Social Work Research Findings No. 35Support at Home: Views of Older People about their Needs and Access to Services: 1999
|This study investigates needs and service provision from the perspective of people in the 75+ age group who are living in their own homes. A representative sample of people from Glasgow and Edinburgh participated in the study. Information about services was gathered from providers.|
- Almost one third of the people surveyed felt they needed help with some aspect of daily living. Social isolation, type of housing and other environmental factors affected how much support people felt they needed. Many of those most in need did not use social services.
- Lack of knowledge about services and how to access them was a major reason for needs being unmet. Many older people saw access to social services as being controlled by the health service. They tended not to approach the social work department directly for services.
- Care management guidance stated that ongoing contact should be maintained with service users. However, some clients did not know how to contact their social work department, did not have a named contact and were not aware that they had redress if things went wrong.
- People valued being able to make their own support arrangements. Advice and information to help them to do this did not appear to be readily available through social and health services.
- The tightening of eligibility criteria for home care in both cities means that people not 'at immediate risk' are less likely to receive a service than previously. Findings from the research indicate that, for more isolated people, the home care service is critical in maintaining contact with networks of support. This preventive role for social services did not have priority in community care plans for the study areas.
The aim of this study was to investigate the need for support felt by older people who are living in their own homes, and to establish how their needs were met. The report compares their experience of seeking help from a range of sources with the stated intentions of service providers. On the basis of the study's findings, suggestions for bridging the gap between needs and services are presented.
A postal survey of people aged 75+ was conducted in selected parts of Glasgow and Edinburgh in 1996-98. A response rate of 65% gave a representative sample of 1022. Seventy-nine respondents who indicated they needed support were interviewed in depth.
Perceptions of need
From the postal survey:
- 53% felt they were limited by illness and disability.
- 32% were limited in mobility or ability to perform everyday tasks.
- 28% had little social contact.
- Less affluent people were more likely than others to experience limitations and isolation.
Housing situation, income and social contacts were found to be important influences on whether people felt they needed support.
People who had said they had little social contact were found to include a number who were suffering from loneliness or some form of mental distress. Bereavement was the most evident cause of isolation and loneliness. However, isolation was not necessarily associated with living alone. Some people living with a partner where one or both needed a lot of support were particularly isolated and lonely.
Environmental factors, such as location of shops and other facilities, and type of housing, played an important part in determining how much support was needed. Information about such factors is shown to be essential in assessing needs in particular communities.
Use of services
From the postal survey:
- 18% said they received help from community nursing.
- 11% lived in sheltered housing.
- 30% said they used home or day care services.
- Users of services were more likely than non-users to be living alone and in rented housing.
- Most people identified as socially isolated were not using social services.
The in-depth interviews showed that both users and non-users of services experienced unmet needs. Being a client of the social work department did not always lead to people getting the range of services they felt they needed. Some people had been told they would not receive a service because they were ineligible or because of long waiting lists. They were not apparently offered advice about alternative sources of support.
Forty per cent of those identified as most in need of support said they did not use home or day care services. Perceived needs were not met because of a lack of suitable services, lack of knowledge about services or individual choice not to use services. Feelings of discomfort, embarrassment or anxiety were given as reasons for choosing not to use a service, even when it was clearly needed.
Information and access
The main route to an assessment of need for social services was via the GP or hospital staff. The research illustrates the key role which GPs can play in monitoring the well-being of older people and making referrals to other services.
The older people interviewed tended not to view the social work department as a source of information or advice and very few had attempted to contact the department directly. There were exceptional individuals interviewed who negotiated their own support without the agency of their GP or of a care manager. Whether or not they themselves or a friend or relative was the negotiator, success depended on having the right contacts or information.
Social work intervention
The practice of care management implies that clients are involved in decisions and that their needs are monitored. Care management guidance in the social work departments concerned stated that ongoing contact should be maintained with service users. From the users' perspectives there was very good, and very poor, practice in relation to monitoring. A few had experienced regular visits from a social work professional. However, some clients did not know how to contact their social work department, did not have a named contact and were not aware that they had redress if things went wrong.
Many participants receiving social work department services, revealed a lack of awareness of who was providing the service and how they might be contacted. Without ongoing relationships being established, staff changes, office relocation or cuts in services could easily break the fragile connections which people had with the statutory sector.
Eligibility criteria for home care were being tightened in both cities. People not 'at immediate risk' are less likely to receive a service than previously. Findings from the research indicate that, for more isolated people, the home care service is critical in maintaining contact with networks of support. This preventive role for social services did not have priority in community care plans for the study areas.
Choice and control
Independence in arranging their own support was highly valued by respondents and the Attendance Allowance was often the means of achieving this. In most cases, access to this allowance depended on help from others rather than from the Benefits Agency.
Individuals expressed strong preferences for particular types of social facilities such as day care and transport. A wider choice but also opportunities for people to influence the choices available were needed.
Palliative measures were found to have an impact on the quality of life and independence of older people. Participants cited exercise, diet, massage and social activities as ways in which they successfully overcame some of the limitations and isolation of old age.
In some of the older people's accounts, receiving adequate support from primary care or the social work department seemed to be largely a matter of chance. The priorities, and workload, of a particular GP or home help organiser could apparently lead to an individual receiving home visits, referrals to other services and information about welfare benefits. Other individuals with similar needs were not experiencing such attention. Although it may seem inequitable, this situation is consistent with the community care arrangements, which set no standards for entitlement to a service beyond appeals for good practice.
Implications for policy
Social work departments which have a low profile effectively place the responsibility for maintaining contact with isolated older people on other parts of the network of support, most notably voluntary groups. Evidence of the importance of the role of the voluntary sector in connecting individuals to formal and informal sources of support creates a strong argument for secure long term funding for voluntary and community based activities.
The ability of people in poor health to cope with daily living is not necessarily fixed over long periods of time. The informal support they rely on is also easily undermined by sudden changes in family situations. Regular monitoring and easy access to service providers for older people and their families allows services to be responsive to change.
Changes in the provision of home and day care, with the aim of targeting services on a smaller number of people with high support needs, could well lead to even fewer non-medical referrals than in the past. A stronger social services presence in primary care settings could bring better monitoring of older people's welfare and wider access to support services and information.
A more proactive role for the Benefits Agency, in line with current government policy, would improve the take up of benefits, freeing up professional health and social care staff from some of the responsibility of assisting people with claims.
The promotion of better public information and closer contact between policy makers, practitioners, users of services and potential users is needed if service users are to see themselves as consumers rather than as passive recipients of services.
The study forms part of a programme of research on the role of social work in social inclusion which is core funded at the Social Work Research Centre, University of Stirling by the Scottish Executive.
'Support at Home: Views of Older People about their Needs and Access to Services', the research report summarised in this Research Findings, may be purchased (price £14 per copy).
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