ESN members in practice

Public managers are constantly making choices.

Local authorities, particularly their political leadership, face tough choices about the level of funding they allocate to the various local services. One of the most important roles of local public social services is to assess the needs and the preferences of dependent older people both at a community and at individual level.

“We made a series of surveys of what it’s like to be old in today’s society and the most striking thing was the number of people who said they were lonely and isolated. So now we’re trying to develop services to support dependent older people’s social inclusion,” says Agnieszka Pierzchalska, Head of Cooperation for the Voivodship of Lower Silesia in Poland.

Local public social services have to balance responsible use of public money with meeting the needs of each individual. Budgets are vulnerable to a change of politics after local elections – especially where a party may have promised to cut local or national taxes.

“The immediacy of the electoral cycle makes it hard to argue to invest in meeting-places and other services which support healthy ageing and so prevent dependency in the future,” comments Reinhard Pohlmann, Head of Older People’s Services for the City of Dortmund.

Older people increasingly have more choice too.

Where user choice methods such as vouchers or personal budgets are developing, older people have new choices to make – not only about the type of service they get, but also about who provides it and when. According to Elisabeth Mejersjö, Director of Social Services in Jönköping, Sweden, people are influenced in their choice of provider by word of mouth, local knowledge, language skills, the variety of services on offer, and ultimately the individual experience of the service.

“Although Germany’s long-term care insurance might be said to enhance freedom of choice by putting resources in the hands of individual, some older people, influenced by their relatives, choose a nursing home over home-care”, says Reinhard Pohlmann. Choosing a nursing home, explains Reinhard, may mean that a person’s condition deteriorates as every simple task is done for them, whereas home-care would have enabled them to retain greater independence and connection to their social networks.

Strategic choices need to be about the future of long-term care in an ageing Europe.

European policy-makers and practitioners are familiar with debates over the sustainability of long-term care models. A number of countries are in the process of introducing reforms to long-term care. Local politicians and directors of social services are faced with important strategic choices.

Elisabeth Mejersjö believes that social directors need to think not only about the costs of providing particular services, but also about the costs of not providing them: “If we reduce funding for health information, preventive visits or day-centres, we might pay more in the longer term by having to provide care related to conditions which could have been prevented or delayed with early intervention.”

Agnieszka Pierzchalska brought out a wider problem about society’s perception of social work and care in Poland: “In the immediate period after the fall of Communism, social services were perceived as a burden. Now attitudes are changing, things are getting better, but it’s hard to raise the profile of social work and social care, to change people’s attitudes towards services designed for the few.”

For Alexis Jay, Chief Social Work Inspector in Scotland, there is a broader issue about the society’s perception of older people as a burden: “We need to start moving away from talking about the ‘demographic time-bomb’ and seeing the benefits of people living longer and healthier lives.”

After all, we all have a vested interest in sustainable and high-quality long-term care.