Les Bright

‘We are not blaming anyone, but if we don't know about amenities, we cannot seek them out’: black and minority older people's views on the quality of local health and personal social services in England

ABSTRACT Improving access to culturally-appropriate services and enhancing responses to the needs of older people from black and minority ethnic backgrounds were among the aims of the National Service Framework for Older People (NSFOP) that was introduced in England in 2001. Progress in meeting the aims of the NSFOP was evaluated by a mid-term independent review led by the Healthcare Commission, the body responsible for regulating health-care services in England. This paper reports the consultation with older people that underpinned the evaluation. It focuses on the views and experiences of older people from black and minority ethnic (BME) groups and of the staff that work in BME voluntary organisations. A rapid appraisal approach was used in 10 purposively selected local councils, and plural methods were used, including public listening events, nominal groups and individual interviews. In total 1,839 older people participated in the consultations and 1,280 (70%) completed a monitoring form. Some 30 per cent defined themselves as of a minority ethnic background. The concerns were more about the low recognition of culturally-specific and language needs than for the development of services exclusively for BME older people.

Housing decisions in later life

Moving house is recognized as one of the most stressful events in people’s lives. In the main, the assumption is that the stress is due to the factors related to relocation: deciding what to take to the new house; arranging removals; having to end and start services, and tell people about change of address; sorting out the new house, including building works; getting used to living in a new area, getting to know people and to sort out daily living arrangements. All of this can be, and frequently is, highly stressful.

Ageing cities: public health approaches to creating a mentally healthy London for older citizens

At a time of increasing interest in mental health in later life, the role of public health approaches is potentially heightened. This paper draws on interview data with older people living in London to consider the interplay between personal and public approaches to health and well‐being. The interviews were under taken as part of the midpoint review of the UK governments 10‐year strategy for older people (Healthcare Commission et al, 2006) and the social characteristics of London are considered.

Unmet needs for low‐level services

This article draws on consultations with older people produced for a Joseph Rowntree Foundation (JRF) study on the unmet need for low‐level services among older people in England. This was published in 2007 (Clough et al, 2007). Since it was published there have been significant changes to the social care scene. The Government has given further emphasis to individual budgets (now termed personal budgets), many local authorities have further restricted the criteria for eligibility to social care services, and publications such as Time to Care (CSCI, 2007) have highlighted the shortcomings of home care services, as well as their strengths and importance. We also know more about older peoples views of health and social care services (Health Care Commission, Audit Commission and Commission for Social Care Inspection, 2006). In this article we set out to relate findings from our research to current realities.

Attachments to Home

The last chapter focused on the process of decision-making, the ways in which people decide what to do. In the next two chapters we look at some of the less tangible reasons why decisions are made. First, we consider what is being constructed as people live with the decisions they have made about their house. This is followed in Chapter 6 with an examination of another part of the backcloth: people’s worries about their lives and how these influence housing decisions.

Theory, Policy and Practice

The focus of this book has been on analysing and interpreting people’s housing decisions. In this final chapter we attempt to locate the themes that emerged in their wider worlds. Thus we look first at the implications of what we have written for theorizing in different areas, in particular decision-making, ageing and research methods. Finally we examine the relationship between our conclusions and policy and practice, especially in relationship to housing but also more widely with reference to the involvement of older people as citizens.

The ‘looking glass self’

In this chapter, we argue that making housing decisions with which people feel comfortable will partly depend upon people knowing themselves and using that knowledge to decide whether, when and where to move. We give examples of people who judged whether housing options suited their personality, would allow them to pursue their chosen lifestyles and would enable them to keep in close contact with people who make their lives meaningful. In terms of lifestyles, people spoke about significant routines, hobbies and activities.

Telling Older People’s Housing Stories

In the previous chapter we provided an overview of the research design. We now wish to explore two distinctive features of our approach that enabled us to gain different insights into the topic: first, the involvement of older people within the research process in order to make the research more responsive to the perspectives of older people and, secondly, the use of qualitative techniques to collect older people’s housing stories. The need for alternative approaches to gerontological research has been acknowledged recently by other researchers:

Preferences in Living Arrangements

In earlier chapters we have argued that, in seeking to understand the reasons people have for moving or staying, account has to be taken of:

Houses and People: The Construction of Living Arrangements

As we get older, the houses in which we live have a huge impact on our lives. In this book we try to get inside the experience of housing by examining the ways in which people construct, and re-construct, their lives in relation to their housing. In later life people are likely to spend longer inside their homes and, increasingly, to find some aspects of their daily living arrangements difficult to manage. It is not surprising to find that studies are beginning to recognize the impact of housing on people’s health. Nor is it surprising to discover from our research that one of the great concerns people have in old age is that of where they will live and how they will cope with changes in their health or circumstances. For many, there is anxiety as to what the fit will be between their capacity and their housing; others, feeling freed from earlier constraints of work or family, are keen to develop new interests and live their lives in different ways.