The Safety Net for Older People Living at Home is Failing and in Urgent Need of Repair

A new interim report from Age UK warns that that the safety net we expect to be there for us as we age, if we are living at home, has become dangerously weak, with older people living alone in declining health, with no family and friends to support them, at particularly high risk.

Age UK estimates there are approaching half a million people (465,000) aged over 65 in England living with three or more significant health conditions who are also in need of help with at least three essential daily activities (i.e. care needs), such as getting out of bed, going to the toilet or getting dressed. [i]

But of these half a million individuals, only about one in three receives care at home, with the remainder relying on family - or managing without. Even among those fortunate enough to have family support, nearly two in three depend on a partner who is often an older person themselves with their own increasing health needs.

More broadly, of all those aged over 65 in the UK, nearly a third – more than 3.6 million people [ii] - live alone , while around 1 in 10 (1.2 million people) are ageing without children. [iii]

All these numbers are expected to rise steeply over the coming years as our population ages, so we need to strengthen the support on offer to older people at home sooner rather than later.

The report argues that while we may all assume that health and care professionals will keep a gentle eye on the wellbeing of older people who live at home and whose health is of concern or in decline, this can no longer be guaranteed, because of deficits within our over-stretched health and care services, plus fragmentation between them.

It explains that these problems are now often so great that a loved one needs to ‘hold the ring’ for an older person in this position, to chase progress and join up services for them. This job often falls to an adult child, or an ageing partner, placing a very considerable burden on families and often causing them considerable anxiety and distress.

Many older person do not have someone like this to help them and without this support they risk failing to get the treatment and support at home they need. The end result is likely to be an unplanned and otherwise avoidable admission to hospital, or worse: the report contains some disturbing case studies of what can happen when an older person’s growing health problems at home go unrecognised.

This latest analysis from Age UK shows the health and care system has, to date, failed to expand or change fast enough to support our ageing population, piling pressure on hospitals – as the rate of avoidable emergency admissions has more than doubled for older people over the last 13 years.

Overall, England has seen a 63% rise in the overall rate of these avoidable admissions since 2003. But for older people, these rates have increased by a staggering 107% for those aged 65-69, and by 119% for older people aged 75-79. In the most recent year for which figures are available (2016/17) there were 341,074 avoidable emergency admissions for people aged 65 and over, Age UK found. [iv]

Caroline Abrahams, Charity Director of Age UK said: “The safety net for older people living at home has worn dangerously thin after years of underfunding and an absence of workforce planning across both health and care – this is why the numbers of older people whose emergency admissions to hospital could have been avoided are rising so fast. The case studies in our report show just how difficult it can be to get the joined up health and care services you need at home if you are an older person, especially if there is no one around to help you.

“Our GP and community health services like District Nursing are understaffed and overstretched, and yet many older people are completely dependent on them to sustain their independence, health and wellbeing. Older people with multiple health problems also often have associated care needs, and we already know many don’t get all or sometimes any of the care support they require. Yet without this kind of help, properly co-ordinated and designed to tackle their specific health conditions, which may be quite complex, small health problems can escalate rapidly into crises. Then, if they need to be admitted to hospital the full extent of their difficulties may finally be recognised, but it would be so much better for them and for all of us if they had got the help they needed earlier on.”

“The NHS long term plan which is currently being developed must grip this situation and put in place a raft of measures to restore the safety net for older people living at home. Care navigators, multi-disciplinary teams operating in the community, more ‘hospital at home’ type services, and the stronger involvement of the voluntary sector should all be part of the mix. Nor can the NHS create a stronger safety net on its own; social care must play an equal part – and yet is currently so underfunded it is in no position to do so.

“This can’t go on: we need to build up all our community health and social care services once again, gradually fill the yawning workforce gaps in both health and care, and do more to support the family members who step in to ‘hold the ring’ of a system under huge pressure – often ageing partners with their own health problems. In addition, policymakers must wake up to the reality that increasing numbers of older people are ageing alone and design services and approaches that are effective at reaching and supporting them too, rather than expecting a committed relative or friend always to be on hand to do this for them.”

Case studies in the report include:

‘Ralph’ – an older man whose growing need for support after his wife was admitted to a care home went unrecognised, even though he was regularly visited by District Nurses; he was eventually found unconscious and died soon after of blood poisoning.

‘Alan’ – an older man coping with multiple health problems who lives in difficult circumstances at home, with no meaningful contact with his GP, despite having been in hospital for a long time, leading to long delays for the wheelchair without which he cannot get out of the house.

‘Jean’ – an older woman who fell and broke her hip and wrist. After a month in hospital she was discharged back to her own home. About a year later she got pneumonia and became delirious, which paid domiciliary carers failed to notice. It was someone from the ‘meals on wheels’ service who came in later who raised the alarm. After Jean was finally discharged from hospital, Sarah moved her mum in to live with her.

‘Kate’ – an older woman completely off the radar of local health and care services, who finally began to get the support she badly needed after the intervention of her local Age UK.

[i] Estimates from ELSA Wave 8 (2016/7). Source: Marmot, M., Oldfield, Z., Clemens, S., Blake, M., Phelps, A., Nazroo, J., Steptoe, A., Rogers, N., Banks, J., Oskala, A. (2018). English Longitudinal Study of Ageing: Waves 0-8, 1998-2017. [data collection]. 28th Edition. UK Data Service. SN: 5050, (Source). Results scaled up to population levels using the Estimates of the population for the UK, England and Wales, Scotland and Northern Ireland by Age, 2017 (ONS, 2018).

[ii] Labour Force Survey, ONS, 2016

[iii] (Source) 

[iv] Age UK analysis of the February 2018 release of the NHS Outcomes Framework Indicators prepared by the Clinical Indicators team at NHS Digital. (Source)