Arrangements where older people with support needs both receive and provide help may have much to offer, writes Brian Wilson.
One of the most striking rural trends – with profound implications for service delivery – is the projected increase in numbers of older people. A report last year by the Rural Services Network noted, the number of rural residents aged 65 and over is expected to rise by 62% over the twenty years from 2009.
In that same period the number aged 85 and over is expected to more than double. Significantly, for local authorities and healthcare providers, the number likely to need some social care support in rural areas is projected to grow by 70%.
Four months ago the Government received a report from the Dilnot Commission, proposing reform to the way that long term care for the elderly is funded. Other events may since have pushed this topic out of the headlines, but it will surely come back again. Indeed, a Government consultation paper, 'Caring for Our Future', has just been produced.
All of which makes a recently released research report, called Not a One Way Street, rather intriguing. Jointly written by the National Development Team for Inclusion and Community Catalysts, it has been published by the Joseph Rowntree Foundation as part of its Better Life programme.
The report examines, what it calls, support for older people with high support needs that is based on mutuality and reciprocity. In other words, support where those involved both give and receive, rather than the traditional approach where they are just recipients.
The project came about through unease that this group of older people are sometimes seen (implicitly, perhaps) as "a burden". It recognises they are a very varied group, frequently with skills or resources to offer despite their own care needs.
Some example it cites are based on approaches such as support circles, volunteering and peer mentoring. In the latter case, those with more experience assist those with less experience to deal with their support needs.
The report finds that these sorts of arrangements differ considerably and may be formal or informal. At one end of the spectrum are shared housing arrangements, designed to encourage social contact and shared activities. At the other end are informal arrangements, with neighbours offering regular help to each other.
One rural example involved a couple in their 80s, struggling to look after their large house and feeling increasingly lonely. They contacted the co-ordinator at a local Homeshare scheme, who linked them up with a 27 year old American student in need of somewhere to live. The couple provided rent-free accommodation in their home. In return they received help looking after the house and with the weekly shop, as well as some new company.
Another example involved a woman aged 84 with dementia, who lived in a small rural community and was no longer coping well on her own. When a close neighbour noticed meals and medication being overlooked, they alerted social services. This resulted in the neighbour being trained as an approved Shared Lives carer.
The elderly woman moved in with the carer, where she is looked after and much happier. However, she is expected to contribute to the family and social life of the carer's house. Unlike Homeshare, Shared Lives schemes are regulated and the carer is paid a flat weekly rate.
Examples like these have enabled older people with support needs to remain within the familiar surroundings of their rural communities. Moreover, the first one made available affordable housing to the student, while the second one created a local job. The merits from a rural policy perspective seem clear.
Of course, many older people feel strongly about retaining their independence and may not be comfortable entering into such formalised arrangements. Other types of mutually beneficial scheme, such as those based around neighbourliness, may be easier to establish.
However, as noted in the report by the Rural Services Network referred to above, traditional adult social care services – such as home help, day care facilities and sheltered housing – can be both costly to deliver and difficult to maintain in a rural setting. As a result they are generally thinner on the ground than in urban centres. All of which makes reciprocal arrangements a potentially attractive proposition.
If any Rural Services Network members have experience of them it would be fascinating to get their feedback. Could more be done to encourage these arrangements in rural areas?
This article was written by Brian Wilson whose consultancy, Brian Wilson Associates, can be contacted at This email address is being protected from spambots. You need JavaScript enabled to view it. . Brian is also the RSN Research Director.
