Anna Davies is Policy and Research Manager at Independent Age.
As a charity supporting older people, we know that conversations about ageing and future care needs are often put off until times of crisis. In some ways this should come as no surprise – thinking about mortality and threats to independence stir up complex emotions for everyone. But we also know the impact of these missed conversations: in particular families struggling to make decisions around care or housing without being sure of their relatives’ wishes. And with more and more older people likely to be relying on family support in the future – one estimate suggests a 63% increase in the number of older disabled people receiving informal care by 2035 – this is not an issue that is going away.
New research we’ve developed at Independent Age reveals the scale of the problem. A survey we commissioned from ComRes found that while four out of five people agree that it’s important to discuss key topics like housing and care in old age, less than a third of British adults have ever had a conversation of this kind with a family member. And the picture doesn’t improve as people get older and these issues get closer to home – almost two thirds of those aged 65 and over have never had a conversation with family members about these key topics. That’s around 7 million older people and their families in a state of uncertainty about how they’d manage if they needed care and support in older age.
Exploring the reasons behind these missed conversations in focus groups, older people and their families told us that:
- They often lacked knowledge and confidence to begin a conversation and were anxious they might suggest the wrong thing
- They wanted to avoid thinking about scenarios that might threaten future independence such as needing to leave your home
- They wanted to protect family members from worry or upset
- The timing never seemed right and they felt it was better to wait until an event or trigger made the conversation unavoidable
- Distance and a lack of time together could also act as a barrier
What can we do to address this issue? Clearly, these conversations are always going to be hard to face. This is not something that government, policy makers or the third sector could or should try to fully ‘solve’ on their own. But we think there are things we can do to better support families to have these conversations earlier and more often:
Arming people with clear information: Our survey found that 63% of adults would be likely to look online for information about different options before having a conversation with family about ageing and care. But we know the care system is complex and overwhelming for people coming to it for the first time. If we want people to consider and talk about their care options at an earlier stage, we need to simplify and better explain those options. The onus is on information and advice providers (like us at Independent Age), local authorities and the NHS to improve the accessibility of their information on care.
Supporting families to initiate conversations: Older people and families told us that they would welcome input from trusted professionals. They felt this could provide a valuable outside perspective and validate the need for a conversation. We would like to see more health and care professionals consciously encouraging the families they work with to think about discussing key topics around ageing. But we recognise that for this to happen, more capacity must be available in our health and care systems. A 2015 BMA survey of 15,560 GPs found that only one in ten felt that current appointments were long enough. This pressure makes it hard to explore wider issues in the context of an appointment. Sufficient investment to enable GPs to offer appointments of at least 15 minutes would offer more frequent opportunities for in-depth discussions.
Addressing fear of residential care: Thinking about the possibility of needing to leave one’s home is a major taboo for the older people and families we talked to. Care homes are usually only in the public eye when something goes wrong, so few people see the positive benefits a good care home can have on the well-being of older people.
We need to do more to tackle widespread fear of residential care environments by developing a clearer picture of what goes on in them. We are currently undertaking research on the problems older people and families face in choosing a care home and will be publishing information to help families to compare different options. We also want to see an increase in care home outreach activities to break down barriers with the local community and show more people what living in a care home is like. Initiatives such as Care Home Open Day are a great start, but outreach needs to be ongoing.
Advice charities like Independent Age also need to play our part. Alongside this research on difficult conversations, we are also launching an online resource for families who want to talk to older relatives about sensitive issues. It gives some suggestions for how to begin conversations and specific information on five key areas we think families should consider talking about. The guide can be found on our website: www.independentage.org/difficult-conversations
The full research report is available for download here: www.independentage.org/difficult-conversations-report
Independent Age offers impartial advice over the telephone for older people, their families and carers on issues such as care and support, money and benefits, health and mobility.
Call our Helpline on freephone 0800 319 6789, Monday to Friday, 8am-8pm, and Saturday to Sunday, 9am-5pm, or email your query to firstname.lastname@example.org. Our advice publications are also available online at www.independentage.org/information