Rotherfield St MartinIt’s not steamrollers and hats

Marylynn Fyvie-Gauld

Setting the context

• Numbers of people requiring informal care will increase from 2.2 million today to 3.0 million in 2050

• Total care on formal long-term care is projected to be 60% above current level by 2040

• Total expenditure will rise from £11 billion per year to around £15 billion by 2040

(Karlsonn, Mayhew, Plumb, Rickaysen, 2006)

• Expenditure on older people has increased from £8.8 billion to £9.1 billion in 2008-09 (4% increase)

• Expenditure on residential care increased by £2 billion between 2007/08 to £7.6 billion in 2008/09

• Expenditure on nursing care has fallen by 5% in cash terms to £1.4 billion in 2008-09

• Expenditure on domiciliary care increased by 8% between 2007/08 to £6.5 billion in 2008/09

(Office for National Statistics, Government’s Actuary Department, 2010)

• The numbers of people aged 85 and over increased by 64,000 between 2004 and 2005 representing a growth of 6%

• The expansion in the population of 75 and over has implication in policy terms and for social care as it is this group that require more help and support (Policy Institute, 2007)

• This is particularly the case for the South East where the age group 75-84 is project to increase by 32% and 39% for people aged 85+ (ERPHO, 2007)

• Older people in rural areas face particular problems

Client Group as a percentage of gross expenditure 2008-2009

Source: Office for National Statistics, Government Actuary’s Department, 2010

• CASSRs purchased or provided in excess of 200 million contact hours of home care during 2008-09 representing an increase of 7% on 2007-08

• Home care contact hours have increased by 32 percent since 2003-04

• The number of hours provided directly by CASSRs has fallen by 9% to 19% of total contact hours compared with 22% in 207-08

• Contact hours provided by the independent sector increased by 11% between 2007-8 and 2008-09 and now represent 81% of all contact hours

• The average hours of home care per client has increased while the numbers of clients has decreased

(Community Care Statistics, 2010)

Informal/formal care per week

0%

20%

40%

60%

80%

100%

irregular lessthan 1hr

p/w

1-2 hrsp/w

3-5 hrsp/w

5-10hrs p/w

11-20hrs p/w

20-30hrs p/w

31+ hrsp/w

Informal Care

Formal Care

• The local authorities have a new role to play in the care and support of older people in a climate of spending cuts and increased demand within ‘Equity and Excellence: Liberating the NHS – Opportunities and Challenges’ (2010):– A critical role in the assessment of need and

allocation of resources– Commissioning and monitoring services– Overseeing local care markets– taking action in case of neglect or abuse

• In order to fully discharge their obligations Local Authorities will have to work closely with others to find ways of meeting needs

Shropshire Voluntary Sector, 2007)

15.3% are registereddisabled

Services Used (in percentages)

The initial response

• The vast majority (96.9%) waited 1-3 weeks for an initial response and only 3.1% waited between four to five weeks

• 91.3% stated that they were very satisfied• The difference between the length of time

between the response rate and levels of satisfaction was statistically significant

(χ2 = 8.589, df=1, p= 0.010)

Exercise Classes

‘Making new friends and improving my activity level’ (80-89 female)‘The exercises classes were very beneficial’(70-79 female)‘exercises classes have helped since having heart problems’ (80-89 female)‘useful exercises’ (70-79 male)‘more mobile now thanks to the exercises classes’ (70-79 female)

The link between exercise and mobility

• Mobility impairments predict mortality and dependence but physical activity for this group is associated with lower risk (Hirvensalo, Rantanen and Heikkinen, 2000)

• Physical activity decreases the incident of chronic disorders (Manu, Chakravarthy, Joyner and Booth, 2002)

• Nine randomised controlled studies revealed a link between exercise and reduction in falls (Carter, Kannus and Khan, 2001)

Falls and Accidents

The affect of falls• 20% of people over 65 who fracture their hips are dead

within a year and life for those who survive is more problematic (Department of Health 2003)

• 85% of deaths in the home are due to falls (Colledge, 2002)• DoH (2003) calculates that the seriousness of falls may be

reduced by up to 30% if health and social services work together

• In excess of £942 million is spent on osteoporotic fractures of which 87% are hip fractures (Colledge, 2002)

• Older people are reluctant to admit to falls because it undermines their status as independent (Yardly et al, 2006)

• Nearly half of the members who admitted to falling said that it had changed their lives

Isolation among older people

Under 16s and people over 65

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

1971 1981 1991 2000 2003 2005 2010 2015 2020

under 16 65 and over

Use of antidepressants increases with age up to very high levels. As death approaches, the use of antidepressants increases regardless of age. (Hansen, Rosholm, Gichangi and Vach, 2007)

Office for National Statistics, Government’s Actuary’s Department, 2005

Social/Chats/Friendship

• Over 51% of people aged 75+ live alone (Age UK, 2010)• Over 1 million people aged 65+ say they are always or

often feel lonely (Age UK, 2010)• Over 5000 older people spent Christmas day alone in

2006 (Age UK, 2010)• Isolation is one of the causes of depression and affects

10-16% of people aged 65+ (NIMI, 2003)• There is a key role for the voluntary sector in

combating depression and preventing isolation and depression among older people (Manthorpe and Illiffe, 2005)

Social/Chats/Friendship

• ‘they provide lots of opportunities to socialise and to be of help to others’ (70-79 female)

• ‘You need never to feel lonely or have no-one to discuss your worries with – always there to help you’ (70-79 female)

• ‘Its always helpful when you have other people who experience the same problems’ (80-89 male)

• ‘The helpfulness and friendship’

‘I get out more and meet different people’ (80-89 female)‘The social side, as being on your own can be lonely, making new friends’ (80-89 female)‘It has given me a more positive attitude, opportunities to meet and make friends’ (70-79 female)‘I’ve got someone there I can always go to for help or just a chat’ (70-79 female)‘Its lovely to get out of the house and have some social time with other people’ (51-69 male)

Isolation in Context• According to Age UK (2010)

– 12% of older people (1.1 million) feel trapped in their own homes

– 6% of older people (that is nearly 600,000) leave their house once a week or less

– Nearly 200,000 older people in the UK do not receive enough help to get them out of their house or flat

– 17% of older people have less than weekly contact with family, friends and neighbours

– 11% have less than monthly contact• ‘isolation has become one of the main problems

for people in the country. St. Martins in all villages would help’ (80-89 female)

Other important services• The car transportation Scheme:

– The shrinking world of one member– The transport scheme versus the taxi – a tale of the

hospital visit• Trips out: ‘When you no longer have a car it is easy to

become housebound, especially when you do not live in the centre of the village. The Scotney project has forced me to use old skills, such as embroidery and painting which I had lost confidence in doing’(80-89 female)

• ‘not everyone has the means of transport and any trips are well organised with transport, especially for people in wheelchairs’ (80-89 male)

Meetings with speakers: ‘I look forward to meetings each week, also the speakers – I have leaned a lot from them’ (80-89 female)Computer help and training: ‘the computer training was beneficial and enjoyable’ (70-79 female)Bereavement support: ‘Visiting Rotherfield St Martin when feeling at a low ebb was so helpful’ (70-79 female)Odd Jobs: ‘as one becomes old, the little jobs that seemed so simple become difficult and it is very difficult to get professionals to come. (80-89 female)

Making a differencepast and current service use

• the vast majority of respondents felt that Rotherfield St Martin had made some difference or a big difference to their lives

• Reduced use of the district nurse (χ2 = 6.036, df=1, p= 0.014)

• Reduced use of homes care (χ2 = 21.818, df=1, p= 0.001)

• Reduced use of social services (χ2 = 7.670, df=1, p= 0.006)

• Increased use of neighbours and relatives (χ2 = 21.434, df=1, p= 0.001)

• Reduction in the use of other services (χ2 = 6.785, df=1, p= 0.008)

• Reduced use of personal care (χ2 = 17.111, df=2, p= 0.001)

© Rotherfield St Martin

• Voluntary Groups as a means of rejuvenating neighbourliness is a long held belief

• Northmore et al (2006) argues that the voluntary and community groups occupy a unique position, ‘We believe the sector can develop and champion initiatives to stimulate and maintain neighbourly behaviour’

• ‘People Power’ and The Big Society’ (2010) are government initiatives aimed at stimulating voluntary work with the promise of future rewards

• ‘Neighbours helping each other is a very basic human activity that people can easily understand: you help your neighbour now; another time, you may need help’ (Fyvie-Gauld, de Podesta, 2005)

Volunteer Characteristics

• Traditionally more women than men volunteer especially in caring organisations because of the link to the carer as female (Kuntz 2001).

• Allison, Okun and Dutridge (2002) identified career, esteem protective, social, understanding and value as motives for volunteers

• Okun and Schultz (2002) found that as age increases social motivation tends to drive volunteering

• John Wilson (2000) suggests positive effects of volunteering include life-satisfaction, self esteem, self-rated health and functional ability

• Volunteering can be a life-long commitment for some, others start on retirement as a way of continuing work discipline or as an antithesis (David, Smith and Gay, 2006)

The Volunteers of Rotherfield St Martin

I’ve always volunteered’‘Those who are well, look after those who are poorly until they die, and then the next lot underneath will have retired and be able to volunteer to look after that lot, and so on. It will fuel itself’‘Able to give back to the community in which I enjoy living in’‘Because that’s what you do – you don’t really think about it as volunteering’‘social contact and giving of self worth’‘Getting to know other people and their needs’‘I’m very pleased that I have been able to meet so many lovely and happy people’‘I am proud to be associated with such a useful project’‘I think you can enjoy giving and still be altruistic’

‘I love being a volunteer, I’m just glad that I am able to help people’ ‘Personal involvement, satisfaction, usefulness, meeting people who I might otherwise ignore, not notice, not hear their stories, hearing different aspects of events’‘You get some satisfaction at helping out a bit’‘Meeting interesting, often older, people and helping them to achieve their goals’‘I have met some lovely people’‘makes me feel I have done something good today’‘Its an adventure’

The story of widening horizons of one volunteer

Support for volunteers‘Rotherfield St Martin is good to is volunteers’

Communication

• 97% of the volunteers said that their expectations of volunteering had been met

• Women were more inclined than men to rate their experience of volunteering as excellent (χ2 = 4.381, df=1, p= 0.014)

Training

The Skills Third Sector has identified the need to train volunteers (2010)

• Supply of care is a diminishing resource:– Increase numbers of single person household– Increase in the numbers of childless older people– Increase numbers of females in paid employment

• Countervailing issues– The trend to retire younger (now in jeopardy)– Improvement in health among older people– Changing social attitudes leading to increased

male participation

• Could lead to an increase in the numbers of potential informal help/volunteers

(Karlsonn, Mayhew, Plumb, Rickaysen, 2006)

The Community and Rotherfield St Martin

• ‘Community’ is a familiar term that is used in a variety of everyday contexts and conversations. It is often used to refer to ‘good’ social relations because it suggests connected groups of people who care about and for each other. It is this idea of care and social bonds that puts community firmly in the realm of what we might mean by the terms ‘welfare’ and ‘social well-being’.

• (Mooney and Neil, 2009)

‘Provides a focus for the elderly members of the village’‘Puts Rotherfield on the map! Brings the community together i.e. surgery church, school, all involved’‘Helps community relationships, saves them some money, enriches their lives’‘Stronger sense of community, bringing people together in an area where the population is widespread’ ‘It provides a fantastic community spirit, which appears to be unique to Rotherfield’

Unique to Rotherfield?

• As a transferable model:– ‘absolutely, it really needs another Jo, full of

enthusiasm and energy – the problem is the cash’– I think this organisation is suitable to a village such as

Rotherfield, I don’t think it could be quite the same in a town’

– I think this is essentially a village operation’– ‘it needs to be restricted in size’– It should always be small. As soon as you get above a

certain size you have to have tramlines – I don’t like things getting too big because you lose the local flavour’

‘The model could be adopted in other rural areas. It is designed to support all aspects of people’s needs, emotional, social, physical and mental’‘There is a need nationwide for such outreach’‘This is an excellent scheme and if incorporated everywhere it would change the nation!’‘We lost our way with government supplying everything, all they need to do is to give seed funds, and leave the local communities to it, because the local communities can make tailor made services for their own people’

‘A model of good practice’‘Don’t make it too big because people become alienated outside their community’‘If it became larger and more people involved, it would become more bureaucratic, more paperwork, more rules and the nice touch would be eroded, the nice touch of Jo and the helpers’

• ‘gemeinschaft’ (traditional, unionised) versus ‘gesellschaft’ (urban, fragmented) Tönnies (1963)

• the case of Crowborough

In conclusion (at last!)

• The ‘care gap’ is increasing Counsel and Care (2007:2) state that older people are finding it impossible to obtain low level care and are being ‘squeezed out in favour of crucial and substantial care services’

• Preventative services is not recognised as important by many local authorities (Counsel and Care, 2007)

• Joseph Rowntree Foundation (2006) suggested that many older people really value what they call ‘that bit of help’

• Wanlass (2006) argues that funding such services reduces both health and social care costs

• Project numbers of people requiring assistance and the vision to focus more on preventative services is a logical step in the provision of care

• To do this Government will need to encourage diversity and flexibility of provision

• The potential exists within the voluntary sector to produce a wide range of services and clearly a capacity that needs to be harnessed in the future by health and social care