Older people: much achieved, so much more to do
Eileen Mullan is quietly spoken, reflective and remarkably humble, a strong leader who builds consensus and gets remarkable results by promoting and supporting team work. That is perhaps why she is so widely respected in the sector, and also why she will be missed by staff and trustees alike.
She joined the board in 2008, becoming chair in 2013. In that time much has changed for older people, much remains the same, new challenges have arisen, and there have been disappointments too. She also has reflections to share on two important emerging issues: relations between older people and younger generations; and on what remains for many the final taboo, the end of life.
“Nine years ago the key issues for us were around access to health care, the adoption of a rights-based approach to older people, ensuring they have enough money for their needs and that they are able to enjoy a happy life.
“We are getting better but we are not as far down the track as we should be.”
She argues that the single most important positive development in that time has been the establishment of the Commissioner for Older People (COPNI) which was set up in 2011 after extensive lobbying by AgeNI and other groups.
It is now well established, acting as a champion for older people, using its legal investigative powers and holding government, departments and officials to account as well as raising issues through the media.
On the debit side has been the failure of Stormont to include older people in Equality legislation. This foundered because political parties were unable to agree, not on how to protect and define rights for older people, but because of disagreements over how to frame rights for the young.
This leaves Northern Ireland as the only part of the UK where it can still be lawful to discriminate against people on the grounds of age.
She said: “This means, for example, that an 82 year-old needing a hip operation could be refused one on the grounds of age. This clearly needs to be fixed.”
An example of where there has been progress, but not enough, is in dealing with loneliness and isolation amongst older people. When Eileen joined the board this was a serious concern for age-related charities.
What has changed in the interim is a series of studies demonstrating the linkages between loneliness and poor mental and physical health. The emergence of strong evidence has raised the profile of the issue both in the media and amongst policy-makers. Yet this does not appear to be reflected in decision-making.
Eileen quotes cuts to rural transport as a prime example of this. “Many older people in rural communities are reliant on public transport. It means they can hop on a bus and go somewhere. If the service is cut they have to stay at home.”
“People seem to think it is okay for older people to be on their own. It’s not – getting out and about is how you stay physically and mentally tuned. We need to reach a stage when people are supported to live at home, and to play a part in the community.”
When the current Programme for Government was published there was no section devoted to, or even mention of older people. This was a great disappointment to AgeNI. After all, without this, where was the hook for it to advocate policy?
But Eileen sees the flipside of this as well
“You can also say about PfG, so what - every one of the stated outcomes is relevant to older people? You do not constantly have to be naming something and putting it in a box. You just have to look at the issues in a different way.
“Government should be working for all of us – some will need more support than others at different times but the overall objective of PfG is improving the health and well being and for us to work together to achieve that. That’s good and should be embraced. Everyone is important and our interests and needs overlap. And all of us will grow old. “
She says that politicians have always been responsive to older peoples’ issues and sees no reason why this will change.
Eileen brings a very clear focus to her work in the sector: “If someone needs help civil society should help you. We therefore must be really clear that the organisation is responding to need.”
This might seem obvious, but it is not what some in the Third Sector are doing in a time of cuts. There is a very big difference between bidding for a contract or applying for funds even when it is not directly what the organisation does and what its clients need. Better to understand that need and then seek the right funder.
“At AgeNi we have a consultative forum of older people who form part of our governance – its chair is on our board. It meets to discuss key issues and acts as our critical friend. We don’t do something because we think it is what we think they need. We can’t do anything unless older people tell us that that is required.”
That’s why AgeNI has yet to formally respond to the most important policy document affecting older people, the Expert Panel Review on Adult Social Care (Power to People). It goes out to older people first for consultation and it will be their voice that will guide the response.
But this consultation will not avoid the hard issues, especially the debate about whether care recipients should contribute to the costs of care, and if not, how that should be funded given the ageing population and consequent shrinking tax base that will put pressure on future government spending. How will we manage that, and make sure as well that everyone in need gets the right support? It’s a big question.
This leads to a further important debate: how to maintain and improve good relations between generations in the context of the ageing population and the travails of the young as wages slip backwards in real terms and home ownership is not an option for so many.
Does she see the risk of intergenerational conflict, especially now that older people are working for longer and at least some of them have different motivations for working – stimulation and company rather than the salary? Does this not encourage employers to pay low wages, or even utilise volunteers for work that should be paid for?
She acknowledges the risk, but says that the primary issue here is not generational – it relates to the culture of employers in whatever sector. And it is they – bad employers - who need to be challenged.
“We should never be setting age groups against each other. Quite the reverse. Nobody of any age should be disadvantaged. There has been quite a lot of research demonstrating how much we can learn from each other. And there are far more benefits to older people working longer, for the individual, the economy and for younger people. “
She pointed to two pieces of research, one showing the transformative effect of intergenerational work, and another demonstrating that fears of age-related tension are not being realised.
“We do need to have a mature debate about all these issues and not pitch people against each other. Remember too that there are lots of older people in poverty.
“Wealthy people can be any age – and also there will be plenty who have a house but struggle to pay bills because their wealth is tied up.”
We can all be certain of one thing. No matter how long we live we are all going to die. Death, after all is a natural process, it is not a medical procedure. Yet although we put so much planning into other key moments in our lives: how children will be born, their naming/baptism ceremonies, weddings how we end our lives is most often left to medical professionals and how we are remembered in our funeral ceremonies is left to the guess work of family.
Eileen said: “This is not a conversation for older people, it is one for all of us. There is a really useful booklet prepared by the Public Health Agency on what you can do to prepare for your own end of life: Your Life and Your Choices: Plan Ahead.
“This is important because when people do come into hospital and it is a critical emergency people need to know what your wishes are about treatment, what treatments you do not want and whether you even want to be there in the first place: it is quite natural for people to want to spend their last hours at home. This should not be left in the hands of doctors, or upset relatives to guess.”
“Information is power. If we’ve decided what we want we can just get on with living – otherwise we’re leaving it with others.”
How we fund future care, how we promote and improve intergenerational relationships and how we deal with end of life are three profoundly important issues for government, civic society and every one of us to ponder on and debate.
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