Prof Eamon O’Shea – “Overview of international approaches to enabling older people live in their own homes – Challenges in Ireland

Independent Living: Giving Meaning to Home

Professor Eamon O’Shea

Irish Centre for Social Gerontology

National University of Ireland, Galway

Older Population: Ireland and EU

Year Ireland

% of Population

EU25

% of Population

1950 10.7 8.2

1975 10.7 11.4

2002 11.1 16.4

2021 14.8 19.1

2050 25.9 29.9

Life Expectancy at 65 and 75

Year 65M 65F 75M 75F

2001/03 15.4 18.7 8.9 11.2

2005/07 16.6 19.8 9.8 12.1

Disability

323,707 people with disabilities (8%) 136,696 >65 years Incidence of disability increases with age 65 year old 9 times more likely to develop

disability than person aged 15-24 Multiple disabilities Of disabled people aged 65 years or over

two thirds experience multiple disabilities

Care and Caring

149,000 carers (CSO) 97,500 households contain carer of older person

either within or without (ESRI/O’Shea) 89,000 older people require care in the community

(Fahey and Murray) 13,000 of these estimated to be in very highest

dependency category (O’Shea) 31,000 needing high or continuous care (Mercer) 20,000 in long-stay care

Social Spending on Age

Ireland overall ranked lowest of EU15 in terms of social spending per older person

Ireland spends one third of what Denmark spends per person aged 65+; 40% of what UK spends

Total expenditure on long-term care in OECD ranges from 0.2 to around 3% GDP; Ireland 0.62%

Much but not all of this difference is explained by demography- particularly pensions payments

Welfare Regimes

Universalist- Social Democratic - Nordic countries

Conservative – state corporatist – Germany, Netherlands

Liberal welfare -Anglo-Saxon – UK Southern European - Italy, Greece, Spain

Welfare Paradigms

Statist- state has extensive responsibility Familialist/Individualist – Individuals

responsible for finance and provision- extensive use of means testing

State pays- others provide – state main funder- multiple providers

Community Care in Ireland

4.2% of older people in long-stay care account for 60% of overall public budget of about 1 billion

Community care is under-resourced Provider/bureaucrat-driven Poor support for carers Poor co-ordination Care not embedded in local communities

UN Principles

IndependenceParticipationCareSelf-fulfillment Dignity

WHO Active Ageing

ParticipationHealthSecurity

Active Ageing: Six Determinants

Economic Health and Social Services Behaviour Personal Physical Environment Social

OECD Healthy Ageing

Improved integration into the economy and society- social capital

Better lifestyles- physical activity, nutrition Adapting health systems to the needs of the

elderly- prevention, self care, mental health, home visits, co-ordination

Environmental factors; transport, housing

Challenge of Ageism

Value of older person in changing world Healthy, active, successful ageing is ethically and

politically problematic Emphasis on functional capacity can polarize older

people into functioning and non-functioning Agich (2003) challenges very idea of independent

living – relational view- inter-dependence is the norm

Older Person Centred Approach

Co-ordination and inte-gration

Income

Environ-ment

Housing Support

for carers

Health

Social networks

and activities

Transport

Technol-ogy

Older Person

HOME

Where we are

matters to who

we are

Home

Past Self Housing type Living arrangements Staying indoors Getting out and about Neighbourhood

Wrong Place

Heidegger’s existential homelessnes -belonging nowhere

Choosing between nomadism and sedentariness

Choosing between digital interfaces and the human touch

Choosing between disjuncture and connectedness

Home as Identity

Person and home intertwined Home is within us as we are in it Home as belonging – displaced long-stay

residents Home fosters meaningful relationships Home as boundless – Bachelard (1994) – a

tool for analysis of the human soul

Technology and Home Living

Information and Communication (ICT) technologies offer opportunities to make independent living a reality

Technologies can help in prevention, management of

chronic conditions, as well as enhance quality of life

New technologies can alleviate caring pressures within families

Effective use of technologies offers an alternative to institutional care

Technology Solutions

Sensors, hand-held devices, communication networks, data processing servers can enhance independent living

Technology can help identify and monitor fallers, cognitive decline and social isolates

Telemetric monitoring systems that transmit health data directly to the physicians.

Technology can enhance social connection and participation

Technology can help foster inter-generational relationships

Barriers to use of technology among older people

Readiness, acceptance and accessibility Income and education barriers Health and social care sectors have been

relatively slow in offering technology-based tools Mismatch between needs and technology devices

which leads to lack of acceptance, lack of usability or even lack of usefulness. Need to move from high-tech to appropriate-tech

ICT services sometimes seen as a threat to human contact, privacy or personal control

Future Attitudes and Expectations

Today’s “computer generation” has a friendly attitude to technology and is likely to demand increased technology-supported services in their old age

Ongoing socio-economic and socio-cultural dynamics lead us to expect that the next generation of ICT users will have somewhat different expectations and attitudes towards technology

Public Policy for Independent Living at Home

Maintaining the self Maintaining communities Supporting families and connectivity Creating and meeting expectations Integrated solutions for home care Maintaining built environment and public

infrastructure Ensuring equity