At a glance 65: A Better Life for older people with high support needs: the role of social care

The Joseph Rowntree Foundation has identified seven key challenges to be addressed for older people with high support needs to achieve a better quality of life. Social care has a key role to play in meeting these challenges.

1. Old age is not about 'them': it is about all of us
2. Older people are individuals and they are, as a group, becoming more diverse
3. Relationships matter to us whatever our age; we have a fundamental human need to connect with others meaningfully
4. Older people with high support needs have many assets, strengths and resources that they can also bring to the development and provision of services
5. Whatever our age or support needs, we should all be treated as citizens: equal stakeholders with both rights and responsibilities
6. The individual and collective voices of older people with high support needs should be heard and given power
7. We need both to innovate and improve existing models

SCIE's role is to share knowledge about what works and use this to produce practical resources. Many of these resources will support people working in all aspects of social care to address these challenges.

Challenge one: 'We all need positive images and balanced narratives to challenge ageist assumptions. Old age is not about "them", it is about all of us'

Social care services should see older people with high support needs in a positive way that challenges ageist assumptions. This will support personalised approaches and ensure people get the support that is right for them and means they can live more fulfilling lives.

There are two e-learning resources that are designed to support positive practice about older people and are especially focused on challenging some of the misconceptions about older age, dementia and age discrimination.

• Dementia awareness e-learning course

Challenge two: 'We all need to make the effort to see and hear the individual behind the label or diagnosis, taking into account the increasing diversity of older people as a demographic group'

This challenge relates to personalisation, one of the key concepts in current social care policy and practice. It means starting with the person and their lives rather than what services already have to offer. SCIE has a range of resources to support working in this way.

There are two online gateways that lead to resources to support personalisation for older people and to good practice in working with older people living with dementia. The emphasis throughout is on working with people as individuals with different backgrounds, strengths, life histories and experiences:

• Older people and personalisation resources
• Dementia Gateway

There is also an e-learning resource on a simple and effective way of developing person-centred care and support:

• Getting to know you

Increasing diversity means that it is important to address the needs in different communities, for example older people in black and minority ethnic communities, and older people in lesbian, gay, bisexual and transgender communities. This makes it important to recognise how older people experience discrimination on the basis of their age and other aspects of their identity as well as understand how different backgrounds and life experiences may shape what is important to them.

These resources address a range of equality issues relating to older people:

• Personalisation briefing: Implications of the Equality Act 2010
• Supporting black and minority ethnic older people's mental wellbeing: accounts of social care practice
• Working with lesbian, gay, bisexual and transgender people - older people and residential care: Roger's story
• Assessing the mental health needs of older people: Black and minority ethnic communities

Challenge three: 'We must ensure that all support is founded in and reflects meaningful and rewarding relationships. Connecting with others is a fundamental human need whatever our age or support needs'

Whatever our age or support needs, having meaningful relationships and staying connected with friends and family is vital to quality of life and wellbeing. Older people with high support needs will develop new relationships with care workers supporting them at home and may make new friendships if they move into a residential home.

Care workers need to be able to build good relationships with the older people they are supporting and in turn require the right support and conditions to do their job well. SCIE has a range of resources that can help social care staff with communication skills, understand dignity in care and relationship-based care.

• Dignity in Care
• Older people and personalisation
• e-Learning: Communication skills
• Getting to know you

Challenge four: 'We need to use the many assets, strengths and resources of older people with high support needs through recognising and creating opportunities for them to give and receive support'

Working with older people with high support needs in planning, designing and delivering care and support is a fundamental way to make improvements to ensure a better quality of life. It also means people improve their self-esteem by feeling they are making a contribution. A Better Life also shows many examples of older people providing as well as receiving support. These range from caring for a partner to offering emotional support and friendship, as well as helping out with practical tasks.

SCIE has a wide range of practical resources on participation and co-production. Some cover general principles and approaches but others give specific examples of good practice for older people with high support needs, including co-production in residential care:

• Co-production in social care: What it is and how to do it
• Social Care TV: Participation in dementia care planning
• Co-production and participation: Older people with high support needs 
• The participation of adult service users, including older people, in developing social care

One aspect of using the assets of older people with high support needs is supporting them to regain their physical abilities and strengths where possible. This is called reablement and is an important aspect of care and support that promotes independence and quality of life by building on strengths after a period of time in hospital while aiming to prevent further difficulties.

• Reablement resources
• Social Care TV: Reablement: Maintaining independence
• e-Learning: Reablement

Challenge five: 'We must all be treated as citizens: equal stakeholders with both rights and responsibilities not only as passive recipients of care. We must also have clarity on what we can reasonably expect from publicly funded services and what we will need to take responsibility for ourselves'

Older people with high support needs are citizens with rights and responsibilities and are equal stakeholders in publicly funded care and support services. SCIE’s resources on equality, participation and co-production are relevant to this challenge.

Personal budgets in social care are also an important way in which older people who are eligible for local authority funding can have more choice and control over their lives.

This report outlines what is needed so that personal budgets work well for older people, particularly those with high support needs including dementia.

• Improving personal budgets for older people: A research overview

SCIE also has resources to help people understand good practice in some more difficult areas of social care where the support provided can involve restricting a person’s freedom.

• Minimising restraint resources
• e-Learning: Managing risk, minimising restraint: Challenges, dilemmas and positive approaches for working with older people in care homes

Challenge six: 'The individual and collective voices of older people with high support needs should be heard and given power. We must use a much wider range of approaches to enable this'

Older people with high support needs should be able to make decisions about their care and support so they can live a good life that is determined by them.

Collectively, older people with high support needs can shape services and policies and have a role to play in developing user-led organisations (ULOs). SCIE offers a variety of practical resources to support both the collective and individual voices of older people with high support needs being heard and given power.

• A commissioner's guide to developing and sustaining user-led organisations

There can be difficult issues around choice and control for older people living with dementia or other conditions which mean they may have mental capacity issues. The Mental Capacity Act 2005 provides the legislative and practice framework to ensure people are involved in decision-making where they have mental capacity issues.

SCIE has nine e-learning resources that cover the Act and ways of supporting the people it covers to be involved in decision-making.

• e-Learning: Mental Capacity Act

There are also four Social Care TV films on mental capacity and decision-making for older people with high support needs:

• Social Care TV: Ada's assessment
• Social Care TV: Peter's IMCA
• Social Care TV: Emily's safety
• Social Care TV: Raymond's money

The participation and co-production products introduced for Challenge four are also relevant for this challenge.

Challenge seven: 'We need to be open to radical and innovative approaches; but we also need to consider how often simple changes can improve lives within existing models'

Many of the SCIE resources introduced for the six other challenges show innovative new ways of working and approaches to improve care and support that already exist for older people with high support needs. However, sometimes changes only need to be small, like supporting people to go out to a park or allowing partners to help with care in residential settings.

For this challenge there are additional SCIE Social Care TV films that illustrate new approaches and simple changes to care and support for older people, particularly highlighting the importance of relationship-based working:

• Social Care TV: Defining Excellence – Excellence in Residential Settings – Older People
• Social Care TV: Defining Excellence – Excellence in Domiciliary Care
• Social Care TV: Nutritional care for older people

SCIE's guide to co-production.

Hospital admissions can have a significant impact on the quality of life of older people with high support needs. SCIE has a series of Social Care TV films that show different ways of working and providing clinical care in older people’s own homes that can help prevent unnecessary hospital admissions.

• Social Care TV: Avoiding unnecessary hospital admissions: The headlines
• Social Care TV: Avoiding unnecessary hospital admissions: Wandsworth Community Ward
• Social Care TV: Avoiding unnecessary hospital admissions among older people: Residential care homes

Telecare is an example of a technological innovation that can contribute to a range of support options for older people living in their own homes and maintaining choice and control. These Social Care TV films explore its uses and the ethical debate surrounding the use of such technology.

• Social Care TV: Telecare – Providing more personalised care
• Social Care TV: Telecare – The ethical debate

Older people with high support needs may use care and support from different services and professionals. This means it is important for these different professionals and agencies to work together effectively in order to meet people’s needs and improve their lives.

This SCIE e-Learning module explains how to promote best practice in collaborative working between practitioners and agencies.

• Interprofessional and inter-agency collaboration (IPIAC)