Advocacy and older people – special report

Why do older people need advocacy?

Age Concern Essex
“Older people need to be protected from those who think they know what is best for them. Good advocacy helps older people to make an informed choice from those available to them.”

Age Concern Northampton
“Demand proves the need. This can involve any issue – health, care, consumer, housing, disabilities, benefits, abuse, relationships, and financial management for those with mental incapacity.”

Lancaster Advocacy
“Older people can be particularly vulnerable. Some older clients may have gone straight into residential care from hospital. Older people may find it difficult to challenge doctors or social workers even when their treatment has been poor.”

Norfolk Elders Advocacy Alliance
“As a factor of the ageing process many people appear to be unable to face the stress of taking on complaints systems alone. With a citizen advocate to support them, they are sustained and able to take strength from that relationship, however impersonal.”

Peaks and Dales Advocacy Forum
“As people get older they are disadvantaged by the system. Their contribution is not recognised or valued and many feel let down. This is made worse by the isolation many older people feel as a result of the loss of partner or simply loss of mobility. Advocacy allows their voice to be heard and their views respected.”

Source: Older People’s Advocacy Alliance

Special report

Older people – along with the rest of the general public – do not know what advocacy is and as a result are unlikely to request it, according to a new report from the Older People’s Advocacy Alliance published last week.

Advocacy is often confused with information, advice and support services. There can be overlap but roles are distinct.

Action for Advocacy says: “Advocacy is taking action to help people say what they want, secure their rights, represent their interests and obtain services they need. Advocates and advocacy schemes work in partnership with the people they support and take their side. Advocacy promotes social inclusion, equality and social justice.”

The Older People’s Advocacy Alliance defines advocacy as: “A one-to-one partnership between a trained, independent advocate and an older person who needs support in order to secure their rights, choices and interests.”

But ignorance about the nature and purpose of advocacy is not restricted to service users.

Social care professionals may not understand it either, according to OPPA’s research.

It found that awareness of advocacy for older people is “very limited” even within older people’s organisations.

Social workers can misunderstand the role of advocates or even be suspicious, seeing them as troublemakers or pursuers of complaints, says Karen Mellanby, policy and communications manager at Action for Advocacy and a qualified social worker.

Advocacy for older people also has a low profile in the wider social care and health world. A joint review of social care and health services for older people by the Commission for Social Care Inspection, Healthcare Commission and Audit Commission did not mention advocacy.

Advocacy for older people is a “relatively recent endeavour” previously associated largely with younger disabled people, according to 2005 research for the Joseph Rowntree Foundation. This could explain the lack of awareness.

Defining and promoting advocacy is an important part of providers’ work, says Mellanby at Action for Advocacy. Professionals and clients need more explanation and ways of accessing services, she adds.

For social care staff this could include training and improving links with health and voluntary sector colleagues.

Many service users needing advocacy are by definition excluded and difficult to connect with but ways of reaching them range from talks in care homes to leaflets and posters in GP surgeries and hospitals.

Expectations of advocacy have been raised by the Mental Capacity Act, to be implemented in 2007. The act provides a framework to protect vulnerable people who are unable to make their own decisions and establishes the Independent Mental Capacity Advocate service.

Campaigners including the Making Decisions Alliance, a coalition of 40 older people’s and disability organisations, have warned that government guidance on the act must give more clarity on the role of advocates.

OPPA  mapped advocacy services for older people in England and found 136. Age Concern run 57 out of the 136 projects.

London and the north-west have the most advocacy services and the north-east the lowest.

Provision is “clearly very far from comprehensive” across England, OPAAL concludes.

The figures “give very serious cause for concern about the lack of availability of advocacy for older people in many areas,” says the charity.

It found a great variety in the type of organisation providing advocacy for older people and has listed them in a directory.

This includes only 16 organisations specifically concerned with older people’s advocacy.

More than half of provision is by organisations whose main goal is not advocacy.

National quality standards for independent advocacy organisations, to improve accountability and quality across the sector, recently published by charity Action for Advocacy should help bring consistency to such varied providers.

The benefits of advocacy for excluded and vulnerable older people are clear and now need to be promoted widely to social care staff and service users.