Archive for the 'Ageing' Category

TripAdvisor helps us choose hotels and restaurants – so why not where we end our days?

Originally published by The Conversation on August 1st 2017. 

Tony Walter

My 91-year-old mother was deeply unhappy at the geriatric hospital in which she found herself after breaking her ankle.

But we knew little of the alternatives. Official inspection ratings offer impersonal information. So how were we, her children, supposed to gauge the quality of other establishments offering care?

Our saviour turned out to be Alison – my mother’s hairdresser. As a specialist in older, housebound clients, she had continued to do her customers’ hair as they moved to various hospitals or care homes.

Alison gave us the names of three places nearby that our mother might prefer, and we arranged her transfer within 36 hours. It was a move which transformed the quality of her last few months of life.

Unlike formal inspectors, Alison was an unthreatening, secret observer of each of the institutions she visited. She proved to be a knowledgeable and reliable guide. Without her, my mother’s life could have ended very differently.

The trouble is, not every family is lucky enough to know an Alison.

In the UK, people are expected to make their own choices about their own care in the final months and years of life. But how can people become well informed about different care providers, especially when a crisis forces decisions to be made at short notice? Alison revealed the importance of informal contacts and social networks in allowing individuals and families to make good choices.

How could her role be made available to all families seeking similar information? Care settings for those nearing the end of life are, in terms of inspection, a bit like restaurants. Technical medical and nursing procedures, like a restaurant’s kitchen, need inspecting by technical inspectors. But most of the care provided at the end of a person’s life is not of the technical kind. It involves hard to measure factors like respect, a sense of belonging, and relationships with staff. It is in many ways like assessing a restaurant’s ambience. In the hospitality trade, this is something best considered by mystery customers who collectively author good food guides, or by informal online ratings like on TripAdvisor.

Such assessments rightly abandon the myth of objectivity embedded in formal inspections. Potential consumers perusing TripAdvisor ratings understand them as subjective experiences to be taken on balance.

So collective, honestly subjective, online ratings should be available for families to make informed choices about different care settings. For well-being over the course of life, we need to be able to read about customer experiences of health and care agencies just as much as we need to read about experiences of restaurants, hotels and holidays.

A great example of what is needed is carehome.co.uk, which gathers and publishes reviews of care homes, along with other information provided by the home. Many of the care homes listed, however, have no reviews. Care at home is reviewed by the online database homecare.co.uk, although the vast majority of organisations that look after people in their own homes have no reviews.

Those two websites are funded by industry subscriptions. Proposed reviews are authenticated and vetted before publication, and reviewers are advised not to publish complaints but send them direct to the agency. These safeguards should eradicate vexatious reviews, although they may also present an unrealistically positive overall view of user experience. The sites are, however, a step in the right direction.

Of course, TripAdvisor-style ratings for the “last journey” tend to come not from the actual service-user or patient. Most reviews are from family and friends, which could be an issue. Complex family dynamics – such as guilt at putting parents into care, or anxiety that care costs are eating up the inheritance – can mean families are rarely the baggage-free observers that Alison was.

Reviewing the situation

Of more concern is that even the most loving, attentive and observant family member may know little about the person’s experiences at the hands of their paid carers. This might only be achieved by CCTV cameras, but do we really want care homes, hospital wards and (in the case of home care) even the person’s own home to become zones of electronic surveillance?

No way of monitoring or collecting information will be perfect. And we should acknowledge that the trajectory of frail elderly dying is always uncertain. No one can predict how they will feel as bodies and minds fail, so all choices will entail a degree of guesswork.

Rigorous formal inspection – and public enquiries when things go dramatically wrong – are of course essential. But if people nearing the end of life (or their families) are to adopt the prescribed role of informed consumer, comprehensive collations of user experiences are vital.

End of life care is more important than booking a restaurant or the next holiday – so information needs to be just as good, or better.

What death means now by Tony Walter is available with 20% discount on the Policy Press website.  Order here for just £7.99.

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The views and opinions expressed on this blog site are solely those of the original blog post authors and other contributors. These views and opinions do not necessarily represent those of the Policy Press and/or any/all contributors to this site.

One size does not fit all: the problem of extended working life policy

Áine Ní Léime and Debra Street, co-editors of Gender, ageing and extended working life, launching today at the British Society of Gerontology conference, discuss problematic extended working life policies, and their potential consequences for both women and men in later age. 

Debra Street

Áine Ní Léime

“How can affluent countries “afford” pensions for ageing populations?

Some policymakers prefer one answer—people should simply work longer, thus cost less. Increased longevity makes policies to extend working lives appear logical and seem potentially benign.

Favoured initiatives range from increasing state pension ages, requiring higher/more frequent worker pension contributions, eliminating mandatory retirement, and introducing anti-age discrimination legislation. They run concurrently with the broader neoliberal agenda of pension privatisation, making individuals (rather than employers and governments) more responsible for providing their own pensions or working to much later ages.

“Extended working life policies focus almost exclusively on reducing state pension costs…”

Such policies are highly problematic and reflect a fundamental misunderstanding of the complexities of current employment arrangements and future job markets. Extended working life policies focus almost exclusively on reducing state pension costs, with scant attention to existing gendered differences across the life course, whether associated with adequate pay and flexibility to balance work and family responsibilities, working longer, or amassing pensions.

The upshot: women and men, unsurprisingly, would fare quite differently.

 

Back to the future: work ’til we die?

Workers in physically demanding and/or stressful jobs such as construction, cleaning or caregiving are likelier to have chronic health conditions or to be worn out by work as they approach the traditional state pension age, usually 65. Many started work at younger ages than the more advantageously employed, so they may already have spent 45 or more years at work by age 65.

Increasing state pension age requires them to work longer still. This punitive measure ignores their experience of already extended working lives, albeit at the younger end of the adult life course. It is unfair to deprive them of the choice to stop or work longer.

Because gender norms designate women as the primary providers of unpaid care for children and others, many have employment histories punctuated by breaks in paid work or long spells of low- paid, part-time employment to juggle work and family responsibilities.

Demanding work to older ages and greater pension contributions to qualify for minimum and maximum state contributory pensions makes it more difficult for women to get a full state pension and greatly increases their risk of poverty in old age.

Extended working life policies assume demand for older workers. Yet little evidence suggests that is true. Research on age discrimination in employment shows that jobs for older workers are typically scarce and poorly paid, if unemployment happens as it did during the recent recession.

Older women seeking employment face the “double whammy” of ageism and sexism, rendering women ”socially older” than comparably aged men, making re-employment more difficult. Precarious work is growing in all countries and, while women traditionally predominated in the precarity, men are increasingly relegated to non-standard work.

Many women and all precarious workers have episodic pension contribution patterns that make poverty in old age more likely. Finally, privatising pensions is especially detrimental to women’s pension provision, since they are typically in lower paid jobs that make private pension contributions unaffordable.

 

Where do we go from here?

The way forward is not obvious. There is a need for more thoughtful, flexible policies, if women, workers in physically demanding and/or stressful jobs, or those in precarious employment are to be expected to work longer.

To understate, we are not particularly optimistic that such adequately enlightened policies will be enacted.

“An adequate universal citizen’s income is one policy refinement that could offer a genuine choice to people nearing retirement age.”

Working longer offers a welcome option for some workers in rewarding, interesting, physically undemanding occupations, but it should not be a requirement for all workers. Calls for an adequate universal citizen’s income is one policy refinement that could offer a genuine choice to people nearing retirement age.

Since women and precariously employed individuals are more likely to depend on safety-net state pensions, a citizen’s income would benefit them most. Unfortunately, debating the merits of citizens’ incomes does not implement them and evidence of policy appetites for such proposals is disheartening.

It seems obvious that the fragility of labour markets for workers of all ages should give policymakers pause before assuming (as they seem to have done so far) that rising pension costs can be stemmed by unilaterally extending working life for all. Such policies will inevitably fall far short of expectations, given that they ignore real experiences of working lives shaped by gender and other work/life circumstances.

‘One-size-fits-all’ extended working life policies—undifferentiated for women and men, for physically demanding work and white collar occupations, for the precariously and the securely employed—are clearly neither benign, nor logical, nor capable of meeting the varied economic needs of ageing individuals.

Gender, ageing and extended working life edited by Áine Ní Léime et al. is available with 20% discount on the Policy Press website. Order here for £60.00.

Find out more about impact, influence and engagement at Policy Press here.

Policy Press newsletter subscribers receive a 35% discount – sign up here.

The views and opinions expressed on this blog site are solely those of the original blog post authors and other contributors. These views and opinions do not necessarily represent those of the Policy Press and/or any/all contributors to this site.

Care and caring: challenge, crisis or opportunity?

SusanMYeandle

Sue Yeandle

As the first issue of the International Journal of Care and Caring publishes, Sue Yeandle, Editor-in-Chief, highlights the global space that care now occupies and introduces the journal as a new forum where world-class knowledge about care, caring and carers can be shared.

Issue 1 of the International Journal of Care and Caring is free to access on Ingenta until 30 April.

“From Nairobi to Tokyo, Sydney to Bogota, Montreal to Stockholm and Gdansk to Glasgow – and beyond – care is more visible than ever, and an issue of growing importance all over the world. It is central to human life and relations. It underpins the world’s health, employment and welfare systems. It affects every family and human being on the planet.

“In all its horror, glory and daily realities, care touches us at every level.”

Continue reading ‘Care and caring: challenge, crisis or opportunity?’

Globalisation and our views on ageing

The world is now a much smaller place, with more and more people choosing to study or work abroad and, consequently, creating transnational families and connections. In this blog post, Martin Hyde, co-author of Ageing and globalisation, discusses how this increase in globalisation has affected conventional views of ageing.

martin-hyde

Martin Hyde

Sometime last year my parents called me to say that they wouldn’t be able to meet up on the coming weekend as they had to go and look after my brother’s kids.

Nothing unusual about this, as more and more retirees find themselves called upon to perform grandparenting duties in times of need – in this case my brother had to travel for work and my sister-in-law was not feeling well.

What made this somewhat more unusual was that my parents were in France at the time and my brother lives in Australia. So, they duly cut their stay in France short, bought return tickets to Australia, flew back to the UK packed their bags and went out to Australia for 3 weeks (my brother had had to go to China and South Korea).

“Wherever we look…we seem to see evidence of the increasing globalisation.”

Unusual but not unique. As families become increasingly transnational more and more people are drawn into these long-distance family and caring relationships. But this is not limited to family relationships. Wherever we look, from travel and transport to economics and the media, we seem to see evidence of the increasing globalisation. Continue reading ‘Globalisation and our views on ageing’

Age: the topic that neither Clinton nor Trump dare address

 

kate_demedeiros_taskforce_may52015

Kate de Medeiros

There is one major topic in the American presidential election that neither candidate – nor the media for that matter – have dared to touch upon: age.

Kate de Medeiros, author of The short guide to aging and gerontology, asks ‘why?’

Age – specifically older age – has been conspicuously absent as a line of personal attack between the candidates, as a demographic target of would-be voters, and as an articulated position regarding health care and pension policies.

Don’t get me wrong. In some respects, I am glad to see that the ageist rhetoric which has clouded other U.S. elections hasn’t appeared this time, at least not explicitly.

Perhaps because the two candidates are so close in age (Trump is 70 years old; Clinton, 68), or because the oldest people in the American baby boomer cohort (those born between 1946 and 1964) are now 70 themselves, we’re not hearing whispers of dementia like in the 2008 election. Then, the 71-year-old John McCain, running against a 47-year-old Barack Obama, was often referred to by contenders and the media as ‘confused’, ‘out of touch’, and lacking vigor and energy.

Of course, chronological age alone says very little about a person or their functional abilities. Although Trump has repeatedly stated that Hilary Clinton ‘doesn’t have the look’ or the ‘stamina’ to be president, it’s unclear if his remarks were based on her gender and a double standard of ‘beauty’, on her age, or something entirely different.

Continue reading ‘Age: the topic that neither Clinton nor Trump dare address’

Age-blaming and the EU Referendum

In today’s guest blog, author Caroline Lodge looks behind the post-Brexit headline ‘age-blaming’ to reveal a different and more nuanced story behind voter choices…

Caroline Lodge

Caroline Lodge

Age-blaming is the practice of blaming older people for social, economic and political problems.

In popular discourse the problem of the old is that they take up too many resources, take more than their fair share of benefits, block beds in hospital, wont move out of their large houses and are responsible for taking Britain out of the EU. This post explores what lies behind the age-blaming that followed the EU referendum result. Continue reading ‘Age-blaming and the EU Referendum’

As pension ages rise, what are our prospects for working longer?

In March of this year the UK government began its long-term review of state pension ages, with a number of commentators predicting large increases in the age of eligibility. David Lain, author of Reconstructing Retirement, sets the context for this review by considering wider changes to retirement policy.

David Lain 4It is commonly said that retirement is changing, with people increasingly expecting to do some form of paid work after ‘retirement’ age.

Sara Rix from AARP, for example, reports perceptions from the US that Baby Boomers will ‘reinvent and/or revolutionise retirement… they will… combine work and leisure in new and more rewarding ways’.

Increasing employment

In reality, however, it is arguably governments that most want us to ‘rethink’ retirement. In my view UK and US governments are actually seeking to reconstruct retirement, by increasing employment at age 65+ and dissolving the notion fixed retirement ages. They are doing this in two ways. Continue reading ‘As pension ages rise, what are our prospects for working longer?’


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