3. RESULTADOS
3.2. ESTADO ACTUAL DE LA SOBERANÍA Y SEGURIDAD
3.2.2. Eje Acceso a los Alimentos
As the preceding chapters have shown, the degree to which pensioners considered themselves ‘independent’ and felt happy with their quality of life, was more complicated than simply whether they were non-disabled and able to remain in a self-sufficient household unit. So the question then, is whether independence is related to the quality of support that pensioners have been able to negotiate.
Broadly, the services flagged as the ones that maintained independence were the same ones that pensioners had identified as their priorities (health, transport and home-based services), a rational assessment based on experience. The explanations that people gave for these related back to the core components of independence, their autonomy and self-sufficiency (examined in Chapter 3), and were related again to personal circumstances. For example, transport services, which were identified most often as key to independence, focused upon community transport, and tended to be raised by people with quite severe limiting health conditions or disabilities, such as Parkinson’s disease, blindness, or being unable to walk. For these individuals, community transport made a dramatic difference to their lives, enabling them to continue to get out and about, maintain a community involvement, use a variety of services, and generally orchestrate a degree of control and convenience over their lives. Ruth, who was regularly attending hospital for cancer treatment, explained how a pre- booked transport system to hospital reduced her sense of dependency on her husband:
‘I think it’s a godsend. Because normally [husband] takes me to the hospital where I have to go, but this way now, I’m quite relieved in the knowledge that I’ve got about being able to phone the doctor and he can arrange that for me.’
Other service priorities for maintaining independence included mobility aids, medical treatment and personal care, all services which promoted and supported the capabilities of older people with health problems or who were disabled.
Older people also emphasised their relief at not having to organise a battery of services themselves (particularly in situations which might already be quite stressful), providing support for a simple approach to access. It was also vital that older people met with a positive response when they first approached a service, since interviewees tended to rely upon tried-and-tested routes of access, and
were often put off pursuing a service if the response they received was negative, ambiguous or confusing. This points to the need for flexible service access, in which a range of services can be made available through multiple and cross-sectoral entry points. One example of the kind of joined-up service provision that was most appreciated by interviewees was the ‘rapid response team’ that Elliot explained had stepped in after his wife’s fall. This had both responded to their immediate needs and flagged the availability of relevant supplementary services. This took a great deal of stress out of a crisis point in their lives. Elliot explained how it worked:
‘That was a team of nurses, an occupational therapist, a physical therapist, the doctor and all sorts, you know, and they all came out, one after the other to look after us. And then…after a few weeks they go over to the caring side and you get a carer, carers coming in and you get an occupational therapist allotted to you.’
Notably, this kind of joined-up provision was atypical of the services that most interviewees had received during health transitions.
The well-timed targeting of services, in particular during the period following a crisis and phase of increased need, played an important role in maintaining independence in later life, enabling interviewees to feel more confident that they could cope with an unfamiliar set of circumstances, and as far as possible, maintain valued aspects of their lifestyle. For example, Erwin felt that his hospitalisation for an angina attack had made him more aware of his vulnerability, and this had caused a dip in his self-esteem. However, the support he had received at this stage, both from his healthcare team and from the voluntary sector and social services, in terms of providing domestic support and respite care for his wife, enabled him to negotiate this crisis and to view the downturn in his health as, ‘only a temporary loss of independence. The independence will come back.’
A key informant in area four, who worked in a cross-sector role with older people, noted that a key aspect of promoting independence among older people was concerned with providing services that emphasised their value and enhanced their sense of being able to cope. In this, she highlighted the importance of continuity of care, but explained that it was the seeds of confidence that were built in people which would enable them to cope with the sometimes unpredictable course of future events: ‘One of the things we’re aware of is that if someone is in hospital or receiving a lot of care at home that lasts for a particular period of time, so individually they feel loved, cared for, the experts or the important people are looking after me, you know, the consultant said this. And you get cheered by that.’
Charles, who had been living with Parkinson’s disease for fifteen years, continued to live an active and fulfilling life, and emphasised that he was able to do this because of the health management strategy that his doctor had negotiated with him, in particular, a well-regulated course of medication. He contrasted this with the experience of many others with Parkinson’s, who had been less fortunate,
‘I’ve seen people do with this worse than I am now.’
Confidence was a reiterated theme in terms of the services that promoted independence; loss of health and becoming disabled having a heavy impact upon people’s self-concept, as seen in Chapter 4 (see Section 4.4). Well-targeted packages of support could counter this and enable older people to re-imagine themselves as capable of coping with life’s changes.
A recurring theme from interviewees living in new style homes was the degree of choice they enjoyed about whether to draw upon support services or to do things for themselves. A couple of people commented that they would dislike being in homes in which everything was done for them. In their current context, they had the choice about whether to cook for themselves, and sometimes did so. If
they preferred to do their own laundry they had their own washing machine. A hairdresser’s was available on-site, but it was up to them whether they used it. When asked what services helped independence, there was a tendency to refer to the general set-up in the new style home:
‘I’ve got no worries. I’ve got a nice big flat…I’m comfortable. I’ve got good companions around me. That’s a big thing…I go in and out as if I was in my own flat here. This is my castle, this is.’ (Martin)
Sometimes pensioners could get withdrawn in residential homes and benefited from being encouraged to engage in a range of activities. Marion noted that she appreciated her daughter’s encouragement to make use of her home’s facilities, because ‘you can get stale.’ A key informant in area four also emphasised that new style supported living schemes aimed to actually turn around people’s concept of themselves as dependent, and that this was done by a package of individualised support services:
‘I have seen them from when they’ve come in here, and I see the changes then that sort of come about within the next six months after the tenants have come here, in that they could move back out of here now, they’ve regained a lot of their independence from having the support they receive here.’
These kinds of services regarded independence as a fluid concept, which could be significantly influenced by a package of support.
The services that made most difference to pensioners’ sense of independence were those that were targeted at pensioners after their health had been compromised in some way, which enabled them to manage their mobility and maintain a sense of stability and control over their lives.