The ongoing pandemic has spotlighted the underlying fragility of England’s social care system. Much of the attention has been focused on residential care homes, in which the first wave of the pandemic saw an extraordinary number of excess deaths among residents.
The majority of older people in England who receive care for daily living, do so however, while remaining in their own homes. This is in line with the emphasis in elder-care policy internationally on ‘ageing in place’ – enabling older people to remain in their own homes and communities as the optimal approach for securing their wellbeing.
‘Ageing in place’ is widely preferred by older people. The various challenges experienced in care homes for residents and their families during the pandemic may reinforce this preference. Community-Care reform initiated by Thatcher in the 1980s, is a salient reminder, however, that service-users’ preferences are at risk of co-option by governments with other motives, such as constraining public expenditure. With that in mind, and as we continue to wait for the current government’s long-promised plans for the reform of social care, it is important to highlight that ‘ageing in place’, without adequate investment in the services that support older people to age well in their own homes and communities, will fail to deliver older people’s wellbeing.
A review by ten leading charities has found that in late May 2021, 1 million over 65s are at risk of chronic loneliness despite the easing of lockdown. The same review warns that the struggle to address this will be tough since many of the community-based support services for older people have shut down completely during the pandemic. What’s more, 7% of support organisations questioned as part of the review had not yet resumed normal services. What that review does not highlight, though, is that even before the pandemic, services were already in decline.
In 2018 and 2019, with colleagues working on the ESRC-funded Sustainable Care Programme*, I interviewed people aged between 65 and 92 (average age was 81) in London and South Yorkshire who were still living at home and in receipt of formal or informal care. Community support organisations, such as faith groups, cultural centres and clubs, played a vital role in supporting our participants’ wellbeing. They provided a place to go, including luncheon clubs, tea dances, sewing and domino clubs, bingo and exercise classes, to escape home, which was often described by participants as prison-like. Mairead, 83 years old, told us “getting out of the house does you good, yes. I never feel cold when I’m outside. When I come in I feel the cold. Mandek aged 90 said “I like to go to town, you know, just get on a bus, go to town… I feel better because if I have to stay all week in the house, I’m a little bit depressed. A little bit, yeah”. And Melaine, 85 years old noted “it’s so important to just get me out of the house… I come here and church, that’s the only two places that gets me out of the house”.
At the time of our research, many of the community services on which older people relied so heavily for companionship, were already facing financial difficulties after almost a decade of austerity. Research by the Institute for Fiscal Studies found a 21% fall in local government spending in real terms between 2009-10 and 2017-18. In this context, local governments made efforts to protect statutory services (for example, social care) at expense of more discretionary services, such as culture and leisure – precisely the services that our participants valued so much. But, still spending on adult social care fell in the period (-5%), and the number receiving adult social care fell much more than spending, with support being focused on those with highest care needs. Analysis of the impact of austerity on the income of voluntary organisations has found most significant impacts have been for small and medium sized organisations, and for those in the most deprived areas.
Our research focused on older people born outside of the UK – in the Caribbean, Ireland and Poland. Due to historical migration, England’s ageing population is increasingly ethnically diverse. But older people are often homogenised in ageing research, and migration research mainly focuses on younger people or recent arrivals. As a result, we still know very little about Black, Asian and Minoritised Ethnic populations’ experiences of ageing in place. Our own research points to the important role played by ethnic organisations in supporting these populations. As Iris, aged 86, told us “It’s good, it is good really. We are Caribbean’s, we can talk and sometimes they’ll come with a dish that they’ve cooked, or a cake or something like that you know. Yes, so it’s nice to have them. You’re not lonely, I am not lonely”. The manager of an Irish NGO recalled: “A few months back I heard two gentleman talking in Irish… they felt in a safe place they could do that, and all that goes with it about bringing back their culture and with the way they were brought up. So, I think providing a space where Irish people can come and enjoy and share their cultural heritage”.
These ethno-specific organisations were often built by those who had arrived to Britain in the post-war era as part of their place-making in local communities. They helped protect against effects of the racism and hostility widely experienced at the time. And, they addressed needs that policy makers and service providers ignored. Research suggests, however, that the impact of austerity for ethno-specific organisations such as those we encountered in London and South Yorkshire, has been amplified by the ‘hostile environment’. Austerity provided an excuse to push race and ethnic inequalities further down the policy agenda and funding cuts created competition for scarce resources, undermining solidarities.
‘Building back better’ requires an inclusive ‘ageing in place’ policy agenda, which not only addresses the impact of the pandemic and the scars of more than a decade of austerity on our local communities; it also requires a recognition of the increasing ethnic diversity of our ageing populations, and the racialized structural inequalities mediating their experiences of ‘ageing in place’.
*My co-researchers in this work were Louise Ryan, Magda Lorinc and Obert Tawodzera. I gratefully acknowledge the support of the Economic and Social Research Council (award ES/P009255/1, Sustainable Care: connecting people and systems, 2017-21, Principal Investigator Sue Yeandle, University of Sheffield)