Context
The numbers of people over 65 without adult children are set to double from 1.2 million at the present time to 2 million by 2030. At the moment 92% of informal care is provided by family [1] and 80% of older people with disabilities are cared for by either their spouse or adult children [2]. The older a person is, the more likely they are to be cared for by their child. However, the number of older people with disabilities who live alone and have no child is also projected to increase rapidly, rising by nearly 80 per cent between 2007 and 2032 [3] This year for the first time, more older people need care than there is family available to provide it.
“As the baby-boomer generation ages, a growing ‘family care gap’ will develop as the number of older people in need of care outstrips the number of adult children able to provide it. This is expected to occur for the first time in 2017” The Generation Strain, Institute of Public Policy Research 2014
Successive Governments have failed to get to grips with the issue of both how to fund social care and ensure that it is of a good quality. This coupled with the austerity programme of reduced public spending has resulted in fewer people receiving social care [4] and Government policy insofar as it exists has been to focus on families doing more. Little thought has been given what happens to those older people who have no children (or other family) to help and support them in later life.
“We need to start thinking as a society about how we deal with care of our own parents. One of the things that has struck me as I’ve been doing this role is that nobody ever questions the fact that we look after our children, that’s just obvious. Nobody ever says it is a caring responsibility, it’s just what you do. I think some of that logic and some of way we think about that, in terms of the sort of volume of numbers that we are seeing coming down the track, will have to impinge on the way we start thinking about how we look after our parents. In a way, it is a responsibility in terms of our life cycle that is similar.” [5] David Mowat Minister for Care January 2017
“Family planning must be as much about care for older generations as planning for younger ones. A wholesale repairing of the social contract so that children see their parents giving wonderful care to grandparents – and recognise that in time that will be their responsibility too” Jeremy Hunt Secretary of State for Health 2015 [6]
So far, the growing numbers of people without family has not appeared on the radar of social care policy at a national and often local level. There is no current evidence to suggest that criteria to access social care will be loosened or that there will be a significant boost in social care spending during the lifetime of this Parliament. Despite the fallout from the so called dementia tax, Government is likely to focus policy on individuals with assets funding their own care rather than raising taxes nationally.
Access to family care for people ageing without children
Research has shown that people ageing without children are less likely to have informal care support when their health deteriorates
“The absence of children is not clearly associated to a disadvantaged situation when health is good, but when someone becomes frail and loses their independence in carrying out daily living activities, childlessness becomes a problem. The worst situation in terms of the availability of informal support is clearly that of the frail elderly who are both childless and unmarried or widowed, especially if they are men” [7]
Furthermore it has also been demonstrated that extended family e.g. siblings, nephews/nieces, cousins, friends and neighbours do not make up the care deficit if one does not have a nuclear family. Essentially, the more support a person needs, the less robust their support network is in being able to meet their needs
“Childless people tend to compensate for the absence of exchanges with their own children by more frequently extending their networks to neighbours and friends, and by getting more involved in community activities. They also tend to develop stronger ties with other family members – parents, siblings and, along the generational line, nephews and nieces………However when strong support is needed, these compensatory arrangements work only partially. When getting frail and acquiring limitations in their ability to carry out the activities of daily living, childless people receive much less support than parents, are more likely to enter residential care, and do so at lower levels of dependency”[8]
The lack of informal care has an inevitable knock on effect to formal care; evidence shows that older people without children and especially those who are widowed are more likely to need formal care services [9] People ageing without children are 25% more likely to enter into residential care [10] which given the limited alternatives to residential care that exist in the UK and the precipitous state of the residential care market is extremely worrying.
However there is evidence to show that although individuals ageing without children do use formal care more than those with children, it is a more complex picture than one would expect
“Two of the very few studies on the utilisation of formal care services by the childless clearly indicate that elderly non‐parents tend to use formal service provision more frequently and intensively than parents do. But the same studies also show that the utilisation of public care services by the elderly is strongly mediated by the presence of children, who act as advocates on behalf of their parents (Choi 1994; Larsson and Silverstein 2004)….. As a consequence, the utilisation of public care services by the childless do not fully compensate for the support deficits they face”[11]
It has been established that people ageing without children often have poorer health and higher mortality rates than people with children [12] [13] Poor health is the key determinant in whether people need care and support in later life. It may therefore be the case that people ageing without children are more at risk of failing health in later life than those with support from children. If this is the case, then they are more likely to need care and support
Solutions
It can been seen from above that
People ageing without children have less access to informal care support
Networks of friends/neighbours/wider kin do not substitute in intensity of support for adult children or partners. There are particular issues for the single/windowed ageing without children
People ageing without children are more reliant on formal care but can have greater difficulties accessing it
Poor health is the key determinant in needing care
People ageing without children more likely to drink more, smoke more and be underweight
People ageing without children 25% more likely go into residential/nursing care
What needs to happen?
Existing service planning and provision must take into account the growing numbers of people ageing without children and adapt accordingly
People ageing without children need support to plan and prepare for their later life.The capacity of advocacy services must be increased
There need to be co living solutions including co housing
There need to be local groups for people ageing without children
Conclusion
People ageing without children who need care and support in later life face significant barriers including
No one to play the role of advocate to speak for them and curate care
Lack of informal support networks compared to those with children
Shrinking state provision
To overcome these hurdles, people ageing without children need targeted interventions that accommodate the lack of family support available to them. Failure to tackle the issues raised will lead to increased use of health and social care services and a considerably poorer later life for individuals without children.
[1] Measuring National Well-being – Households and Families, 2012 Ian Macrory: Office for National Statistics
[2] Hoff A, Current and future challenges of family care in the UK. Zittau/Goerlitz University of Applied Sciences,2015.
[3] Pickard, Linda et al Mapping the future of family care: receipt of informal care by older people with disabilities in England to 2032. Social Policy and Society, 11 (4). pp. 533-545. ISSN 1475-746
[4] Age UK Briefing: Health and Care of Older People in England 2017
[5] http://www.telegraph.co.uk/news/2017/01/31/parents-responsible-care-elderlymothers-fathers-much-children/
[6] https://www.gov.uk/government/speeches/personal-responsibility
[7] Childlessness and support networks in later life: a new public welfare demand? Evidence from Italy
Marco Albertini Letizia Mencarini 2011
[8] What Childless Older People Give: Is the Generational Link Broken? Albertinin M and Kohli M Ageing and Society 29(08):1261 – 1274 · November 2009
[9] Wenger, C. G., Dykstra, P. A., Tuula, M., & Knipscheer, K. (2007). Social embeddedness and latelife parenthood: Community activity, close ties, and support networks. Journal of Family Issues, 28, 1419–1456. doi:10.1177/0192513X07303895
[10] Childlessness at the end of life: evidence from rural Wales WENGER G. Clare Ageing and Society, 29(8), November 2009, pp.1243-1259.Cambridge University Press
[11] Childlessness and support networks in later life: a new public welfare demand? Evidence from Italy Marco Albertini Letizia Mencarini 2011
[12] How Does Childlessness Affect Older Americans’ Health Status and Behaviour? Robert D. Plotnick February 2011 Daniel J. Evans School of Public Affairs and Centre for Studies in Demography and Ecology University of Washington
[13] Modig K, Talbäck M, Torssander J, et alPayback time? Influence of having children on mortality in old age J Epidemiol Community Health 2017;71:424-430.