Older people: "undervalued, unappreciated, patronised"

Her term is almost up and Claire Keatinge would be forgiven for putting her feet up for the last few days and preparing for whatever her next challenge might be.

But she refuses to talk about the future and is as passionate as ever about her current role and the plight of older people.

“This is still a very ageist society,” she says. “That is why I remain convinced that there is an absolute need for a commissioner whose only powers and duties refer to safeguarding the interests of those over 60 and there is a huge need for all of us to reflect more enthusiastically on the positive contribution of older people from being seen as passive recipients of services and a “drain” on resources to be looking at their rights and the contribution they make to society. “

“Currently they are undervalued, unappreciated, patronised, disregarded and set aside as soon as people consider their chronological age. “

Strong stuff indeed.

Unfinished Business

And there is also a deep sense of frustration about hitherto unfinished business.

“I had an appointment with the Health Minister to discuss outstanding issues but there is no health minister and my frustration is huge. The health and well-being of older people who are not getting the help that they need is outstanding and it is not acceptable to put older people on the long finger and make them wait whilst we sort out other political issues.”

It is a good time to ask her where she feels more should be done, and her response, focuses on health.

“ In his recent report Sir Liam Donaldson raised important issues on the question of leadership and accountability” (in the health service) “ it is hard for me to provide advice to government  which is my statutory function and to see the layers of bureaucracy that it needs to go through to come to a decision to fail to act. “

She cites the example of carers. There are many thousands of people across Northern Ireland who care for their partners or children for example, so that they can continue to live in a loving home. This is rewarding work but it is also demanding and can lead to social isolation and low incomes.

All too often older carers in particular, do not get the training, support or respite that they need and subsequently their own health and well-being suffers.

COPNI carried out extensive research into the problem and discovered that although Health Trusts have a statutory duty to inform carers of their right to have their needs assessed there are no targets to identify older carers or to deliver on the requirement to carry out assessments.  The uptake of assessments is, unsurprisingly low, and so therefore there is not enough information for the trusts to plan for and then deliver services for older carers.

Sitting on advice

COPNI has made a series of recommendations to the Minister on how the situation might be improved but action is yet to be taken.

Keatinge said: “I provided that evidence to the Minister who is sympathetic and understanding I then expect that to translated into action. The advice is clear and evidence-based. I expect the Minister to either take that advice by instructing officials to implement it, or else for the Department to provide very clear evidence which they will stand by, in a public arena, to say why it is not right.”

She says that it is unacceptable for government to be given formal advice by her office and then just sit on it and wants to see politicians being much more robust with officials.

The question of leadership and accountability in the health service, which is a common theme of observers and critics, is likely to be a key challenge for her successor and will not be easily resolved.

So what of her successes in office?

Tackling crime

She cites three examples.  

The first is the way that her office has been able to intervene in cases where older people have had problems with public authorities. She has been able to directly intervene on occasions and also to provide independent resolutions of disputes.

“A few examples: a case where a council says that it will no longer go up an unadopted road in a rural area to empty someone’s bin, but that person is an older person with a disability. It should not really need me to fix that, but that is the sort of thing we have dealt with.

“Another would be a case where a public authority was proposing to close a facility for older people with advanced dementia and to disperse residents. Independent mediation was deployed to ensure that all parties could agree on the right solution.

Some cases involve adaptations to peoples’ homes, often when they have been discharged from hospital where the right provision has not been put in place correctly and on time and consequently the individual has not been able to stay in his or her own home as a result.

She cites one shocking example: “We had a case where someone was waiting for an accessible shower facility and in the meantime her spouse was using a child’s paddling pool on the kitchen floor to keep her clean. This individual fell as a result and broke his hip.”

A second area where progress has been made is in relation to crime. COPNI research demonstrated that the clear up/conviction rate for burglaries was poor when the victim was aged 60 and over: with victims under 60 almost twice as likely to see their cases solved than older people.

It is not clear why this is the case, but some have speculated that the police feel that older people do not make strong witnesses.

Whatever the cause of this the Policing Board and PSNI have taken the issue on board and there are now clear targets in the Policing plan to improve clearance rates for crimes committed against older people.

The true value of older people

A further example is COPNI’s Appreciating Age report which attached a value to the contributions made by older people and projected it over the next 50 years, subtracted the cost and concluded that over that period older people will contribute £25 Billion to the economy. This directly challenged assumptions that older people are a “burden” and the conclusions are now finding their way into public discourse.

Keatinge’s time in office is nearly up and one thing she will more than anything is working older people themselves.

“I feel both enormously privileged and hugely appreciative of the time and the expertise that organisations that work with older people, individual academics and older people have given me.

She specifically cites community-based groups – many very hard pressed for funds – who are working to improve care in the community, the lunch clubs, the community and faith groups, and the good morning schemes all of which will be on the front line of integrated community care, if and when Transforming Your Care is fully realised.

Passionate, forceful and articulate, Keatinge will be a hard act to follow.