Sunday, 9 October 2016

Thinking About Women, Dogs, Long Lives and Care Free Days

I've just enjoyed 2 'free from' days. Last Friday (an annual leave day) I decided after tweeting 'good morning' to the wonderful folk that are the #earlyrisersclub (those people who start their day around 05.00) that it would be good to spend some time free from email, phone calls, text messages, tweets and so on. I found the experience a liberating one. I wasn't tempted to communicate with the outside world – well at least not digitally. I did speak to Mary, and took her dog out for a walk with Cello, and spoke with Kevin who was tending to his boat  on the beach. It was a quiet yet enjoyable couple of days. I did wonder if life might be like that in retirement (now just 2 years away). Of course a 'free from' couple of days will be different from living a life 'free from' workplace conversations, conference presentations, meetings and so on.

I do know that one of the things I am going to do when I retire is to write a book of collected stories of older women and their dogs. It's not such a bizarre idea as it sounds. I am an ethnographer, with leanings to social anthropology with much of my research drawing on psycho-dynamic theory. I am interested in how people build and engage with relationships, and have often used thoughts about the construction and use of interpersonal relationships to frame my writing. I am a people watcher and whilst I've been accused of sometimes being too silent, I do like listening to conversations. It is easy to do both activities in my small village in Scotland.

There are 140 people living there. The village has 2 hotels with bars, 2 slipways for launching boats, 1 village high street, a community hall (complete with a newly acquired defibrillator), a lifeboat station and a tiny, newly open tea room and shop. A number of the houses and cottages are owned by people who don't live in the village but come for holidays and so on. It's a great place to be. And if your mental health and wellbeing isn't where it should be, leaving aside my professional qualifications, there are 2 psychotherapist's, 1 GP, and 1 specialist in acute medicine, a retired dentist, 2 retired psychiatrists, and a slightly colourful lady who will offer you a range of alternative therapies, living in the village.

Like many small communities people care about others and will go out of their way to help. This is particularly true in terms of looking out for the elder members of the village. The oldest resident, Paddy, who is now aged 101, was once the former village GP. The 2011 census showed there were 91 people over the age of 65 living in the village, and 66% of the population were female. A large number of people sharing both demographics are for a whole host of reasons single. Women continue to live longer than men, but the life expectancy gap is getting closer. In the UK, women aged 65, can on average, can expect to live for another 21 years, whereas for men it is only a further 18 years. In my village, a lot of these older single women also have dogs and I often come across them as I walk Cello. I would love to capture their life stories and at the same time hear something about how they came to choose their dogs and the contribution their dogs make to their quality of life.

The World Health Organisation assesses Quality of Life (QoL) as being based upon an individual's perception of their position in life, in the context of the culture, and value systems in which they live and in relation to their goals, expectations, standards and concerns. Such perceptions will reflect everything from their physical and mental health, family situation, education, wealth, employment, religious and cultural beliefs, and the persons lived environment. Internationally, the UK is ranked 13th for its QoL (see here) but perhaps not surprisingly, only ranked 23rd for its Happiness Score.

In a world characterised by both dispersed families and a growing number of multi-generational homes, maintaining one's QoL in later life can be a challenge both for those growing older and at times for those around them, their family and friends. At a societal level, an increasing concern is that as the numbers of people living beyond 85 – 90 continues to grow, will there be enough younger people available to support those of a pensionable age. At an individual level, the challenge can become too difficult for many. A growing number of people seek to live out their last years in a residential care setting, and for some this will be due to frailty, poor health and a need for care to be available 24 hours a day.

Today, 1 in 7 people in England over 85 live permanently in a residential care setting. Even so there is a great deal of evidence to show that many of such people don't always have their needs properly assessed and responded too. The consequence is that many have have repeated and often unnecessary admissions to acute hospitals, something that should be entirely avoidable. It is the Care Quality Commission who are responsible for checking the quality of care in residential care homes. They say there are some 15400 care homes (other independent bodies recognise there are some 22000 residential care settings). It doesn't seem to be working, and so I was interested last week to get my hands on a copy of the NHS England report The Framework for Enhanced Health in Care Homes, which was published late September.

Unusually the report was co-developed and co-produced by health and social care staff, families, older people themselves as well as the usual policy suspects and experts. It is brilliant in its assertion of a number of principles that should shape successful enhanced health care in such settings: Person centred change – that is putting the needs of the older person at the centre of any changes (and supporting carers and families to accept this); Co-production of care – making sure the whole system acknowledges the interrelationship of services they provide; Quality – drawing on both research informed evidence as well as evidence from experts by experience; Leadership – effective leadership that is able to transcend organisational and disciplinary boundaries. 

Many of these principles are not new, and perhaps some will think they should be underpinning current services – but clearly they are not. The report is worth a read, but more importantly, we all need to contribute to delivering the necessary actions required to make the QoL for the elder members in our society better, wherever it is they choose to live, whether this be in caring communities such as my village, residential care settings or anywhere else.