A Consumer and a Critical Friend
Most of my life I have taken an interest in being a user of services – mainly health, education and transport. I have been part of teams providing services and learnt the value of different perspectives. Here I am reflecting on my experiences and those of my older friends as users of services for older people. Through my 25 years as a “care manager” for my mother who died at almost 100 I learnt the important role that carers carry and the increasing challenge and unmet need of older peoples’ mental illness.
Can I now as a consumer, help the services to improve? As an eighty year old my focus is on how we can maximise the quality of life in those extra years that medical science has given us. My agenda is wider than the quality of health and social care services, although these are key to my future.
At present I live alone in my own home, as fully engaged as possible in a range of community and neighbourhood activities. I benefit from the local self-help local groups we have developed, showing we are not a “burden” but contribute in many ways to enhance our well-being and the lives of others. Inter-generational and multi-cultural events are part of our agenda.
My friends and networks are both distant and local. My family support me by telephone, e-mail and occasional visits. I have benefited enormously from the NHS – having successfully had my knees replaced – and have learnt to live with my chronic ailments, including glaucoma. However each NHS experience had major hiccups in the follow-up care programme.
The outstanding factor is often the gulf between the rhetoric of policy and the reality of provision. For example I was recommended to undergo an assessment for help to remain at home – which took 14 months to implement and proved to be irrelevant as I am not yet decrepit enough to meet the local criteria. However I do use a number of low-level, easy access, non-stigmatising services like Shopmobility scooters, some help at home the local leisure centre health suite.
I use these and many other experiences in my work as a volunteer older person adviser, in various “governance” multi service groups. For example I currently contribute to a local Primary Care Trust committee called ‘Critical Friends’ which addresses Ageism in the local NHS. My participation has been a result of my involvement in the Better Government for Older People network over the past four years. The aim is to contribute to the improvement of services through this and other local, regional and national groups.
I think this kind of involvement can be one way forward, providing that older people involved are given the facilities, information and support to play our part by giving a different perspective to that of the service providers and contributing to a strategy for change. Of course, much depends on the level of participation. Tokenistic gestures to meet regulatory requirements are not going to change the culture of the organisation. Outcomes need to be assessed to see if we have made a difference.
The challenge of Ageism
In my view whilst work has begun, the complexity of ageism is not fully recognised or understood as a phenomena. Its existence, endemic in our society, is impeding the implementation of better services. In my lifetime the same learning had to be applied to sexism and racism. I had to learn and understand about racism when a student told me we were running an institutionally racist department. We had to learn and understand the phenomena before we tried to root it out. We started by having training – all of us. Should we not do the same for ageism? There is scope for this in the growing business of age services.
The growing awareness of hidden abuse of older people (including their neglect) is a major challenge. As a former childcare officer I am aware that we missed the area of sexual abuse of children in the 1960s and 70s. Will the abuse of older people be the major headline for the early 21st century? How can we encourage and protect the witnesses who want to give evidence?
Addressing life transitions
A whole range of transitions has hit me in the last decade. They seem to occur with increasing speed and intensity as I get older. For example I have faced many personal bereavements, sensory impairments, moving house, financial adjustments, changed family roles. I have learnt to live with physical disabilities. I work harder to achieve less! On the positive side, I have more freedoms to choose how I spend my time and money, where and with whom I travel. My transition to using IT has also been positive.
Policy making and services should focus on making all these transitions as successful as possible at different points in our lives. This certainly applies in later life. The Expert Patient Programme and the Active Ageing Programmes are examples of such services.
The final transition, through the dying process is one of the most neglected areas needing attention.
Equal human rights and responsibilities
Facing the future implies a responsibility on all of us, to consider and explore what we can do to maintain a civilised approach to an ageing society. Older people need to speak up for our age and be pro-active in fostering cultural change. On a personal level we need to explore what options we have to maintain a quality of life within our limitations. However, good quality responsive care for vulnerable people is the measure of a civilised society. Our challenge for the future is to ensure it is in place.