comparación General de los cultivadores tradicionales

Transitions in older people’s life circumstances are inevitably tied to changes in help needs. As noted in Chapter 4, ageing is associated with decline in health and mobility, and these changes become more acute in terms of help needs as older people lose their networks of social support through bereavement and inaccessibility. These life transitions hold implications for the CSM which the DWP recognise in their documentation on the model:

‘It is important that The Pension Service can determine which segment its customers fall into, but also that it can track people as they move between segments, and is able to respond to their new needs. Even more importantly, it needs to be able to identify through key indicators, when customers are about to move segments and be able to offer help before the point of crisis is reached.’

(DWP, 2003b)

However, at present, the CSM presents a static picture of pensioners’ needs, concentrating on pensioners’ current needs and help seeking behaviours, as depicted in Figure 6.1. Identification of key indicators or trigger points for transitions entails mapping probable movements between segments. This is necessary for a fuller understanding of the dynamics behind assisting adjustment to change. Taking for example, an acute change in health, it is possible to map a number of hypothetical transitions between segments, as illustrated in Figure 6.2.

Figure 6.2

Mapping health transitions

• With the onset of ill-health, from segment one to either segment four or five, depending on the level of social support available.

• From segments two and three into segments five or six, with the onset of ill-health, depending on the level of social support available.

• Conversely, from segments four to six back into segments one through three, where an acute health condition is successfully treated.

• From segments one to three to segment five for couples, with the onset of ill-health.

• From all segments, but in particular from segments three to six, to segment seven, with the intensification of health conditions.

Common health transitions

Segment 1 Segments 2/3 Segments 3-6 Segments 1-3 Segments 4 or 5 Segments 5/6 Segment 7 Segments 4-7 Decline in health Recovery from illness

These examples operate within the boundaries set by the model, which dictate pensioner segments according to individuals’ levels of health, income and social support, prior to a health transition. The study can contribute to a more multi-dimensional understanding of movements between model segments by drawing from the three case study transitions in later life presented previously in Chapter 4 – moving into an extra care facility, bereavement and a hospital intervention. These cases are particularly useful for understanding singular transitions that move pensioners out of their initial segment and then, with gradual adjustment, back again.

Due to the nature of the life transition, pensioners who are living in an extra care residential facility tend to have health issues, and therefore move from the previously higher needs segments four to six. The map of these people’s pathways through the model then terminates with segment seven. The progressive nature in the numbering of segments also implies that segment seven is, in some way, a worse off state than all the other segments. However, as discussed in Section 6.4.3, the model does not adequately account for variations within the segment, as some pensioners who move into segment seven actually experience an improved lifestyle and enhanced feelings of independence. For example, Alan, formerly a segment six, chose to move to a residential home because his arthritis was getting progressively worse and he found it difficult to cope in his own home. The move was a positive experience for him as his practical needs were catered for and he experienced enhanced social contact. Esther’s circumstances spell out an example which maps a transition from segment three to segment five after suffering a stroke, and into segment six after losing her husband. She probably provides a relatively typical portrayal of elderly couples’ trajectories. When she was interviewed, Esther had limited contact with her extended family and expected to eventually need to move into a residential care home (segment seven).

In contrast to the transition into supported living, cases of bereavement and recovery after a stay in hospital are likely to occur to pensioners within any of the segments one through six. These events are followed by a period of intense need for practical and emotional support (segments four through six), intensifying the needs of people who already had high support needs. After a period of adjustment, these people variously return to their previous positions in the model, or their stabilised circumstances assign them to a new segment. These movements are depicted in Figure 6.3.

Figure 6.3

Mapping life event transitions

Common life event transitions

Segments 1-3

Movements up the model with inheritance and

gain in autonomy

Segments 4-6 with probable return to initial Segment 3

Hospital intervention

Bereavement

Movements down the model as assets (financial,

social support) become more restrained

A bereavement transition is less likely to have a long lasting effect on health (although pensioners who experienced the loss of a loved one, notably men, often experience a decline in health). This transition can also impact on a person’s financial position, through inheritance and liquidation of assets, moving widows and widowers into segments one or two, or from segment six to segment four. By the same token, bereavement of a partner can profoundly decrease a pensioner’s financial stability. This was the case for Laurie, whose household income dropped considerably when several disability benefits were reduced when her husband died. Household help, which the couple had qualified for when her husband was alive, was also withdrawn and so her daughter was now helping out. Laurie was finding it difficult to cope on her reduced income and level of support. Although beyond the scope of this study, Laurie’s case has implications for both the equivalisation and the extended run-on of disability benefits and services for supporting independence in later life.

Understandably, hospitalisation is associated with a health transition resulting in various short- to long-term lasting effects that can ultimately move older people into the higher needs segments. The case study on the home-from-hospital scheme concentrated on individuals who had mainly undergone a planned procedure that would take them through a period of adaptation and eventual return to the previous segment. As this transition was planned, the interviewees could anticipate help needs and plan their support systems in advance (although this did not always happen). The length of time of recovery was key in this transition. For example, Lesley’s hip replacement surgery was followed by complications which extended her caring needs beyond the contracted period of the settling-in service. A widow, she was in her 70s and a segment one prior to the operation. According to the model, her transition phase positioned her in segment four. She expressed her distress over relying on social services for help, as her informal network of family and neighbours could no longer sustain the level of care she needed. The model would anticipate Lesley returning to her initial position at segment one after recovery. However, at the time of interview, she was hovering somewhere on the boundary. Lesley’s experience demonstrated how fragile informal support systems can be, especially when the need for intense care persists. It also identified a trigger for formal intervention following routine medical intervention.