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Linking Communities developing services and resources for older

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					                               Linking Communities:
                              developing services and
                             resources for older people

                Carnforth Community Development Group           9th March 2011
                             Reviewing local services for older people

Overview
This paper looks at what people value about their community, services and activities.
We think that the best way to improve the lives of older people is to embed activities
and services in the community.
The report uses information from a) a survey undertaken in three areas of Lancashire
in 2008i, b) those living in the wider Carnforth area who responded to a questionnaire
in Autumn 2010ii and c) from a national studyiii. They are marked in the text below as
ACL 2008, ACL 2010 and Clough 2007. The information is presented only as a start in
collecting fuller details about the local area. In the next stage of the research we will
want to get more detail about the area and the use of services and facilities.
Main messages
1. Living life to the full
The focus of the developments that are wanted on this project should be on what
helps older people to lead fuller lives.
     Older people talk about their lives, not services. Thus someone may talk about
     the joys of seeing children and grandchildren, and yet feeling lonely, not
     bothering much with meals since the death of a partner; alongside this, they may
     have problems with practicalities: - the payment of bills, getting the rubbish out
     in the proper recycling bins or putting drops in their eyes. ‘We all want ordinary
     living’, as one person commented. …
     Some older people worry months ahead about Christmas cards and presents, or
     birthdays. Others who would like to go out for a walk have lost confidence in
     their capacity or in feeling safe outside. The dilemma they face is that they do not
     know what should be done. …
     Many of the wants that people have, for example, to have someone shop with
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     them or help to choose clothes, are very intensive in terms of staff time and
     reflect perhaps the ways in which social bonds of friendship are less easy to
     maintain.
     Too often a focus on specific problems, and on services to resolve them, neglects
     opportunities to lead fuller lives. At the end-of-project consultation, people gave
     examples of communities where older people expanded horizons: groups that
     went to theatres, museums, walks or swimming and aqua-aerobics. Alternatively,
     the focus of engagement with someone with dementia may be on their need for
     personal and home care, not on their need for attachment. …
     Social care services have tended to focus on personal services within the home.
     Yet changes to the environment – post offices closing, bus services changing,
     more expensive adult education classes, pavements that seem unsafe because of
     cyclists or closures of public lavatories – may mean that older people go out less,
     exercise less, socialise less and feel less good about themselves. Moreover they
     may be less able to contribute to family or other social networks. There is strong
     evidence that people’s feelings about themselves and the worlds in which they
     live, affect their sense of well-being and quality of life, which in turn affects their
     health. (Clough 2007)


2. Feelings about oneself and ageing
Respondents in the recent survey (ACL 2010) were asked to respond to the following
question: ‘Thinking about your own life and personal circumstances, how satisfied are
you with your life as a whole?’ on a scale between 0 and 10 (completely dissatisfied to
satisfied). The average score was high, 7.52, with only one person scoring 4 or below.
Although it is very probable that more satisfied people are more likely to respond, this
is a high figure, especially as there were several negative comments made about being
old. Most thought their health to be good or very good, though 3 people with long
standing disabilities described health as bad. Numbers are small so we should be wary
of drawing general conclusions.
The positives of getting older
It is imperative to challenge the picture that old age should be equated with doom
and gloom. In the ACL 2010 survey people wrote about the good things inherent in
getting older: -


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   ‘Confidence, experience of life’; ‘still in a position to help others if needed’.
   ‘Having grandchildren and great grandchildren, and having close family ties’.
   ‘Having a good outlook about life, etc. etc. etc.’ ‘Tend to mellow and enjoy the
   environment etc after working full time. Just wish for better health and better
   pensions to enjoy leisure time.’
   ‘Retirement – best job I ever had.’ ‘Not having to work after 60.’ ‘Freedom to
   choose my lifestyle.’ ‘Hobbies.’ ‘Able to take holidays at any time of the year.’ ‘I am
   removed from the pressures of life, am comfortable in my warm cosy home and
   able to please myself.’
   I am 90 years of age and housebound, but I live with my daughter, and we have a
   good family life with my grandchildren and great grandchildren so I am never
   lonely.’ ‘Now at age 88 I have found many wonderful and good relationships. I
   have time to relax or study or help others, and feel appreciated most often.
   Relationships vary greatly, e.g. in intimacy which I find most important.’ ‘Having the
   company of others of similar age and interest.’
   ‘Being able to take a bus ride on the travel pass. After 45 years of work it is a God
   send even though I have a small car for shopping/taking mother out.’
   ‘I’m still here and reasonably fit.’


Exclusion and loneliness
Nevertheless we do know from other studies that the way that people feel about
themselves, and about getting older, influences the way that they live, what they do
and, in turn, their health. To some extent we influence our own ageing. There are
numbers of older people who are depressed, often undiagnosed and untreated.
Loneliness is a key factor in depression. The next set of comments come from ACL
2008.




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I would like to know there is somewhere to go, rather than waking up and feeling
depressed.
When people are active they don’t notice that they are alone. But then they become
less active and say time and time again 'I am lonely’.

   Many older people feel excluded from events that should be seen as part of a full
    life, such as theatres, cinemas and keep-fit; they may be excluded also from
    everyday activities - shopping and meeting friends.
   There are various reasons for this: lack of transport; fear of going out; lack of
    money. However, often it was the complexity of making arrangements that stopped
    people going out.
   Some individuals and rural communities felt isolated. There were concerns about
    the impact on their capacity to cope and feelings of depression. Meeting people
    and doing things made a difference to health and well-being.
   There were particular concerns about evenings and week-ends.
   Cuts in adult education and increased charges led to more isolation.
   Being able to get out to meet people, shop and go to activities makes a huge
    difference to one's life: there was a lot of discussion of isolation and consequent
    impact on health and well-being; many factors influenced whether people were able
    to get out - transport, existence and costs of activities.
   People do not always let others know of their needs, and may dislike the idea of
    support from others.
In the recent survey (ACL 2010) of the 31 responses
     14 had daily contact with friends or family and 29 had contact with a family
       member or friend during a week.
     Only 3 people had contact with their neighbours on a daily basis and 23 had
       contact with their neighbours at least once a week.
     2 respondents had contact with family or friends less often than every two weeks
       and one had no contact with neighbours.
3. Community
People commented on what they liked and disliked about their community. They note
also the way that their circumstances, or the environment, change. It would be worth
pursuing what are the differences in perception from those living in villages to those in
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Carnforth.
   Circle of friends, associates, neighbours; 2) Pleasant surroundings; 3) Rural locality;
   4) Many activities on offer.
   Carnforth is a small, friendly place.
   People show an interest in me and what I do. They are generally helpful and
   friendly.
   I have good neighbours, I belong to Holy Trinity church and have great support
   there. I am in the choir and take part in many activities there.
   Having taken part in many aspects of village life during the years I have lived here. I
   know a great many people. Today I am limited in what I can do because of health
   reasons.
   This is a lovely area to live; we have enjoyed many happy years here. Our age
   group has passed on and left the area. We feel a little isolated at times.
   Good network of many activities if one felt lonely; 2) safe community.
   People smile a lot and are friendly.
   Everyone helps each other.
   Countryside one way, town the other way. People are friendly.
   There are plenty of different clubs with different activities. The local institute has a
   computer centre. We have a good bus service and all the necessary amenities such
   as shops, post office, doctors, pubs, Churches etc. The is a lovely walk down the old
   railway track and walks along the river. Local people are very friendly.
   There is no need to be lonely as there are many village activities such as WI,
   various Churches, leisure club, friendship club and more. We have a good ½ hour
   bus service in to town.
   My husband died 1 year ago and I am just adjusting to being a single person
   without a car. (I don’t drive).
   When we were younger we were members of most local activities. My husband
   being a founder member of the bowling club, also secretary of the Autumn club,
   horticultural society. We are now unable to take part so we are forgotten.
   Nowhere to go in an evening to meet local people and have a drink and chat.
Importantly although some people reported that they did not go out in the evenings
because they did not feel safe, most stated that they felt safe in the places where they
liveiv. One explanation is that strategies are developed to manage the situations that
seem unsafe, perhaps avoiding particular places or times of the day. One comment

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was: ‘Local pubs etc are no go areas for older people at night. Tend to stay in because
of this. No nice local. Have had trouble with local youths but the police have been
excellent.’ (All from ACL 2010)
4. Services used
   The table below show the percentage of participants who have used a service or
   facility within the last week or month. Numbers were small so the percentage figure
   may give a misleading sense of statistical certainty. (From ACL 2010)

    Service or facility                         Within last     Within last month
                                                week %          %
    Medium to large supermarket                 74.1            92.6
    Post office                                 69.0            96.6
    Corner shop or newsagents                   66.7            88.9
    Bus, ‘dial a ride’ or train                 53.6            67.9
    Chemist, doctor or dentist                  51.7            86.2
    Cafe                                        39.3            60.7
    Bank or building society                    38.5            61.5
    Coffee morning or lunch club                34.5            44.8
    Park or open space.                         30.7            53.8
    Community centre/rooms                      26.9            38.4
    Garden Centre                               24.1            55.2
    Library                                     23.3            36.7
    Pub                                         22.2            38.5
    Place or worship or faith centre            19.2            30.8
    Social Club                                 19.2            30.7
    Day or evening class                        18.5            25.9
    Public sports facility (e.g. swimming       17.2            24.1
    pool)
    Hospital                                    11.1            29.6
    Cinema or theatre                           11.1            22.2
    Chiropodist                                 10.7            25.5
    Sports club (such as bowls, tennis,         0               7.7
    golf)
    Bingo club                                  0               3.8

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   Respondents were also asked to rate the five most important service and facilities.
   The table below shows the ten that were most highly rated. Those that were
   concerned with the practicalities of everyday life were scored more highly than
   social events.



                    Service or facility                        %

                    Public Transport                           11.6

                    Post office                                10.9

                    Supermarket                                9.3

                    Newsagents / Corner shop                   6.2

                    Library                                    6.2

                    Park / outdoor space                       5.4

                    Place of Worship                           5.4

                    Community centre                           5.4

                    Bank                                       4.7

                    Lunch Clubs / Coffee Mornings              4.7

                    Chemist                                    3.9

                    Day or evening classes                     3.9

                    Public Sports facilities ( e.g. swimming   3.1
                    pool)

                    Social club                                2.3

                    Garden centre                              2.3

                    Cafe                                       1.6

                    Pub                                        1.6

                    Sports club                                1.6



Other services or facilities that were mentioned once were cancer care, having visitors,
chiropodist, public telephone, refuge collection, highways department and street
cleaning.


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5. What would make a difference?
When asked in the ACL 2010 survey what would improve life one person commented:
‘People over 60 are well catered for at the moment’. However, most had views of what
they would like to see happen.
   ‘Community centre within walking distance.’ ‘A place where people can go for small
   lectures on interesting subjects. Things that get people together without costing a
   lot. Hobbies gardening etc.’
   ‘Social visits.’ ‘Lack of social opportunities.’
   ‘If the people showed a little more respect to our age group … A little help crossing
   the road and helpful in carrying the bags home.’ ‘If people could be a little more
   caring, maybe ask if we needed anything when they were going shopping etc. As
   one gets older we are not considered to be essential to the community and are
   shown little respect from the younger generation. At our age it is very noticeable
   locally.’
   ‘Classes as before. ‘Day or evening classes actually in Carnforth, although cost of
   classes becoming prohibitive. All classes are Lancaster or Kendal/Milnthorpe.’ The
   cost of participation was mentioned by several people whether for classes or clubs,
   and costs were rising.
   Others stressed that they could not get to events without someone to help them.
   ‘Make sure all information can be available – by email, post.’
   ‘There are several activities in the area but I am at fault for not joining in.’ This
   raises questions as to whether people feel welcomed, or whether they can be
   helped to overcome shyness at going to new places.
   Not surprisingly transport was a repeated theme, with individuals sometimes noting
   that they were all right as long as they could drive. ‘Better timing on buses so that
   they connect better with buses in Carnforth. Better to connect with buses than
   trains.’ ‘No/limited access to a vehicle; nobody to go with; no local public transport.’
   ‘We are thankful for Dial a Bus who assist with the shopping at the supermarket
   and carrying the shopping to the door. We are disappointed that fares on the Dial
   a Bus have increased their fares before local buses.’ ‘Bus with room for walkers.’
   ‘More drivers to be able to take the older people to a wider variety of events, e.g.
   theatre or just locally to village hall events.’
   ‘Appointment system at the doctor’s needs revising. You cannot book in advance
   and the line is always busy resulting in no appointments available.’

                                                8
    One person bemoaned the closure of a local library just as she had got to the age
    when she wanted to use it. Another noted the difficulty he and his wife had in
    collecting books for as they could not always manage the walk to the mobile
    library.’
Additional information comes from the earlier report.
   Managing the house and garden were major worries for many: finding reliable
    people to provide services; managing small tasks like repairing shelves, changing
    light bulbs or taking down curtains turned into headaches; some wanted people to
    tidy up the garden or a yard rather than a gardener.
   There were many references to the value of handypersons for just this sort of task –
    but also to their scarcity.
   There were also many references to long waits for OT assessment and adaptations.
   Difficulties in getting foot care were common, whether for straightforward nail
    cutting or more complex work.
   People worry about how to cope with many of the seemingly small matters of daily
    life: answering letters; dealing with banks and managing PIN numbers; looking after
    the house; ensuring that those who came to do work were reliable. (ACL 2008)
   From a different study: ‘Another policy focus that promotes a focus on fuller living
    is that of maintaining healthy living. So debates about the social care services that
    people want take place in the context of inadequate funding of community health
    services.’ The report also captured one of the problems of getting older, that of
    worry about how to cope in the future with known problems of current disabilities,
    or the life changing events that may occur. ‘They wanted to know that help might
    be available to meet needs in a crisis or to help in the home if things got bad. They
    could think of many ways in which such help would be best if it enabled them to
    mange everyday activities, such as writing cards and managing bills, taking a dog to
    the vet, mending a leaking tap or negotiating with a gas company.’ (Clough, 2007)


In the same study it was reported that people want: -


       ‘Sources of information that are easily accessible and up-to-date.
       Someone to talk to about options.
       A system that alerts people to the possibility of support services, rather than
        one which relies on people not asserting themselves, a hidden form of rationing.

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         Monitoring, or occasional visiting, to some older people: a mix of oversight and
          assessment.
         Easier access to social services departments, especially by phone.’ (Clough, 2007)


The authors summed up the sort of approach that is needed. ‘Perhaps at the heart of
what we are trying to express is whether, when they approach health or social care,
older people feel that the practitioners want to help. Too often, people have felt that
hurdles have been placed in their way, hurdles that they cannot get over.’ However,
some practitioners stressed their frustration that they were not able to provide what
they thought was needed.


6. Information and entitlement
In the earlier survey (ACL 2008) there were many comments about the difficulty of
knowing what is available, and to what you are entitled.

I live in a rented property which is in poor condition; I am ill and do not know what to
do.
I am not sure about how to get a carer these days - do social services get one for you
or is it do it yourself?

 This was by far the most frequently voiced concern: who can get services and in
      what circumstances? what needs paying for? what do social services provide? There
      were examples of people finding out too late that there were services that would
      have helped them.
 There was widespread confusion as to where to go to get information and doubts
      about the reliability of what was given out.
 The new Help direct gateways may work as a single point of access.
 However, finding out was only half the battle: participants wanted help with
      negotiating; they wanted someone on their side helping to get support, especially if
      they were unwell, tired or depressed.
 There were several reports of voluntary organisations finding it impossible to contact
      people who might want to use their services on the grounds of data protection.
 There was confusion about what paid carers are allowed to do: 'Is it regulations or
      just that they can't be bothered?'
     Professionals who joined the discussions highlighted gaps in arrangements for daily

                                              10
   living: medication for those with memory loss; repeat prescriptions and review from
   the GP, eye-drops; exercise buddies after a fall. 'Getting any service is very
   complicated for people; getting a wheel chair is health not us; getting a ramp
   would be us’. ‘You need someone to make sure things happen'.


7. What works well today – and messages for the future
There is knowledge of some of the factors that are seen as central to good practice:
   a. Consistency - and joined up services: services work best when the providers
      liaise, do not repeat the same questions and do what they say.
   b. In a crisis there needs to be a speedy response.
   c. Services that are personal and that respect the dignity of the individual are
      valued.
   d. Community resources – many of the positive comments were about schemes
      that had been developed that both helped older people and maintained their
      role in the community: schoolchildren helping to manage wheelie bins on their
      way to and from school; time-banks where people shared resources; older
      people listening to children read at school.
   e. Buildings – places where people could meet others were very important. There
      were suggestions that in rural areas there should be more imaginative use of
      buildings – why not use a cricket pavilion?
   f. 'Could village halls become local resource centres?' mused the members of one
      group. 'Can better use be made of these premises so that the whole community
      benefits from them?' another asked. Centres provided a place to socialise and
      meet others, to mix with your peers. They were valued for people with mental
      health problems.
   g. Lunch clubs were appreciated both for the food, when it was good, but also for
      the other activities that took place there. Several stressed that the social side
      was more important than the food, for example that luncheon clubs are
      important for men who had lost their wives. (From ACL 2008)


8. Looking after older people in the community
We conclude this report with the importance of embedding support in local
communities. One thrust of discussions in 2008 was that there should be a way to find
out who needed help and to provide support. ‘Yet there were clues that this would not
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be easy: people might not want others to know their business; when people were ill or
depressed, they were less likely to ask for help; there was also discussion of the facts
that there were fewer people around such as the milkman who would notice if
someone had problems.’ (ACL 2008)
In another report the authors relate the experiences of older people to service
provision and local communities. They describe the work of an organization called
Caring Together: -


    Rooting itself in the local community and building alliances with existing groups and
    community activists, it has been able to mobilise the resources of older people in the
    locality, drawing upon and energising neighbourly networks and reservoirs of
    reciprocal support towards sustaining people’s quality of life, even in the face of
    restrictions. (p.197) …
    Caring Together offers opportunities for sociability and friendship, education, social
    and stimulating activities, mutual support, practical assistance, advice and advocacy
    across the spectrum of old age.v


It would seem that the solutions lie in the way that resources may be mobilised in the
community.


Roger Clough and Ian Sidney                                                     March 2011



i  Clough R. (2008) Local People, Local Services: Consultation on Social Care in Lancashire, Chorley: Age
Concern Lancashire.
ii 31 respondents: 13 aged 60 to 74; 18 aged 75 +; only 5 were men.
iii Clough R. with others (2007) The Support Older People Want and the Services They Need, York: Joseph

Rowntree Foundation.
iv 70% said they definitely felt safe, and the rest stated they were safe ‘to some extent’.
v Godfrey, M., Townsend, J. and Denby, T. (2004) Building a Good Life for Older People in Local

Communities: The Experience of Ageing in Time and Place. Joseph Rowntree Foundation: York.




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