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6.0 Care, Support, Safety and Protection
Staying at Home
The vast majority - over 95% - of Scotland's over 65s live at home (General Register Office for Scotland, 2003), with 4% (33,700) in care homes (Scottish Executive, 2004c) and 0.4% (3,200) in long stay hospital care ( ISD Scotland), and research has consistently shown that most people want to stay at home as long as possible. To want to spend as much as possible, if not all, of one's life in one's own home is understandable: it maintains privacy, autonomy, and the continuity of social networks; and many people regard loss of home as a bereavement exceeded only by the loss of a spouse. The right services can help people stay at home exercising control and choice over what happens in their lives for as long as possible. In addition to traditional services, direct payments discussed in more detail below can provide additional choice and flexibility for people who need support. Leaving home and entering institutional care, however necessary such a move, is often seen as a regrettable loss of independence and the disruption of previous life and social networks.
The Scottish Executive's policy of Free Personal Care has succeeded in keeping many frail and dependent older people at home as they wish; and although care provision varies across the country, continuing efforts are being made to maximise the equity, quality and effectiveness of such care.
Telecare Services
For many older Scots, family networks are of course available and function very well; and they, together with the wide range of health and social care services currently provided, succeed in supporting even the very frail at home. There is now a growing body of evidence that telecare services provide people with greater safety and security at home, while maintaining independence for longer.
Telecare is not a substitute for existing community provisions in health and social care. However, by using technology in parallel with other forms of care and support it extends their effectiveness, helping people to remain at home who would not otherwise be able to do so.
Case Study: West Lothian Council
West Lothian's goal is to support older people in staying in their homes by considering what infrastructure and services are required to maintain people with a variety of levels of dependency in a community setting. This has meant looking at alternative models of care and at different components of care, such as telecare and telemedicine.
There are now two and a half thousand homes in West Lothian with telecare, where people have a range of monitors in their homes connected to a round-the-clock emergency call and response service. Monitors can include smoke, heat and flood detectors; fall sensors; panic buttons; wandering sensors (which can be used with people with dementia); and medication reminders. Remote door controller systems allow older people to let family and neighbours in and out of the house without the need to go to the door every time. This West Lothian initiative has been credited with reducing the level of delayed discharge, by averting the unnecessary admission of the frailest elderly; and cutting the average length of stay in care homes, by deferring care home admission until the later stages of advancing frailty. It has become clear that success depends as much on the people as it does on the technology. The technology is a useful part of an overall service, adding value and efficiency as services have been re-engineered around it.
The aim now is to make telecare more available across the country. The Scottish Executive's Telecare Development Programme builds on the work in West Lothian with a two-year capital funding programme covering 2006-07 and 2007-08 that will promote and support the development of telecare programmes throughout Scotland.
Direct Payments
Improving access to Direct Payments is a key driver for the Scottish Executive in empowering individuals to take greater control of their care needs, and how these are delivered. Direct Payments are money that Social Work Departments can provide to individuals to buy the support they need to live at home, rather than receiving a community care service from the council. They are not always suitable for everyone, but local authorities in Scotland have a legal duty to offer Direct Payments to eligible individuals, which includes those aged 65+ living at home.
The great benefit of Direct Payments is that they provide individuals who are assessed as needing community care services with the flexibility, choice and control over how their assessed needs are met. The Scottish Executive funds several organisations to promote awareness of Direct Payments nationally, and is assisting with the development of a network of local Direct Payments support organisations so that individuals have easier access to the information and assistance they may need to use Direct Payments. Updated draft policy and practice guidance on Direct Payments is presently out to consultation; revised guidance is expected to issue shortly.
Case Study: Direct Payments
Mr Scott has been on direct payments for 2 years and has a care package of 30 hours per week (17 hours of which is free personal care). He has contracts with five self-employed personal assistants ( PAs) and is delighted with the care he receives, emphasising the importance of relationship building between himself and his PAs in order to achieve this. He is able to pay a small pay supplement to PAs from his own resources that has helped with recruitment and retention in the rural area in which he lives. Mr Scott's PAs also offer additional basic health care support. His experience of support from his local direct payments support organisation has been extremely positive. For example, they have been able to respond immediately to problems, have an over 65s representative, and organise Liability Insurance.
Safety and Protection
As with any other age group, older people have every right to feel safe and secure in their homes and communities. While older people are far less likely to be victims of most types of crime than are younger age groups, they are more likely to be victims of the fear of crime. And for them the fear of crime is insidious, demoralising, and potentially pervasive in its effect - limiting leisure, social and community activities, and impairing health by preventing simple outdoor exercise like walking and rambling.
Poor health, social exclusion, and physical decline can lead to greater physical vulnerability, and vulnerable older people are more likely to be victims of elder abuse. This can be physical, psychological, sexual, or financial; or it can take the form of neglect. It can be carried out by family members, carers, or professionals - wherever there is an expectation of trust. Older people can also be victims of domestic abuse - either abuse continuing from previous years, or abuse that has begun in later life.
We want to see a Scotland where older people are free from fear, and feel safe going out and about; where they are free from abuse; and where as a result they can play a full part in their communities and in society.
Safety and security concerns were raised by a number of respondents to the consultation. Most responses related to the need for better policing, CCTV, and Neighbourhood Watch schemes to ensure that older people feel safe within their communities. Some respondents also felt that such measures would help to counteract anti-social behaviour, ageism and racism.
Community Safety
Everyone wants to live in safe, strong and attractive communities, and previous sections discuss important aspects of housing, transport and the environment that relate to this. Older people will feel more secure, as will everyone else, in such communities.
Older people are concerned about crime. Effective policing is vital in the detection of crime, and hence making people feel safer by reducing the fear of crime. In "A Partnership for a Better Scotland" (Scottish Executive, 2003a), Scottish Ministers gave a commitment to increase the number of police officers on operational duty in every Scottish force and to improve on the level of overall police numbers. Police officer numbers in Scotland are at record levels with 16,226 at 30 June 2006, which is an increase of over 1,500 since 1999. Over the same time, police support staff numbers have increased significantly, by over 2,000 to 7,249.
The Scottish Executive is working in partnership with the police service to introduce new ways of working; harnessing new technology and easing the bureaucratic burden on officers to increase the time individual officers can spend out in the community. This allows police officers to focus more of their time doing what they do best - preventing and detecting crime and helping to create safer communities.
Operational aspects of policing are of course a matter for Chief Constables - it is they who have to make decisions about how to use the resources which they have at their disposal - and this includes the deployment of police officers to particular duties such as frontline policing. Policing priorities can change from day to day in order to meet competing demands. Whilst it is the case that having more police on the beat can provide greater levels of public reassurance, this has to be balanced against the wider demands of tackling criminal activity and promoting safer communities more generally.
Creating safer communities is a complex task that involves contributions from a range of other agencies in addition to the police. Community Safety Partnerships ( CSPs) play a vital strategic and co-ordinating role in this. The work of CSPs affects the whole community; however, many community safety issues are particularly important to older people. For example, older people are most at risk from falls/accidents in the home. Older people are also often the backbone of local crime prevention initiatives such as Neighbourhood Watch, and of tenants' and residents' groups who may provide crucial intelligence to the police. They may also be actively involved in intergenerational activities which seek to build bridges between young and old. Many Community Safety Partnerships seek to engage with older members of the community on a regular basis, for example, through dedicated community safety forums.
Tackling antisocial behaviour is a major priority for the Scottish Executive which is why a significant investment of over £120m over 2004-08 has been made available to local agencies to improve the services available to prevent and tackle antisocial behaviour. This underpins the new legal measures introduced by the Antisocial Behaviour (Scotland) Act 2004. New or extended services include antisocial behaviour investigation teams, community wardens, victim and witness support schemes and mediation services. Public information campaigns and Antisocial Behaviour roadshows have sought to put across the message "When you can't ignore it…Don't." These services benefit the whole community including older people.
Elder Abuse
We recognise that some older people may experience abuse which too often remains hidden, with fear of reporting the consequences leading to toleration of abusive behaviour, sometimes with tragic consequences. Those who suffer abuse must be better supported: receiving the protection they need to stop abuse when it is detected or reported; being confident that all interventions will be undertaken sensitively and constructively; and receiving the care and support people need to help them recover from such experiences.
This requires a concerted effort between the statutory agencies with a role in care and protection to better co-ordinate their activities, and improved guidance, education and information to ensure that individuals know what protections they are entitled to, and whom they can approach for assistance whenever it is needed.
Scottish Ministers have decided to legislate to bring about improved protections for adults at risk. The Adult Support and Protection (Scotland) Bill will help to limit abuse by offering greater support and protection to adults of all ages who may be at risk. There are new powers to investigate suspected abuse; carry out an assessment of the person and their circumstances; intervene to manage the risk of abuse; or, in exceptional circumstances, to remove the victim to a temporary place of safety and to exclude the perpetrator. The Bill will also establish local multi-disciplinary Adult Protection Committees to both oversee and co-ordinate the work of various agencies involved in adult protection. Subject to Royal Assent, the Bill is expected to be commenced early in 2008.
Domestic abuse
It is sometimes forgotten that older women too can experience domestic abuse, in some cases continuing for many years. The report "Older Women and Domestic Violence in Scotland" (Scott et al., 2004) raised awareness of this issue and identified barriers and particular issues that older women can face in accessing support. Older women are, for example more likely to be cared for by their abuser, or be his carer. The Scottish Executive's Domestic Abuse National Strategy (Scottish Executive, 2000) aims to ensure that women of all ages who experience domestic abuse receive an effective and appropriate response from the agencies with which they come into contact.
Conclusion
The consultation told us clearly that feeling safe and secure is very important to people as they grow older. People want to feel safe in their homes, when they travel, and in their communities as they go about their day to day lives; and they want to feel safe in accessing the range of services that they may need - secure in the knowledge that they will be treated as individuals, given care and support when needed and treated at all times with dignity and respect.
The Scottish Executive will continue to work in partnership with the police service, local authorities, health services and others to ensure that Scotland is a place where all older people, and particularly those who are most vulnerable, can live lives that are free from abuse and from fear and with care and support when that is needed.
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