This section sets out highlights from engagement with Bexley residents:
Development of the Ageing Well Strategy 2017-2018
The development of this strategy included a wide range of community engagement (on-line consultation on the content and themes of the strategy, face to face engagement with groups, engagement at the Ageing Well market place event. The primary purpose of the strategy is to set out the key priorities in the Borough to tackle some of the barriers and opportunities to help residents to live well into older age.
Tackling loneliness and Isolation
- Being healthy and active was of very high importance to most people. Residents often expressed that it was linked to loneliness and vice versa.
- More befriending services needed as several would like to talk to others but there were long waits for a befriender. Befriending for those with a visual impairment was difficult to find.
- More affordable groups and chances for older people to get together are needed. Recreational courses – maybe in adult education.
- Courses aimed at grandparents and grandchildren learning and doing activities together.
- Most people knew their neighbours but some did not like or receive help or support from them.
- Maintaining bus passes and access to transport such as dial a ride – to keep older people active and connected.
- The need to capture the work of churches – as they provide lots of activities and opportunities for older people and families.
- Commissioners and providers should go out to local groups to promote what is available (e.g. Community Connect) to increase awareness and to prevent isolation.
Staying healthy and active
- People worried about being a burden on family and friends, and becoming ill.
- Staying fit and active was a particular concern for carers, who worried about their cared for person and who would look after them if the carer became ill or unable to provide care. For this group having time to do things for themselves was very important. Activities for those who are cared for is important in order to give carers a break.
- Some residents did not feel listened too, especially by GPs. They felt appointments needed to be longer and more emphasis should be put on prevention.
- Many residents have experience of volunteering and thought of this as a good way of keeping active and engaged with the community. Those who were not involved in volunteering cited lack of time, family commitments, or poor health as barriers.
Enjoying time at home and planning for the future
- Concerns about being able to pay for good care – they would spend all their money on care and had saved so they could give their children something when they died but this would not be possible.
- Concerns that residents may be unable to maintain the upkeep of their homes.
- For people with a disability, the ability to stay in their own home, remain independent, coupled with keeping active and healthy was the biggest concern. Some residents were already living in sheltered housing /accommodation. Having to rely on others, even spouses, to be independent becomes an issue as people grow older.
- Worried about going into care homes and the quality of care they might receive.
- Need to ensure a range of affordable housing options for older people.
- Access to good quality independent help on financial matters is important, together with planning into older age and making individual’s wishes known.
Environment and Communities
- People generally felt safe in their own homes.
- Many residents expressed concerns about going out at night and during the day particularly at times when crowds gathered.
- The need to make the environment easier for older people for example keeping pavements in good repair.
- Need good access to parks and open spaces.
- The perception amongst residents with a BME background was that ageing within their community or social isolation in later life was not a concern as extended family look after them. However, the group was not aware of what services are available or where to look for information but generally assumed they would ask their GP, family or friends or search online.
- Several people said they were afraid to travel on the buses especially at peak times when there were large groups of young people.
- Older people want more information and support to deal with fraud, scams, and door to door sellers.
Accessing services and support – the barriers
- Concern about form filling, assessments and the time it takes to get support and advice.
- Some groups said accessing services and support was harder – for example those who might need an interpreter.
- Providing older people and their families with information in paper format is important.
- Publicising the opportunities for people to meet up for example activity clubs, community coffee clubs.
- Targeted communications – newsletters as an example.
The information gained from residents assisted in finalising the strategy and will be used to develop the action plan during 2018. The development of the action plans will be overseen through the establishment of an Ageing Well Partnership which will include residents, commissioners and partners.
Care at Home Research – Healthwatch Bexley, University of Kent and Christ Church University, Canterbury 2015
This research presented the findings of a domiciliary care research study undertaken by Healthwatch Bexley, and academics from the University of Kent and Christ Church University, Canterbury. Commissioned by the London Borough of Bexley, this study explores the perspectives of people receiving domiciliary care in the London Borough of Bexley. A total of 26 individual interviews with ages ranging from 55 years to 102 years were undertaken between May and September 2015. The findings of the research continue to assist commissioners in the review and redesign of services. The recommendations were as follows:
Facilitating access to community networks: Reducing isolation
The need for companionship is very evident from this research. Although time for conversation/social interaction is not specifically in the remit of paid carers they are working with often very vulnerable and evidently lonely individuals. The carer role needs to reflect this reality by supporting paid carers to demonstrate compassion and kindness during these necessary human interactions. Beyond this there is an evident need to address the important issues of loneliness and isolation with a wider more coherent approach. The health advantages of reducing loneliness and maintaining existing social networks are well-documented. The following would help maximise this benefit:
- A multi-agency group should be established to provide better and more informed care choices. The remit of which should be a focus on practical outcomes in relation to transport, housing, health and social care.
- The provision of transport schemes to increase access to meaningful activities outside the home was given a high priority by most of the participants in this research.
- Commissioners should ensure that provision for emotional support is part of standard care packages and that options include access to talking therapies, befriending and mentoring.
- A multi-agency approach should also ensure that links to Social Prescribing for isolated clients is established and maintained in order to provide access to community networks including libraries, reading materials, films, voluntary groups and local age related groups/activities.
- A one-off information giving visit would be helpful in reducing isolation and loneliness (McEwan et al (1990, in Cattan et al. (2005)).
- A useful contacts list with useful telephone numbers, voluntary organisation information and relevant websites for all family members.
- Commissioners should explore provision of social groups and befriending services, tailored to the needs and preferences of the individual for both family carers and recipients.
Care agencies need to have regular communication with commissioners so that they can highlight those most at risk of loneliness. Commissioners should incorporate partnership working with volunteer organisations in order to address those issues and provide support to this vulnerable group.
Maintaining high monitoring standards
Commissioners must ensure that care providers are maintaining the highest standards of care. Missed care and lateness were common complaints among recipients, along with lack of carer consistency, resulting in reduced quality of care and potential safeguarding issues. Health needs change rapidly among older and disabled populations, but these developing needs were not being assessed or met far too frequently. The following actions are recommended:
- Regular face-to-face reviews with care recipient and family members in order to reassess care plans, provisions and ensure satisfaction.
- Minimum standards of training for care workers and additional training provided when skills gaps are identified.
- Home Care provision should link into wider policy initiatives such as the loneliness group and the Older Persons Strategy in order that recipients receive a joined up service. There should be ongoing monitoring to ensure that home care is incorporated into the wider strategic framework for supporting the care needs of residents.
Respondents in this study felt that their input into the type and level of care they received was limited. People receiving care in their homes should be able to choose options to suit their needs and preferences. To achieve this, the following steps are recommended:
- Individuals and families should be more involved in the organisation of care and the on-going care plan.
- It should be made easier for clients to complain, so that any issues are highlighted earlier. An allocated contact at the Council is recommended to improve this.
- Consistency of carer and timings allows clients to build relationships with care workers, allows care workers to learn the routines and preferences of the client, and provides reassurance that plans can be made for the day. More changeover time could be built in to care worker schedules to protect against lateness, and communication needs to be improved when care schedules are affected.
- Flexibility in care provision should be allowed, so that care provisions can adapt to the changing needs and lifestyles of care recipients, with regular reviews of needs.
Improve information on other services
Care recipients reported diverse experiences of how information on other services was provided. Commissioners should ensure that clear guidance and pathways are provided to help care recipients access complementary services.
- Care recipients should be offered the opportunity to ‘top up’ existing care packages with private funding, to increase care without losing consistency of care provision.
- Provision of a ‘check list’ to ensure all relevant public and voluntary sector services are being accessed should be part of a regular review process.
Smooth transition from hospital to home care
Some participants described difficult experiences of leaving hospital to return home to receive domiciliary care. The following would make this easier:
- Timely assessment for and provision of enabling equipment in the home, as well as adaptations when appropriate.
- Improved communication to ensure care recipients and their families are fully involved in care plans, know what to expect from whom and when so that there is a clear patient care pathway established.
Effective communication and continuity of care
In order to ensure that the experience of Home Care is a positive one, clients must feel that they are important, listened too and fully informed about their choices. Care workers must also ensure that communication is clear, accurate, effective and professional. The importance of effective communication and continuity of care moves beyond meeting basic physical need, workers should develop relationships founded on trust, compassion, knowledge, experience, cultural awareness and empathy, all of which are essential to ensuring that the experience of Home Care is a positive one.
The findings of the research continue to inform commissioners, and a number of themes dovetail with the development of the Ageing Well Strategy.