Age-old problem

To coincide with the launch of a Help the Aged
campaign on age discrimination in public life, care analyst Melanie
Henwood and Help the Aged’s Tessa Harding report on how care
services are discriminatory.

While it may be true, at least in politically
correct, polite society, that overt racism or sexism is rarely
encountered, or at least that such prejudice is unlikely to go
unchallenged, a very different stance seems to be acceptable in
respect of age discrimination.

Imagine the reaction if NHS specialist stroke
units routinely excluded all Chinese or Asian patients, or if
social services only provided home care packages for women. Yet
when the basis for discrimination is simply age, a multitude of
attitudes, practices and beliefs are apparently condoned, when in
any other context they would be deemed totally unacceptable.

Age discrimination is deeply entrenched in
society. Age discrimination in the labour market is well known, and
begins to impact on people from the time they enter their forties,
and sometimes at even younger ages. By the time they reach their
fifties, 30 per cent of people are no longer economically active.
Moreover, as Candy Atherton MP pointed out last November in the
course of the second reading of her private member’s bill on
establishing an Age Equality Commission: “The issue is not only
about employment, but about health care and access to services and
training. It is about cultural life, volunteering and participating
in society as a whole.”

Age discrimination can be found in all public
services. There is increasing recognition of how this effects older
people as users of health and social care services. The fact that
last year’s National Service Framework for Older People (NSF)
recognised the need to state the central objective of “rooting out
age discrimination” is just one indicator of the pernicious nature
of the problem.

The health secretary is to be congratulated
for ensuring the issue was given top billing in the NSF, and
setting the standard that: “NHS services will be provided,
regardless of age, on the basis of clinical need alone. Social care
services will not use age in their eligibility criteria or policies
to restrict access to available services.”

The most explicit example of direct age
discrimination in social care lies in the widespread application of
lower cost ceilings for social care support for older service users
than are applied to younger disabled adults. Pressures on budgets
have resulted in local authorities setting a maximum amount per
week that they will allow for care packages, particularly for older
people. Typically these cost ceilings are set by the cost of
residential care. As the table (right) demonstrates, such average
costs for older people are lower than for other adult client
groups.

Limiting the expenditure on home care packages
has profound implications. The Social Services Inspectorate has
found overwhelmingly that older people “…have been offered far
fewer options than other service users. Assembling a care package
was often a pragmatic exercise with limited scope for flexibility,
innovation and choice.”

As a result, community care objectives have
not been realised, and resources have been wasted. And for
individuals, there is simply a tragic waste of opportunity as older
people have failed to regain the skills and mobility that should
have been their right, and have been consigned to a miserable
quality of life punctuated by the erratic visits of care staff, or
to premature and unwanted admission to residential care.

There has been belated recognition of many of
these issues by the Department of Health. The new policy emphasis
on intermediate care, prevention and rehabilitation services, for
example, acknowledges the skewed priorities that have distorted
care for too long. Changes in the payment of residential allowance
should alter the financial incentives for local authorities. The
Fair Access to Care Services guidance cautions against making
“blanket assumptions” about any group of people, and against using
age in itself to determine eligibility for service.¹
This is welcome but it is not enough.

It is the subtle and indirect examples of
discrimination that are so pervasive, so taken for granted and
often unconscious. The deeply entrenched attitudes and assumptions
that so many people hold towards old age colour their daily
interaction with older people, and can shape the experience and
opportunities that are offered. In social care, the routine use of
cost-ceilings for care packages for older people can be said to
reflect the assumptions that:

– Older people do not need, or perhaps
deserve, the same levels of investment as younger people.

– Social inclusion is not a meaningful or
relevant aim for older people’s services.

– Choice and independence have a different and
more limited meaning for older people, and there is less need to
provide flexible, responsive or innovative services.

It is good that direct payments are now
available to some older service users, but it is highly revealing
that people over-65 only gained this facility through additional
legislation to extend the right to them. The independent living
movement lobbied successfully for the development of direct
payments – rightly convinced of the value of being able to “buy
independence”, and to employ personal assistants to provide
individually tailored support, rather than having to fit in with
traditional and inflexible services. Why should such opportunities
have been withheld from older service users as a matter of
course?

The slow progress in the take-up of direct
payments by older people is perhaps indicative of the extent to
which many have internalised the messages about what they are
capable of in later life. Little wonder that old age often brings
loss of confidence, loss of self-esteem and a needless sense of
dependency.

The issue of age discrimination is now firmly
on the political agenda. The government has acknowledged that age
“is behind the starting line in respect of measures that already
tackle discrimination” in respect of race, sex and disability. That
in itself is indicative of the scale of the challenge ahead.

A major consultation exercise is to be
undertaken to inform future development, which will include new
legislation to outlaw age discrimination in the workplace and
training (as required by the European Equal Treatment Directive).
It is not anticipated that the legislation will come into force
before 2006, in recognition of the complexity that surrounds age
discrimination. If, as the minister has stated, the interim period
is properly used “to develop clear and workable legislation”, it
will be time well spent, and will provide opportunity to explore
the extension of legislation to dimensions of discrimination in
goods and services. The minister is right that the issues are
complex, and that the battle is for hearts and minds, just as much
as for new statutes.  

– For more information about the campaign,
contact Help the Aged at Age Equality, 207 Pentonville Road, London
N1 9UZ or e-mail age.equality@helptheaged.org.uk
 

Melanie Henwood is an independent
health and social analyst. She is a contributor to the Age
Discrimination Evidence Review published by Help the Aged on 6
March. Tessa Harding is head of policy at Help the Aged and editor
of the Evidence Review.

Reference

¹ Department of Health
consultation paper, Fair Access to Care Services, DoH, 2001
available at web address www.doh.gov.uk/scg/facs/
 

Average gross weekly

Expenditure

(England 2000-1) £

Older People 342

Adults with learning disabilities 669

Adults with mental illness 423

Adults with physical disabilities 512

Source: DoH, Personal Social
Services Performance Assessment Framework, 2001

Age discrimination

A Help the Aged/NOP poll found that 51 per
cent of the population believes that this country treats older
people as if they were on the scrapheap. Forty-four per cent feel
that older people are considered to be a burden on society. In
addition, a new report, Age Discrimination in Public
Policy, finds that:

– A survey of GPs indicates that upper age
limits exist for a range of hospital services, including heart
bypass operations and kidney dialysis as well as routine breast
screening. Some stroke units appear to concentrate heavily on
younger people.

– A survey of accident and emergency
departments showed that patients over the age of 60 had to wait
almost five hours for attention, compared with average waits of
less than three hours for patients under 40 years.

– The operation of cost ceilings for
community-based packages of care for older people means that it is
substantially cheaper for local authorities to place people in
residential care rather than care for them at home.

– Cost ceilings are also habitually set at a
lower level for the support of older people than for younger adults
using social care. For example, the average gross weekly
expenditure in England on residential or nursing care is £342
for an older person, but up to £669 for younger adults.