Although we are some way from finding a cure for dementia, there is evidence that helping older people remain socially engaged can delay or slow the progress of this – and, indeed, other age-related problems. The importance of this observation is that, by reducing the time during which someone needs formal care services, more people can be supported with the funding that is available.
For this to be achieved there will need to be much closer working within local government and non-care service providers will need to think differently about the contribution they can make to the wider community. The following ideas, drawn from a strategic plan I developed some years back, illustrate how community-based projects could be used to reduce the demand for care services and benefit the wider community.
● Establish care courts or retirement communities: Local authority and housing associations are finding it difficult to let sheltered accommodation, yet older people are willing to move into modern retirement communities. This needs to be addressed because the underuse of sheltered schemes by older people represents a significant waste and loss to the community.
Redeveloping unpopular sheltered housing sites – particularly if they are near care and other community facilities – into attractive, mixed tenure retirement communities, not just extra care schemes, could represent a sound investment. Older people living in supportive communities need less care support and are less likely to be admitted to hospital. Those who are tend to be discharged sooner.
The development of retirement communities could also bring the benefit of releasing much-needed family-sized housing.
● Establish a “garden army”: Composed of the “younger-old”, this group would manage the gardens of people who are no longer able to. In return, the army could receive a fee but would be allowed to grow produce that would be sold to help fund the service. Such a project would bring a number of benefits: a horticultural experience (shown to be good for people developing dementia), a role and purpose for the “soldiers”, and bringing interest and social contact into the lives of the garden-owners.
There is also potential for the scheme to expand in a way that could reduce the waiting lists for allotments or improve the appearance of unkempt public spaces.
● Establish a network of self-support clubs: People need information but is it most cost effectively provided by paid staff? Evidence, particularly drawn from leg ulcer and other chronic illness clubs, suggests that user-led clubs are highly valued and can promote compliance with treatment. Further, the social interaction, role and purpose that can come from being involved in a club can bring “protection” from other age-related problems.
There could also be a positive side-effect for the treatment services. If professionals were to run their clinic alongside these clubs they may find fewer appointments are missed and more effective (less costly) patient-therapist partnerships are established.
The demographic tide cannot be turned and many of the conditions that lead to older people needing care cannot be prevented. However, more can be done at a marginal additional cost or through self-funding arrangements that could qualitatively and quantitatively reduce the care and support someone needs. Through delaying the onset of dependency and maximising independence, in ways illustrated above, some resistance can be offered to the demographically driven demand for more resources.
Geoff Ettridge is an independent adviser on care services