Ipsos MORI and partners have conducted a new and timely research project highlighting the experiences of unmet need for care among older people living in their own homes. This research was funded by the NIHR School for Social Care Research and conducted in collaboration with NatCen Social Research, Age UK and Independent Age.
The publication of this report is particularly important because an increasingly ageing population and cuts to budgets are placing pressure on services. At the same time, the Care Act 2014 has introduced a national eligibility framework and an emphasis on prevention and on well-being. These findings play a key role in shaping the national debate and give insight into the following areas: access to care and support, funding of care, support for carers, the impacts of austerity on public services and the place of older people in wider society.
Unmet need is widespread but often hidden. The report finds:
- Whichever measure of unmet need is used, over half of older people with care needs have unmet needs.
- Unmet need affects people eligible for local authority support as well as those who are responsible for funding their own care and support.
- Unmet needs can be hidden where older people look to cope with their care needs but doing this takes all their time and energy. Unmet needs can also be hidden where some needs are being met by others, but the support being provided is precarious or unreliable.
- Linked to this is considerable unmet need for social contact and involvement in interests and activities, related to the difficulties of managing day-to-day life or a lack of mobility.
- Those who live alone are particularly vulnerable as they lack the social and practical support offered by a co-resident carer. Older people show resilience and independence and value managing by themselves and not thinking of themselves as a burden on others. This, alongside difficulty in finding out about and accessing services, is associated with not accessing all the support which is available.
The survey data analysis showed no statistically significant relationships between our measures of unmet need and well-being. However, the in-depth interviews showed that unmet need and well-being are linked in complex and sometimes opposing ways:
- Unmet needs are linked to serious impacts on well-being for some people and for a wider group unmet needs are linked to frustration and a loss of purpose.
- The links between unmet need and well-being appear to be related to social isolation and mobility. Where older people maintain their social networks and mobility, the impacts of unmet need on well-being can be mitigated.
- There are also well-being benefits from retaining independence and managing without help even in the face of difficulties.
What does this mean for the social care sector?
Meeting needs and maintaining well-being among older people with care needs is about more than providing care services.Access to suitable transport, housing and adaptations, and social and community networks can assist people in meeting their care needs and in maintaining well-being.
Dr Margaret Blake, Research Director at Ipsos MORI, said:
This research shows that the causes of unmet needs for care and support are wide-ranging, and that lack of local authority funding is only one part of the problem. Having timely access to information and advice, being able to plan ahead and save for future care needs, knowing how to access care and support services and understanding that they can have an empowering role in maintaining independence, all have a significant role to play in reducing unmet needs.
Janet Morrison, Chief Executive of Independent Age, the older people’s charity, said:
This research highlights how widespread unmet care needs now are in the older population with huge consequences for people’s sense of worth, but also their mobility and ability to remain socially connected. With around half of all older people with care needs now experiencing at least some level of unmet need we need to radically rethink as a country how we are caring for and supporting some of the most vulnerable members of our society. There is a human cost to continuing down our current path. To avoid a future where ever growing numbers of older people end up housebound, coping alone or living their last years lonely and isolated, the government needs to urgently come forward with clear proposals for reforming social care. A consultation has been promised, but older people and their families now need to see some action.
Allison Dunatchik, Researcher at NatCen Social Research, said:
The findings from our research show that a significant proportion of older people have social care needs that are simply not being met. Moreover, our new way of measuring and defining unmet need, based on the national framework laid out in the Care Act 2014, suggests that the scale of it may be greater than previously thought, affecting individuals across age groups and financial circumstances.
Caroline Abrahams, Charity Director at Age UK, said:
Our own analysis last year found that the number of older people in England who don’t get the social care they need has soared to a new high of 1.2 million – up by a staggering 48% since 2010. And importantly, this report highlights that it is a wide variety of older people that are affected by unmet needs – including those who are eligible for funding and those who expect to fund it themselves. This would suggest that what we know may only be the tip of the iceberg, since many older people are not always sure as to how they can make their circumstances known. Whilst this remains the case, older people are being left to suffer in silence, without the care and health services they so desperately need and deserve. This is also having a grave effect on older people’s wellbeing, with many of them unable to get out and enjoy the everyday activities or hobbies they once used to. Older people desperately need the Government to follow through on its commitment to consult on proposals for strengthening social care later this year and finally reaching a sustainable and fully funded solution.
- In 2015, NIHR School for Social Care Research funded independent research to explore unmet needs among older adults who live in their own home. This project was carried out jointly by Ipsos MORI and NatCen Social Research in collaboration with Age UK and Independent Age.
- The views expressed here are those of the researchers involved and not necessarily those of the NHS, the NIHR or the Department of Health.
- The research was conducted using secondary analysis of survey data from the English Longitudinal Study and Ageing (ELSA) and Health Survey for England (HSE) using data from 2011-13. It also involved 24 in-depth interviews among people with care needs during spring 2017. The research explored the nature and prevalence of unmet need for care, factors which predict unmet need developing among those with care needs and the links between unmet need and well-being.