To protect vulnerable people during the pandemic, massive change is possible

Coronavirus has made us all more vulnerable, all more isolated, and made everyday life harder to manage.

However, the consequences of all this affect some people more than others.

Many older people were already vulnerable, already isolated and already needed help in their day-to-day lives – and, of course, they tend to be at more direct risk from the virus itself.

Linda Robinson, CEO of Age NI, told Scope that Covid-19 represents an unparalleled upheaval with many great risks for older people.

She said her organisation has “turned services inside out and made them fit for purpose” in a society that is barely recognisable compared with a month or two ago.

While there are clear worries for older people in general – indeed, society in general – she said that “there are particular concerns for those who are on their own, and those who are looking after someone with dementia.”

She continued: “We are acutely aware of the impact on carers as well as those living alone. To be in that position and to be unable to get out and about is difficult.”

To provide the best possible service for older people at this time, Age NI had to change – and fast.

Agility

Age NI has been supporting older people for over 30 years, helping them to remain independent and connected to their communities. Last year, it had 94,965 engagements with older people through its services, support networks, and engagement activities, including 9,481 calls to its free-phone advice line.

Since lockdown it has had to transform its service model, while the needs of individual service users have grown. In the past three weeks, the organisation has witnessed a 50% increase in calls.

Covid-19 has, unsurprisingly, caused a huge spike in anxiety for the older population and, with the virus spreading and social distancing measures in place, the need for older people to get information, support and advice that suits their individual circumstances is greater than ever.

Ms Robinson told Scope that changing the way they work, and doing so rapidly, was a challenge but something the organisation was able to do.

“In situations like this, it’s the agility of the teams to adapt and change that make the difference. I am particularly mindful of the supreme effort of our front facing staff, the emotion of our call teams and volunteers who are dealing with vulnerable, older people, some of whom are in distress.

“As an organisation, we have a duty of care not just to our team, our volunteers, the older people themselves but also to carers who too are extremely isolated at this time.

“Lots of organisations have had to do things differently. Some of what we offer cannot be the same service, and not as good as a service where you can take someone out of home into different surroundings.

“But the most important element is that they have to have something. It wasn’t even in our thinking that we would close up shop and walk away. We have to give people something. Our staff teams haven’t shied away from anything, I’m immensely proud of them.”

Adapting to circumstances

Home visits and community support still take place - but the shape of those services has changed. For instance, what might have been a group activity providing three-hour respite session per week now perhaps involves a one-hour respite visit every other day.

Meanwhile, staff and volunteers who were based in day centres have been moved onto a new, beefed up phone service that both offers wider provision and allows people to work from home.

In general, vulnerable older people now face more obstacles to fulfil their basic needs. Social distancing means long queues outside supermarkets or smaller grocery stores, while delivery slots are much more difficult to come by. GPs and pharmacies have changed the way they work, as have organisations across the third sector. Age NI provides frontline services and also signposting – so they had to make sure that all the information they provide is and remains up to date.

“In a matter of days, we have turned our organisation inside out. Our call line team has been quadrupled and moved into a virtual call centre in staff homes, our care teams at the front-line continue to deliver personalised care and our Day Centre service users are being contacted daily by phone to ensure that remain connected.

“Add to this our new Check in and Chat Service supported by 50 + volunteers who are calling older people who need a reassuring voice and checking too that other, practical needs are met.”

The phone service now offered by Age NI is as comprehensive as possible. If an older person is feeling lonely and would benefit from some conversation, a volunteer will give them a call. If they need information about managing their needs, that information will be provided.

Service users, and their calls, are subject to a three-tier triage to assess their needs and match them with appropriate help. The new Check in and Chat provision, for example, is a second-tier service.

The right to healthcare in unprecedented times

The Age NI CEO has been working in the sector for over 30 years and says she has never seen anything remotely as challenging as Covid-19 and the stay-at-home policies necessary to try and tackle the virus.

“I’ve definitely not seen anything like this before. Something that happened on the other side of the world has brought here to a standstill. It has brought the entire world to a standstill.”

She said it has created financial difficulties, social difficulties and emotional difficulties – and hopes, ultimately, that it will be a catalyst for positive change.

Every person, organisation and institution is trying to come to terms with a new reality.

One aspect of this that greatly concerns Age NI, and other groups who work with older people, is some of the language used about health provision.

Faced with potential shortfalls in medical supplies or the availability of doctors and nurses, some discussions almost make older people sound expendable.

“Sometimes how people communicate their message can leave others feeling quite afraid. Whenever you hear medical debates around shortages of ventilators, for example, the way people speak about that can be quite scary – ‘Why give it to a 90-year-old rather than a 19-year-old?’ There has been an issue in England with GP letters to care homes that say ‘If one of your residents contracts COVID-19 then we won’t send them to hospital.’

“We are concerned that decisions on health shouldn’t be based on age but instead based on discussion with the individual and their family and medical evidence.”

Accordingly, Age NI is one signatory (alongside the NI Older People’s Commissioner and several other organisations from around the UK) on a letter released two weeks ago saying that age is not a proxy for someone’s health and that fundamental human rights should be upheld.

Institutional stability and the future

All this has happened while the stability of charities is under threat.

The Covid-19 lockdown is an existential threat for third sector organisations because it threatens a catastrophic collapse in fundraising (see previous Scope pieces here and here).

Age NI is no different. Various income streams have disappeared, for now. Events, whether ones dedicated to the charity or their presence at things like the Belfast Marathon, are not currently viable. Retail shops are closed. The future is uncertain.

“At the moment everyone has been putting all they have got into what’s happened over the last four or five weeks.

“However, organisations will face challenges over the next six months to make sure they are financially stable. At some stage all sectors will have to see what happens next and ask how we pick ourselves up from this.”

Ms Robinson is particularly focused on the need for change in our entire health and social care system, especially when it comes to making social care sustainable.

She said change, as envisioned in reports like Transforming Your Care or Bengoa, has been sluggish and plagued by complaints that this is a long, massive process – yet in the past six weeks we have seen our entire health system overhaul itself, to its immense credit.

“This debate needs to happen with all the citizens in Northern Ireland. Now is the time to talk about what happens when we come out of this. What does our Health and Social Care system look like?

“The NHS has performed brilliantly and shows how well worth protecting it is. The big issue for us is the social care workforce. The workforce delivering that is on minimum wage.

“Now more than ever, we need a properly graded scheme for our social care workforce ensuring better terms and conditions for these vital front-line staff. It is really important that the social care teams are recognised for the sacrifices they, as well as our health care teams, are making.”

She said providers also need greater support, both in finances and policies, that reflects just how valuable their services are to society. She noted, as an example, that providers currently have to pay for PPE for their own staff.

All of us are living in the midst of this pandemic. We must simultaneously make the best of today while also thinking how we can create the brightest possible tomorrow. That is far from straightforward – but, as the above shows, difficult things are not impossible.