In this paper, I aim to discuss the historical and political context of social work provision for the elderly. By using and reviewing the views expressed in previous work on the elderly in our society, I hope to demonstrate the context in which social work and social care operate. One of the concerns of this essay is the impacts of discrimination and oppression on the elderly. I will discuss how listening to the views of service users is crucial to developing effective methods of providing social care.
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In the last two to three decades, a fairly wide body of academic work has become available, approaching the issues of ageing and of care for the elderly, within the discipline of Social Policy. Social Policy is an interdisciplinary field born from, and derived upon, other social sciences - economics, politics, sociology etc. (Tinker:1992:3) Within this field, the specific discipline of gerontology - the study of ageing - has developed in recent decades because the elderly population has increased so sizeably in the last 50 years. Cherry Rowlings wrote in 1977 that while in 1951, just
13% of the British population was of retirement age, by 1977 this had increased to 17.3%. (Rowlings:1981:27) Since the 1970s we have seen this trend continue.
This change can be attributed both to comparatively low birth rates, and the increased life expectancy. Businesses, the professions and the media are finding now that pensioners form one of their biggest markets. (Tinker:
1992: 3)
Rather than using medical and biological models, social gerontology focuses on the ways in which social and cultural factors influence people's experiences of growing older. Tinker writes that the 'elderly' are unusual in that they have been labelled a 'special group' in our society, and yet the only think that marks them out is their age - unlike groups seen as 'deviant' they are 'normal' people - and we all expect to join this group in time. (Tinker:1992:4) However, although not labelled 'deviant,' the elderly have nonetheless been constructed as a problem, as Jacki Pritchard writes:
"An elderly person is thought to be of no use once they reach retirement age, probably because they are not seen to be producing anything for the society in which they live. They are considered to have 'had their life.'"
She notes that this differs from other cultures, in which capitalism is less advanced. (Pritchard:1992:16)
And Nicholas Bosanquet has noted that the rate at which the elderly population is growing causes great anxiety in society. He cites Professor
Sir Ferguson Anderson as saying in 1976, "Britain faces social disaster because of the rate at which the proportion of elderly people is rising." (Bosanquet:1978:7)
He goes on, "The emphasis has come to be more and more on the elderly as a burden - even as a threat to the standards of service or opportunity enjoyed by the rest of the population." (Bosanquet:1978:79)
Changes in medicine have made illness and disability a problem particular to the elderly. Diseases that effected the young in previous centuries, have been controlled or wiped out in this country, and now children and young adults can expect to be in good health. Similarly, disability from birth is relatively rare; and blindness, deafness and mobility problems are impairments by far most commonly experienced by the elderly.
(Bosanquet:1978:21)
The medical model of disability has traditionally seen disability as naturally and inevitably arising out of a physical or mental impairment. The more contemporary social model, however, has argued against this, in saying that whilst a person may have a natural impairment, it is society's failure to accommodate people with this difference to the 'norm,' which disables them. For example, though a person may be unable to walk and require the use of a wheelchair, this does not inevitably make their life so very different from the life of an able-bodied person. Rather, it is a lack of easy access to public buildings and transport, poor adaptations in housing and so on, which turn this impairment into a striking disability.
In the case of elderly people, because ill health and disability is now so much restricted to the oldest generations, it is seen as natural and inevitable that older people will lead very different lives from younger adults, and that the quality of their lives will decrease. However, this can be seen as only a construction, as many of the problems faced by older people could be altered by changes in public provisions and social care. Bosanquet notes that mental health, most significantly depression, are as great a problem as physical health for the elderly. He writes that this is because the most important factors people attribute to their happiness at all stages of life, are ones which elderly people are least able to take for granted. These include:
oHealth
oFamily life/friends. The elderly will almost inevitably face bereavement, but also having decreased transport/mobility, and fewer places to go where they can meet and make friends, both increases their sense of isolation and decreases their independence.
oFinancial/ home stability. The elderly live on pensions. The decrease in their health can lead to them losing their home. (Bosanquet: 1978:10)
The elderly are increasingly separated from the rest of the population. They suffer great isolation. But policy has been seen only as pension policy.
Nicholas Bosanquet argues that the Government needs to intervene not only when the elderly person has no relatives, but even in addition or instead of care from family. He stresses that policy must increase choice and opportunity, as the elderly find themselves unable to decide and control their own futures. (Bosanquet:1978:75-77)
One of the most fundamental issues facing the elderly is the problem of housing. Bosanquet reports that since the 1970's, governments have been concerned with designing special flats for the elderly. These solve some housing problems and give people the opportunity to form small communities with others in their own age bracket. (Bosanquet:1978:92) He writes that this is not a new idea; in the Majority Report of the Royal Commission on the Poor Law I 1909, there is mention of special housing for the elderly.
However, the views of what elderly people require from housing has been deeply flawed, due to a failure of policy makers to listen to the ideas of the elderly, about what they need in day to day life. After the Second
World War, there was great interest in building small housing for the elderly. However, reports of the time did not view it as necessary to provide many special features or fittings for the elderly. The post-war Rowntree Report stated that bungalows were the preferable type of housing;
two-story houses provided problems for pensioners with impaired mobility, and the elderly often did not like living in flats, as they were not considered private or independent enough. The report stated that houses for the elderly people must be built with easy access to local shops, close to the person's family and friends, and near housing for younger generations so that the elderly did not feel 'cut off' from the rest of society. The report did state that flooring and any stairs in the property must be designed for safety and ease of manueverability. This would mean using non-slip materials on flooring, and ensuring that stairs were neither too steep or built around awkward angles. However, these precautions aside, there were no provisions made for wardens or for providing a safe environment for those with health problems. (Bosanquet:1978:95)
Subsequently, between 1945 and the early 70's, a good number of small flats were built, but these were not reserved exclusively for pensioners and many housed younger adults. Very few were built with any special design features which would have made them safer and more convenient for the elderly.
More recently the idea of sheltered accommodation has grown up, though many people see this simply as a compromise before the nursing home. (Bosanquet:1978:97)
Bosanquet concludes that the elderly need schemes which help them find a new lifestyle and to decrease their sense of isolation. Luncheon clubs, good neighbour schemes, day centres and holiday schemes are essential provisions in his view. He believes that these services are more important than simply focusing on income support; however policy makers have tended to see this is a luxury, rather than one of the essentials of government spending plans.(Bosanquet:1978:97)
He argues that services should increase their focus on the over 75s.
Younger retired people are more likely to still be living with spouses and in their own homes. More years after retirement, however, and any savings the person may have had will likely have run out, and pensions become increasingly inadequate whilst the cost of living actually increases, as for example the elderly person needs to spend more on maintaining their health, in heating bills and medicine/doctors fees. (Bosanquet:1978:124)
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While this and many other books on the subject of elderly people outline the historical, political and economic factors in pensioner's lives, they do not all cite the opinions of elderly service users themselves. Very often social policy and research is based on accounts given by social workers, or by representatives of a vulnerable group - for example the families of children or in this case elderly people. To address this, Jacki Pritchard's book The Abuse of Elderly People includes a great deal of anecdotal evidence and transcriptions of interviews with elderly people. By focusing on cases of actual abuse, the book may appear to be dealing with an extreme aspect of poor care for the elderly - it may not be expected that abuse is a concern of the majority of older people. However, the principles of the book are useful as it outlines some of the ways in which older people are discriminated against, and how many of their needs and interests are oppressed. Pritchard is keen to stress the different areas in which elderly people may be abused - 1. Physical, which includes medical maltreatment and neglect. 2. Psychological abuse, including threats of abuse, humiliation, harassment, emotional neglect and threats of any kind of abuse. 3. Legal abuse, including material and personal exploitation. (Pritchard:1992:21)
Elderly people are not always given
othe right to choose
othe right to privacy
othe right to independence.
Pritchard considers it vital that if a person is mentally sound, and chooses to stay with their family even when the professional considers the family to be abusive, then the social carer must do no more than offer the elderly person support and inform them of their options. However, of course, there are different standards over what is mentally sound, and even what to do if someone is not. She is also keen to point out the difference in practices between the various professions involved in an elderly person's life. Very often, the policies of the doctors, care home nurses, and social workers arein direct conflict, and the normal policies of one may seem unacceptable to another. Subsequently, what is important returns to ensuring the rights listed above are honoured, and judgement of whether or not this is done can be made only by the elderly person's own experience. (Pritchard:1992:25)
Pritchard reports that carers are more likely to become abusive, when they themselves are denied adequate support. The carer's sense of isolation, their resentment towards the tasks they undertake, and their lack of external support, leads to an increase in abusive behaviour towards the elderly person being cared for. As a common sense measure, therefore, policy must be adapted to provide support and respite for carers, in the interests of all parties involved. (Pritchard:1992:33)
In conclusion, it has been seen that many of the problems that elderly people face could be significantly diminished by improvements in social care. Rather than being 'natural' effects of ageing, these problems are more frequently caused by discrimination in society against older people. As society has placed most significance on the needs of younger adults, there have not been adequate provisions made for the elderly for housing, health care and social integration. In response to these needs, social work needs to take steps to reduce the oppression of older people. This will involve maximising elderly people's ability to make independent choices in their lives, and to enjoy the same standard of life as younger adults. Above all, social workers and researchers should listen to service users as they explain what services they need.
Bosanquet, Nicholas (1978) A Future for Old Age: Towards a New Society.
Temple Smith: London.
Pritchard, Jacki (1992) The Abuse of Elderly People: A Handbook for
Professionals. Jessica Kingsley Publishing: London.
Rowlings, Cherry (1981) Social Work with Elderly People. Harper Collins:
London.
Tinker, Anthea (1992) Elderly People In Modern Society, Third Edition.
Longman: London and New York.
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