Following a recent meeting of the Ageism Special Interest Group of the British Society of Gerontology, AWOC trustee Paul Goulden comments on how ageism in the UK health and social care system affects people ageing without children…
The wider picture
Anyone who has either worked with the health and social care system or has experienced it for themselves or relatives will know the frustrations and difficulties in accessing help and support. This is especially true when the patient or service user is older or perceived as such and the recent meeting of the Ageism Special Interest Group of the British Society of Gerontology made some key points about ageism in health and social care.
In the meeting, Melanie Henwood highlighted that treating people differently due to age is structural ageism, and an issue with the processes and culture that then percolates down to the people on the front line. Ageing is also often seen in terms of frailty and decline, which in turn leads to low expectations about outcomes from health and social care interventions. This clearly has an impact on the options that older people are offered and leads to health and social care systems supporting “an existence” rather than enhancing a life.
Richard Humphries focused on one key point – that the care system rations care to those in high need and is means tested. This then means that older people lose out because even though they may have resources (a home and savings), are ineligible due to the financial assessment rules and may have to enter the private market where there may be choice but access to information and advice is limited. It is also true that whilst there are some great providers, service quality may be variable. The means testing system is therefore a key structural driver of ageism.
Steve Milson and Gerry Nosowska both identified the role of care staff as being critical to tackling ageism in the health and social care system, and in particular the access that older people have to them in identifying and implementing support needs. Without early, preventative support to a wider cohort of older people, the feeling was that we risk continuing to embed ageism into our health and social care system.
And yet we know what good looks like. Not only does the Care Act specify this, but others have highlighted how this can work in practice. A toolkit entitled “Making every relationship matter” (Larkin, Mary; Gopinath, Manik Kartupelis, Jenny and Wilson, Anthea (2023). Making every relationship matter: a practitioner toolkit for relational care with older people. The Open University. Funded by The Hallmark Foundation) clearly outlines how caring relationships can be supported and therefore ageism be reduced, not through major reform or restructuring but in changing the way that those relationships are approached.
The AWOC experience
Ageing as a decline, and access to the health and social care system are both felt keenly by those ageing without children – but in ways which are harder on the individual.
The default assumption that there will be children around to help means that the reaction from care staff to those ageing without children is often one of surprise, as though they are strange and out of the ordinary. Respondents to AWOC surveys and discussions have referred to feeling “othered”, sometimes with the added implication that by not having children they have somehow failed in life. This in turn has led to some mistrusting a health and social care system that doesn’t have a solution for when there is no-one to support an individual, and even a reluctance to engage with it.
People ageing without children are also more reliant on formal services at a time when we know those services are under intense strain. Without family carers to fill gaps, it is more than likely that there will be greater unmet needs. This means those ageing without children are more likely to have to go into a care home, and earlier than others, and that they are more likely to have to pay for services.
But the key concern from those ageing without children is who is going to be there for them in dealing with health and social care, in essence – who is in their corner?
If we can assume that people needing to access health and social care are not at their physical or mental best and then add in the complexities of the current system, then it is no surprise that there are frustrations and difficulties in how this supported is identified and ultimately delivered. But if you then factor in the isolation that someone ageing without children might feel as they have no family members to be there for them, the outcomes are going to be significantly worse.
And what about the more sensitive and riskier areas of care? We may support our parents in a DNAR decision, but what if there is no-one around for us? How do we navigate through the funding issues, when there is no-one to reassure us about our homes and possessions? And whilst hospital discharge becomes a very attractive proposition compared to remaining in hospital, we all know “revolving door” cases where re-admission quickly follows a hospital discharge. Whilst the shift from treatment in hospital to treatment and support in the community outlined in Wes Streeting’s three shifts is a positive move, it does raise the question of how much this is relying on family support.
To add to the problem, there is also the issue of next of kin and the NHS. Whilst a medical next of kin does not have to be a blood relative, it is often assumed that this is the case. And there is no definition in law of a medical next of kin, which then leads us into powers of attorney and deputyships. We’ve previously called for health and social care systems to update their approach to this (see our blog) as the mechanisms that are in place are felt by some ageing without children as being insufficient and complex to navigate.
What is to be done?
But of course it is no good just complaining about the problem – if we are going to improve the chances of people ageing without children getting appropriate treatment and services at the right time then several things need to change. Here are three key recommendations:
Recommendation 1: AWOC – it’s a real thing – so count it
Since AWOC was launched in 2014, we’ve raised the facts about this growing demographic and the needs of actual people ageing without children. But we now need the numbers of people ageing without children to be properly collected to inform further policy decisions, and how this will impact on the individuals and health and social care systems.
Recommendation 2: Invest in prevention and communities
One of the key problems with the health and social care system is that it does not generally have a long term or investment outlook. By this I mean that it has difficulties seeing the value of supporting a service or activity now that prevents, say, hospital admissions in ten years time. In terms of ageism and ageing without children, work by Dr Rob Hadley highlighted that not only do social networks play a vital role in the health and wellbeing of older people, but the impact of being childless has a major impact on how those ageing without children deal with social, emotional and relationship aspects of the life course. So investment in preventative and community services and activities will support long term preventative measures across the life course and ultimately reduce crisis interventions by keeping people away from the crisis for longer.
Recommendation 3: Fix outdated assumptions about family support and advocacy so no one has to ask “Who’s in my corner?”
But by far the most important call to action is that health and social care policy needs to move beyond assumptions that family support will always be there. This default assumption will increasingly apply to those with children too, as geographic distances and busy lives mean that family support will be difficult to rely on. Health and social care services and systems should be designed around need not family status, and we also need those legal mechanisms in place for advocacy for those with no family support.
Paul Goulden
