for older people and are grappling with the best ways to manage increasing pressures and demands. This includes providing innovative, user centric services that reflect local context.
Norfolk Swift Response, for example, provides help, support and reassurance if an older person has an urgent, unplanned need at home but doesn’t require the emergency services.
The Lincolnshire Wellbeing Service provides a range of interventions and support to access community based services to promote confidence in living independently. These schemes try to forward plan and prevent older people presenting at critical points in need of acute care.
Rose Regeneration has developed a ‘village companies’ model. Here, day care support is provided to vulnerable older people in a cluster of proximate villages. The company is professionally managed but influenced and ultimately owned by the relatives of those served and the communities in which they live.
Each village company is funded through a mix of direct payments, local authority contracts and self-funding arrangements.
Financial modelling has shown that a cluster of fifty clients with an average drive time of five miles to each appointment would enable twenty-two people in the locality to be employed; with visits of at least 30 minutes at least three times a day provided to clients; and a guaranteed, hours based employment contract, covering training, mileage and holiday provision given to every employee at a figure close to/or at the living wage.
Such a model not only enables older people to ‘age in place’ but also provides opportunities for people to live and work in a rural community.
Thirdly, how can we offer a wider range of housing options in rural communities for all age groups?
Back to Switzerland – ranked first in the Global Index – some analysts believe the solution is to build more nursing homes. Apparently 60-120% more older people will be cared for in Swiss nursing homes by 2040 than is the case today.
This requires 53,000 additional nursing beds.
Already the number of employees in this labour-intensive sector has increased more strongly than other sectors of the Swiss economy. By 2040 it is predicted 48,000-71,000 nursing FTEs will be required in nursing homes. However, the working population is currently stagnating and economists are not certain if this need can be met.
Taking a different approach, the American Planning Association promotes multigenerational planning. This considers the needs of all age groups throughout all stages of planning (from needs assessment to visioning, plan making, design, implementation, and evaluation) and how government policies, zoning, and building codes can be changed to ensure generational equality and access.
Examples of multigenerational housing communities include Hope Meadows and Rancho Mission Viejo.
In England much of the focus has been on extra care housing or assisted living communities. While these developments have a reputation for being able to accommodate people who would otherwise be frequent users of acute services, largely because their housing is unsuitable for them to self-care, how can we get policy-makers, planners and developers in rural areas to think more holistically?
With an ageing population surely housing projects catering for older people in rural areas is an investment hotspot for developers? How can we develop housing that enables older people to remain active and/or continue to work? Some older people do not want to live in a retirement setting – in the words of one older person “in those places [retirement communities], everybody is old, and you don’t see young faces”.
It is certainly an interesting time to be thinking about the effects of the ageing process on rural communities and economies. In May 2015 Archbishop Desmond Tutu in backing a UN campaign to reduce poverty described how: “As we get older our rights do not change. As we get older, we are no less human and should not become invisible. I am 83 and I am for people of all ages”. For those that want to, how can we support older people to have a stake and stay in the countryside?
To explore these issues further, the RSN is organising a seminar on ‘Tackling the Challenges of Ageing – Fuel Poverty and Services for Older People’ on 18 November 2015.
Hosted by Costwold District Council, speakers include: Alice Woudhuysen (Senior Campaigns Officer, Age UK), Jon Bright (CEO, Oxfordshire Rural Community Council ) and Holly Sims (Corporate Affairs Manager, Calor Gas Ltd). The seminar is free to attend but places are limited to 50. To book your place please contact the RSN by email events@sparse.gov.uk or telephone 01822 813693.
Jessica is a researcher/project manager at Rose Regeneration; an economic development business working with communities, Government and business to help them achieve their full potential. She has undertaken a mid-term evaluation of a Wellbeing Service, whichaims to reduce hospital admissions and the need for long term residential care by putting in place a community package of support (e.g. equipment, adaptations, TeleCare) and recently completed a European project on ‘social value’. Jessica’s public services work includes research for Defra on alternative service delivery and local level rural proofing.
In her spare time, Jessica volunteers for a farming charity that offers a 24/7 advice and support service for farmers, their families and the wider community with the purpose of ‘preventing things from getting to the desperate stage’. She can be contacted by email jessica.sellick@roseregeneration.co.uk or telephone 01522 521211.
For more information about Village Companies please contact Ivan by email ivan.annibal@roseregeneration.co.uk
Website: http://www.roseregeneration.co.uk/ Twitter: @RoseRegen
