For more than half a century now, we have treated the trials of sickness, ageing, and mortality as medical concerns.  It’s been an experiment in social engineering, putting our fates in the hands of people more valued for their technical prowess than for their understanding of human needs.

The experiment has failed.

Atul Gawande, Being Mortal, 2014

It is time to do care differently

The Care Quality Commission has declared that the care system is ‘approaching a tipping point’1 with providers handing back public sector contracts and postponing investment.  When does a tipping point tip?

Less discussed is a workforce shortage that means even if funding questions are resolved business as usual is unsustainable.  By 2037 it has been estimated that we will be between 400,000 and 1.6 million short depending on how attractive working in care work is.

Care and the challenge of ageing

The challenge of reimaging care is not just about how we respond to increased longevity, it needs to address the whole life course and opportunities along the way to reduce risk factors that give rise to dependency and bolster those things that make us more resilient.

Science tells us that biological ageing is malleable2, that we can change trajectory by the choices we make along the way.  We can affect our ability in later life to continue to engage in the daily rhythms and activities that give meaning and purpose to our lives.  Maintaining muscle strength, our grip and suppleness all make a difference.

But it is not enough to say we should all exercise more, true though this is.  There are other societal forces at work.  Maintaining good muscular skeletal health into later life is about mindset too.

The psychology of ageing

The psychology of ageing matters, research points to self-stigma playing a part in the way we age.  Negative attitudes to ageing affect both physical and cognitive health in later life. 

A study from the Irish Longitudinal Study3 on ageing found that compared to older adults with more positive attitudes those with negative attitudes towards ageing had slower walking speeds and worse cognitive abilities.  Perhaps most striking was that frail elderly people with positive attitudes towards ageing had the same level of cognitive ability as their non-frail contemporaries.

Unmet needs

This self-stigma and deep-seated societal stigma that surrounds ageing also affects our willingness and ability to seek help in later life.  A recently published study4 found that many older people deny or minimise needs that went unmet. 

Unmet need is the gap between a person’s needs and the available support.  The amount of unmet need is not a static thing it can fluctuate due to changes in the support available or the changing need for care.

A number of barriers to seeking help and reporting unmet need were found by the study, and most were unrelated to access to the means-tested social care system. 

The factors identified by researchers include a lack of planning ahead, not wanting to be a burden, the costs and perceived affordability of care, a lack of personalised information and advice as well as difficulties access general sources of information, high levels of resilience and desire to remain independent, and a lack of confidence to do things themselves.

Loneliness and lack of social contact emerged as the most commonly offered unmet need for many in the study.  This was even amongst those who had unmet needs for support with the basics of daily living.

How do we do care differently?

So what does this mean for the way we do care?  Here are my five predictions.

First, the need to counter stigma and myth that surrounds ageing will be recognised. Age discrimination may have been outlawed, but everyday ageism is still far from being banished.

Normalising healthy ageing, dispelling the stereotypes, challenging negative attitudes to ageing and encouraging planning and help seeking would be a good start.  Social marketing could help make us all more ready for ageing.

Second, the transition from a deficit model of dependency care to a wellbeing model that builds people’s resilience and social connections will accelerate.

The Care Act wellbeing principle provides the framework.  To work change must be co-created, starting with what people, families and communities can or could do, if enabled.  Initiatives like the Design Council’s Transform Ageing5 in the South West and SCIE’s asset based area6 work in Manchester offer the prospect of scaleable ways ahead.

No one should have to yield their autonomy just because they need help.  Making lives meaningful in old age with flexible daily rhythms and the possibility of contributing and forming relationships requires more imagination and invention than merely making lives safe.

Tapping and growing social capital needs local initiative and Government investment, one way to fund this would be for a proportion of the costs resulting from late action and crisis care to be earmarked for social infrastructure.

Third, everyday household appliances, mobile technology, cloud computing, machine learning and 3-D printing will be harnessed by people to enable and enhance their lives and reduce risks of long-term health conditions getting out of hand. 

Personalised digital support7 ‘bundles’ that use a combination of the Internet of Things – anything from Amazon Echo or Google Home to digitally enabled fridges and smart meters – and dedicated devices will create new digital handy person jobs and anticipatory and preventative service models driven by artificial intelligence fuelled by data.

Four, to encourage planning for later life the Government will finally act to limit people’s exposure to catastrophic care costs.

Five, NHS leaders recognise housing’s contribution8 to preventing and postponing need for care and promoting autonomy and wellbeing.  Housing organisations becomes integral to emerging accountable care systems where the goal is to get up stream and better manage population health.

Debates about how we adapt to our lengthening lifespan tend to be couched in terms of ‘them and us’, rather than recognising that we are talking about our later selves.  We all have a stake in doing care differently and doing it better too.

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