The population of the UK is ageing. The proportion of people aged over 65 rose from 15% to 17% from 1985-2010, an increase of 1.7m people, and is projected to reach 23% by 2035, according to the Office of National Statistics. Of most significance for the social care system is the growth in the number of people aged over 85, which doubled from 690,000 in 1985 to 1.4m in 2010 and is set to reach 3.6m, or 5% of the population, by 2035.
These facts are among the reasons why the future funding of adult social care has become such a big issue.
Elderly people and social care
Elderly people account for the majority of adult social care service users and of public spending on adult care. NHS Information Centre figures for 2009-10 in England show:-
- 77% of the 225,600 council-funded people in residential or nursing homes were aged over 65.
- 65% of the 1.54m council-funded users of community-based social care were aged over 65.
- 56% of the £16.8bn spent by councils on adult social care was for people aged over 65.
Promoting independence and early intervention
Much of the focus of health and social care services for elderly people is on promoting independence and intervening early to prevent people from requiring long-term care and support or hospital admissions.
Reablement services, in which people receive about six weeks of intensive care at home following a crisis or hospital discharge, to help them regain skills and independence, are at the heart of this approach and have been shown to provide good outcomes for families and save the taxpayer money.
The UK government has set aside about £1bn a year from 2011-15 to invest in reablement and similar services in England to promote independence for older people and reduce pressures on the health service, including by reducing emergency admissions and delayed discharges.
Health boards and councils in Wales will be required to set up reablement services under a 10-year plan published in 2011.
In Scotland, a £70m change fund has been set up to help NHS boards and councils transform older people’s services, to shift the balance of care from institutional to community settings.
The risk of dementia increases with age. Alzheimer’s Society figures show that 98% of the estimated 750,000 people in the UK with dementia are aged over 65.
See our expert guide for more on dementia.
Elderly people also make up a significant proportion of people receiving continuing healthcare – an NHS-funded package of long-term care provided for people whose needs for social are and accommodation arise primarily from a health condition.
Continuing healthcare in England is governed by a national framework, designed to ensure consistency of access across the country. However, there are ongoing concerns about some NHS commissioners restricting access, shunting the costs of long-term care onto councils and families.
End-of-life care is a longstanding area of concern in health and social services: services for people are often unplanned, service users lack access to round-the-clock support in the community and many end up dying in hospital against their wishes.
Deprivation of liberty safeguards
Older people who lack mental capacity also account for a majority of applications under the Deprivation of Liberty Safeguards, which cover England and Wales. Sixty five per cent of applications by care homes or hospitals to deprive someone of their liberty for the sake of their care and treatment were for people aged over 65 in 2010-11 in England, NHS Information Centre figures show.
The Equality Act 2010 introduced provisions to ban age discrimination in the provision of goods, services and facilities by 2012. This poses particular challenges for social care and mental health services, given evidence that older people receive less well-funded services than younger adults with similar needs.
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