CHAPTER FIVE SERVICES
5.1 In the main, discussions of services for older people centred on the adequacy, or inadequacy, of current provision rather than on more aspirational ideas about future provision. Moreover, when asked about the implications of the ageing population on the provision of services, responses tended to be simply that more and better services would be needed. There was little appreciation of the economic and demographic problems that might be faced in attempting to meet these needs.
5.2 Four services in particular were discussed: care services, health services, transport services and housing.
Care services
5.3 Current care provision, including care homes, day care and home helps, was an area of some concern for participants. It was commonly felt that there is a shortage of such provision which, in worst cases, results in older people having to go without much needed support and assistance. The following comments highlight the issues raised:
My mother in law, she's 95. She was in hospital, lives on her own, she does everything on her own. They tried to get a package for her coming out, you know a carer coming in the morning and that, and it was near impossible, you know. They kept her in hospital for another week until they could get the carers up and running.
(ABC1, 55-69, Jedburgh)
…if it's personal care, like getting washed and stuff like that, that's free, that's fine. But if it's domestic chores, I mean if you're old and you aren't physically able to attend to your own domestic chores, you're having to pay like just under £11 an hour for it. I think that's extortionate.
(C2DE, 18-24, Kingussie)
5.4 In addition to comments about the availability of care services, there was some concern about current standards of care. Several participants suggested that care staff do not always take the time to get to know, and develop a relationship with, the older people in their care. For example:
As you said, trained staff. You have to actually get to know these people -
I think it's one of these things that happens. As you get older, you almost lose your identity.
(33-57, LGBT, Edinburgh)
…some of them just come in and do the necessary and out.
(Female, 55-69, Disabled, Jedburgh)
5.5 Further, there was a perception that care staff sometimes lack the necessary qualifications to perform their jobs well. While it was clear that such perceptions were influenced to a degree by media stories of mistreatment and neglect in care homes, several of the comments did appear to be grounded in personal experiences.
5.6 Notwithstanding the consensus, discussed in an earlier section, that individuals should assume at least some responsibility for planning financially for old age, there was a general feeling that care services should be provided free for all older people who need them. This is consistent with findings from recent quantitative research conducted by the Scottish Centre for Social Research. 8 The following quote was typical:
At the end of the day, whether people think about it or not, don't you think that services would be provided anyway…the services should be there anyway, regardless.
(Female, C2DE, 33-57, Asian, Glasgow)
Health services
5.7 As in the case of care services, current health care provision for older people was widely felt to be inadequate. There were repeated references to cutbacks and closures which are seen to have resulted in deteriorating standards of service. Participants in rural areas were among those most likely to mention this problem, with several describing how the increasing centralisation of services, particularly ambulance and hospital services, has compromised their access to essential help and treatment. Examples given by participants included:
It's harder to get a doctor now. My doctor she was on every day but now if I phone and want to see my own doctor she's only on once a week.
(Male, 55-69, Disabled, Edinburgh)
When I took ill I was rushed into hospital and when I arrived there they examined me. Now I'm 50 miles from here to the hospital. I had taken a nosebleed and when I arrived up there they looked at me and they didn't even dress my nose and they said just go home and if it does start again come back. Like as if it was just across the road.
(Female, 85+, Kingussie)
The guy living in the old cottage, he'd a heart attack. I rang for an ambulance and it took an hour and a half for an ambulance to come, for somebody with a heart attack…In the end, he moved out and he moved back to England where he was very close to a hospital, they were just that frightened.
(33-57, ABC1, Jedburgh)
5.8 A less common concern with respect to health services was that staff shortages and resulting pressures on doctors' and nurses' time have contributed to a decline in the quality of care provided.
Transport
5.9 Participants generally viewed recent developments in public transport services positively. There was particular praise for 'kneeling' and low access buses and for the new free bus pass for pensioners. For example:
Well I was very pleased to know that they are now giving us a pass for the buses and things like that. That is very much appreciated and it is a good thing because I mean, especially here in this, the Highlands, there's no way, if you haven't got a vehicle you're stranded.
(Female, 85+, Kingussie)
Well I think they're trying…ken with building the pavements up to get easier on and off and these kind of things and the buses are all low down and they've got plenty handrails.
(Male, 55-69, Disabled, Edinburgh)
Housing
5.10 Younger participants had given almost no thought to where they might live when they were old. When asked, they speculated about living abroad, moving somewhere smaller, moving somewhere more rural and were aware that stairs might not be manageable - but it was clear that this was not something they had thought much about or for which they were actively planning. Some older respondents were more conscious of health problems which might make their current accommodation unsuitable - but although they had thought about it, the dominant view was that they would move if and when they needed to, not before. One woman's comment that she would "cross that bridge when I come to it" reflected the prevailing attitude. Similarly, the oldest participants who had needed to move to more suitable accommodation had done so when it became necessary, rather than in advance.
5.11 While some participants felt that Scotland's housing stock was suitable for an ageing population, the consensus was that greater thought needs to be given to the number and types of houses that are being built. More specifically, it was suggested that there should be more single-storey housing - whether in the form of bungalows or cottages - as well as more sheltered accommodation:
I think the systems we've got now are good, but we need more of them…Like more sheltered.
(55-69, ABC1, Dundee)
They are taking down all the high flats anyway. Instead of building them four up even, because that's what we were in, they should really be thinking of building them bungalow-types or cottage-types you know, that there's no stairs or anything for older folk.
(Female, 85+, Glasgow)
5.12 Another common perspective was that there is currently a lack of affordable accommodation for older people. Some of those who mentioned this issue suggested that, in the future, a proportion of the housing stock ought to comprise special low-cost housing, along the lines of council housing, reserved specifically for older people. The following specific suggestions were made:
They should be a corporation, Lothian Region or whatever you call them, they should own those houses and nobody goes in there bar old age pensioners.
(Male, 55-69, Disabled, Edinburgh)
Within that housing stock, there must be a percentage of rental, a percentage of sheltered and a percentage of social housing.
(33-57, ABC1, Jedburgh)
5.13 However, these views about the lack of affordable, suitable housing did not appear to translate into a personal concern about suitable accommodation being hard to find when the time came.
5.14 On a different point, a few participants alluded to the growing potential of new technology to make Scotland's homes more suitable for older people. For example:
There's a great range of equipment now available for people living at home - pads you can put on the floor that if they get up through the night and step on it, it'll alarm. They've got an absolute multitude of high tech equipment that enables old people to look after themselves.
(33-57, ABC1, Jedburgh)
5.15 However, there are potential problems in that the use of technology can be perceived as a way to cut services - perhaps particularly the use of remote technology to provide services to more remote and rural areas. This is illustrated in the discussion below with a woman whose help cord was previously linked to a warden in her sheltered housing and was now linked to a service over 100 miles away:
So what happens if you pull the cord?
It goes to Edinburgh. Now the night if I pulled the cord it would be Edinburgh that would answer it and ask me what it was wrong with me.
…And they just ask you if you're alright and they say that they will contact your family. Now that was another thing, there was a lady in the top flat in the main building, her daughter was in Inverness, right, and she had a fall during the night and when she pulled the cord they contacted her daughter. Now was she going to lie in the floor until her daughter came from Inverness?
Now where is that going forward? That's where I say - all these new fangled ways are not viable, they are just not working.
(Female, 85+, Kingussie)
Advice services
5.16 While the discussions of services for older people focused in the main on existing services, there were some suggestions for new services that might be beneficial. In particular, participants felt that there should be dedicated advice centres for older people to provide assistance with such issues as benefits entitlements, application forms and so on. One participant explained:
Advice because there's loads of benefits, not just financial, as in say community projects that would help, give them something to do, support, disability aids, anything you need, that we know nothing about and they've no way to know anything about, and I think that it could be tied in with doctors because doctors are usually visiting them regularly.
(33-57, ABC1, Jedburgh)
Summary of key points
- In the main, discussions on services for older people centred on the adequacy, or inadequacy, of current provision rather than on more aspirational ideas about future provision. Moreover, when asked about the implications of the ageing population on the provision of services, responses tended to be simply that more and better services would be needed. There was little appreciation of the economic and demographic problems that might be faced in attempting to meet these needs.
- Care services Current care provision was an area of some concern for participants. It was commonly felt that there is a shortage of such provision which can result in older people's needs being left unmet. In addition, there was also negativity about current standards of care.
- Health services Health care provision for older people was also seen to be inadequate. Hospital closures and staff shortages were cited as the main reasons for the decline in the quality of health care provided.
- Transport Participants generally viewed recent developments in public transport services positively. There was particular praise for 'kneeling' and low access buses and for the new free bus pass for pensioners.
- Housing There was a consensus that more suitable and affordable accommodation was required to meet the needs of older people. However, these views did not appear to translate into a personal concern about suitable accommodation being hard to find when the time came and there was very little advance planning. One woman's comment that she would "cross that bridge when I come to it" reflected the prevailing attitude.