Superintendent's Comment

Community Participation and Ageing

Ageing affects people differently.

Improved life expectancy means that today, many older people are able to continue actively participating in community life. As a result, traditional thinking about older age and retirement is being challenged. The participation of some older people in healthy ageing activities can be limited by economic or social disadvantage experienced during their lives. Age discrimination, financial status, public transport, negative attitudes and stereotyping, location of venues and timing of activities, limited opportunities for education, contribute to, or provide barriers to, the involvement of older people. In addition, older people with a disability, or from non-English speaking or Aboriginal and Torres Strait Islander backgrounds, may be affected.

The challenge is to improve opportunities for older people's community participation, by reducing physical, social and economic barriers. Such awareness by communities and governments can ensure that older people are encouraged to participate in paid employment or volunteering, lifelong learning activities, as well as social and leisure pursuits.

…the faces of independence

Most older people prefer to stay in their own homes and communities as they grow older. In order for this to happen, neighbourhoods and communities must be placed where people of all ages can feel safe. A variety of housing types, accessible facilities and services, ease of access and transport options will assist older people to remain fully active, participating in the life of the community. The alternative is that older people become isolated in their own homes or decide to move prematurely into supported or aged care accommodation.

Families have been found to be extremely important to individuals as they age, as has the environment in which they live. Families can support each other even if they are not living under the same roof as most older persons live close to their children and keep in contact by telephone. Ownership of a family home provides older people with "a sense of security and continuity, and a base for daily activities and social interaction in a familiar context".38 A large number of persons over 60 own their own homes. In 1993 this figure was 77% compared with 24% of those under 59 years of age. A familiar neighbourhood where activities are enjoyed has been strongly linked to life satisfaction for the elderly. Disruption in this residence can be devastating.39 It is not surprising therefore to find that "approximately half of newly relocated nursing home residents are in crisis and at increased risk of depression and suicidal ideation."40

In a study conducted for the Aged and Community Care Division of the Department of Health and Aged Care, 55 to 75 year olds were asked whether they thought that people needing a high level of personal care should go into a residential/nursing home or whether services in the community should help them remain in their homes for as long as possible. Of the 1,415 responses, 17% said that they should go into care, 6% were unsure, and the large majority, 77%, said that they should be allowed to remain in their homes for as long as possible.41

Mr Peters daily makes his pilgrimage to Gladstone House catching the bus at 9.07am, every day of the year, rain hail or shine. The source of this devotion is his wife Dorothy.

Suffering from Alzheimer's Disease, Dorothy is no longer able to walk or feed herself. But, even at the age of 90, Mr Peters' love still runs strong and he hates not seeing her, even for a day.

With no other relatives living in Sydney, Mr Peters was very much on his own until recently. Now, however, he has staff from Wesley Home Care calling on him and making sure his routine does not get out of hand. They also book and transport him to and from appointments and keep tabs on his health.

One staff member said: "He will acknowledge that his memory is not what it used to be so a worker visits him each day to ensure he is eating properly and looking after himself.

"Mr Peters greatly appreciates the visits from care workers and loves to talk about his wife," she said.

"He knows he may not always be able to continue his daily pilgrimage but while he can he will.

"The comfort is knowing that whatever his abilities may be, we will be there to help him and care for him."

…the faces of eldercare

• Women live longer than men. There are 75 men for every 100 women aged 65 years and over, and 40 men to every 100 women in the over 85 age group.42
• In 2005/6 estimates predict there will be more than half a million people over 65 years of age with "severe and profound handicap".

Requiring significant support, both from informal family carers and with the assistance of government-funded programs, the majority of these people continue to survive in the community. While this may have the apparent attraction (to governments) that informal care is 'free', that would ignore the fact that between a third and half of such carers have been shown by a NSW Carers' Association survey to have had to either abandon paid employment or significantly reduce it.43

Women experience some disadvantages as a result of lower incomes, interrupted work patterns and lack of adequate superannuation. These disadvantages continue to impact when they are older, and their role as primary carers often extends into their older years. At the same time, men may experience social isolation and a change of roles for which they may be quite unprepared - in retirement, or on the death of their partner or spouse.

Older people as carers

While older people are often referred to in terms of financial burdens, their contributions to the community are often forgotten. Older persons not only contribute to Australia's economy but also to their family's development and well-being. Largely invisible, they are among the main providers of child care in Australia, acting as babysitters for their grandchildren and also supporting family and friends in times of need.44

Grandparents may take over the parenting role for reasons such as their children's death, mental illness or drug and alcohol addictions. Raising a child on a pension and family support is reported to be very difficult, even though grandparents often state that they receive great satisfaction from this role.45

Caring for Older Persons

• There are approximately 620,000 carers in NSW and 1.5 million carers Australia-wide.46 More than 1.15 million in Australia are caring for a person over the age of 60 years.47
• Carers, being mostly untrained in any form of nursing, carry an enormous responsibility (largely unsupported) for their loved one's well-being, both mental and physical.

Many indicators, including Australia's ageing population, suggest:

• a future shortage of carers, which will most likely lead to a shortage of funds. It is thus possible that even if an individual wanted to relinquish the responsibility of caring there may not be a place for their loved one in a home.
• current carers are ageing. A 1997 report from the Australian Institute of Health and Welfare suggested that there are 7,700 severely or profoundly handicapped people with carers over the age of 65.47 As older carers become more frail with age there arises not only the question of who will look after them but who will look after those for whom they currently care.

The attitudes of younger generations are also likely to have an impact on the future pool of carers. The current carers of elderly parents, having experienced war and the Great Depression, were brought up to think of others rather than themselves. However, their children, the 'baby boomers', grew up in a relatively prosperous era at a time when choice (especially for women) was becoming a way of life. As a result, baby boomers on the whole do not expect to have to give of themselves in a manner such as that of their parents.49

A possible result of fatigue, frustration, and general carer stress is what has come to be known as "elder abuse". Abuse comes in many forms, specifically, "physical abuse (the infliction of pain or injury or physical coercion), psychological abuse (the infliction of mental anguish, such as humiliation and intimidation), economic/financial abuse (the illegal or improper use of an older person's property or finances, such as forcing someone to change their will), neglect (the failure to provide adequate food, shelter or care), and in some cases, even sexual abuse."50 The extent of elder abuse is not known, however, from overseas figures it is estimated that between 2% and 5% of elderly Australians could be in an abusive situation.

It is recognised that it is generally women who take up the responsibility of caring for elderly parents and parents-in-law, whether voluntarily or not.51, 52 This may have come about firstly because they are seen by society as carers in general, and secondly because men on the whole earn more than women. This means that in a husband and wife team it will be the wife's lower pay that is sacrificed to care. Pay, however, is not the only sacrifice. Others include careers and the sense of satisfaction and self-worth which paid employment provides; time for friendships, social and leisure activities; freedom; privacy; sleep; and disruption of the household and family life.52 There are also many men who look after loved ones, however, with men dying at an earlier age than women, women are more often left to care. At an age when women expect to be cared for after a life-time of caring for others, many are left widowed.

The government's current ageing policies encourage elderly people to remain at home, allowing residential care to only the most frail and disabled. Naturally, this places greater responsibility on carers. It would appear that this practice saves the government money, however, Professor Fred Ehrlich, in a survey undertaken for the Carers' Association of NSW in 1996, concluded that this may not be true.54 He found that caring had forced 31% of carers surveyed to either leave the paid workforce or work shorter hours As our population ages, the government will not only be required to spend more money on pensions and residential care, but also on support for carers. In a spouse relationship, and even in an elderly parent/child relationship, the carer may be almost as frail as the person for whom they are caring.

The situation of the declining number of carers has even, at this early stage, become a human resources issue. Indeed, a prominent American human resources consultant has said, "If childcare was the employee benefit of the 1980s … eldercare will be the benefit issue of the 1990s and beyond, because the cost of absenteeism, tardiness, phone calls during working hours, employee stress, and shortened hours are exacting their toll." Australia appears to be following the American trend of including carers' leave in enterprise agreements. In 1993 only 7 companies included the entitlement, however, this rose to 470 in 1996.55

RECOMMENDATIONS

• Governments should provide tax benefits to carers and additional resources to fund respite for carers.

…the faces of homelessness

• It is estimated that 250,000 people over the age of 60 are homeless or at risk of homelessness across Australia. War veterans are said to make up approximately 10% of these individuals.56
• Some homeless older people are drug and alcohol dependent and suffer from mental illness. In fact (75% of homeless people have at least one psychiatric illness). In some cases, these people have lived a transient lifestyle, often victims of abuse.57

Homeless aged people are often hidden. Older people who are considered homeless live in insecure housing such as single rooms and boarding houses, private rental or homeless hostels, hidden away from the public eye. Older people can be considered homeless even if, on the surface, they are living 'with a roof over their heads'. Poverty, lack of suitable housing and major life changes such as the death of a spouse, often lead to homelessness among the aged.

Homelessness is not only a problem among the young. The largest provider of homeless services in Australia, the Supported Accommodation Assistance Program (SAAP) has revealed that the elderly made up approximately 5% of their client base in 1996-97. This is a small percentage, however, it translates to around 25,000 people, a very high level of suffering.58 This figure is believed to be an under-estimate as many elderly do not use the SAAP service.

There are four tiers of homelessness among the aged:

1. Absolute homelessness - where people are literally without a place to call 'home'. These are the people seen in the parks and bus shelters, those who frequent soup kitchens and crisis accommodation at night;
2. First degree relative homelessness - where people are moving between various forms of temporary or medium-term shelters, boarding houses and friends' houses;
3. Second degree relative homelessness - where people are constrained to living permanently in single rooms in private boarding houses;
4. Third degree relative homelessness - where people are housed but are without conditions of 'home'. Some examples may be, living in private rental where the rent is so high they cannot afford to fund normal activities of daily living, or they may live in unsafe, abusive situations with friends or family.59

Homeless older people are often prematurely aged. Of the 102 clients receiving service from Wesley Mission's Assistance with Care and Housing for the Aged program, in the first half of 1999, 67% were aged between 50 and 69 years.

Some homeless older people have lived with extended families and become homeless due to the breakdown of family structures. In some cases, older people are often subjected to elder abuse and emotional neglect.

A major cause of homelessness in Australia is lack of suitable housing. "Housing stress caused by evictions or by housing which is unaffordable, inappropriate and/or insecure is often a primary or secondary contributor to homelessness".60 Older people generally rely on the aged pension or veterans pension as their main source of income. In fact, two-thirds of those who receive a pension have it as their sole source of income.61 This often makes private rental impossible to access.

Homeless older people are characterised as having alcohol abuse, physical and mental impairment, lack of social ties and economic deprivation.62 Their homelessness may represent a life-long pattern or it may be the result of a particular crisis situation. A study conducted by Kavanagh in 1997 examined the needs of homeless older people and why it was that many refused to access currently available aged care. In summary, it was found that they were looking for:

• Low cost accommodation;
• Security in terms of both tenure and support;
• Privacy, including control over personal space;
• Proximity to transport, parks, shops, clubs and pubs;
• Free and easy access to residence;
• Facilities for independent living;
• Flexibility in service provision;
• Facilitation of group affiliations and companionship;
• Tolerance of lifestyle preferences and behaviour;
• Meaningful activities;
• Advocacy in regard to health care and entitlements.63

In reality however, there is scant research available to fully understand the plight and needs of homeless older people.

An old couch was all that 65 year old Alfred had to lay his weary head on at the end of each day - until Wesley Mission came to his aid.

Before his plight was addressed, Alfred lived for five years in a small garage, with a rusty roof and no insulation. The garage, which Alfred called home, contained nothing except his couch and some broken pieces of furniture.

A regular visitor to the soup kitchens run by the Uniting Church's Parramatta Mission, Alfred spent much of his pension on medication and prescriptions. When he began looking ill and tired, it was workers at the Parramatta Mission who recognised his decline and brought the matter to the attention of staff from Wesley Mission's Home Care program.

In an immediate show of support, they brought the grateful pensioner some new bedding to replace his old couch and helped him relocate into a new home - complete with insulation. Home Care also ensured his new home was regularly maintained.

As a result, Alfred is now on less medication and can cook a range of thrifty meals for himself. And he can also look forward to a good night's rest.

RECOMMENDATIONS

• Appropriate affordable housing must be made more easily available to older people.
• Funding is required for restoration programs for homeless older people, similar to that provided for homeless youth. This could include a range of options: crisis centre, respite facilities and longer term accommodation.
• Need for medical services such as podiatry, GP visits, dietary advice that is based upon a non-threatening, non-judgmental community health model. (Need creative models of care).
• Make funding available for major research.

Edward Eagar Lodge:

in the inner city provides hostel accommodation for 76 single, homeless people from 18 to 80 plus. During 1998-99, on most days the Lodge accommodated 63 men and 13 women on a crisis and medium term basis. During the year over 1,524 people were turned away due to full occupancy. The day centre operates on weekdays, providing meals, clothing, shower and laundry facilities, counselling, television, lounge and recreational facilities. The centre attracts an additional 100 people each day who come from the streets, other hostels, private accommodation (rooming houses, bed-sitters) and from public housing estates in the area. The Lodge served nearly 30,000 meals during the year.

A heavy drinker for years, Jack is now a reformed man!.

Having lived at Wesley Mission's Edward Eagar Lodge for many years, the spritely 70-year-old was determined not to let a traumatic personal crisis tip him over the edge into a drinking oblivion.

Instead, he called on hostel staff to help him find stability and work his way through the minefield of addiction and dysfunctional.

He now accepts the need to rediscover the important things in life and is committed to adopting a lifestyle that does not revolve around alcohol.

Wesley Mission Community Housing:

provides a range of accommodation options for clients who have progressed from crisis hostel accommodation towards independent living. There are 17 properties across Sydney accommodating a total of 85 people. Over the past year, 134 clients were housed during the year with the average length of stay of 24 weeks.

Charlie Woodwood Lodge:

commenced in 1995, as a purpose-built aged care hostel for homeless, frail, aged men and women over the age of 60 years. This remarkable centre accommodates 20 people who live in five interlinked, yet separate, houses, and who are finding a time for some stability in their lives, after many years in crisis accommodation and living on the streets.

For most war veterans, ANZAC Day already has immense significance. Thanks to the support of Wesley Mission, for Jim Brown it has taken on even additional importance,

This year, April 25th marked Jim's return to the ANZAC fold. In previous years, the wheel-chair bound, former World War 2 spy had to sit frustratingly by while his peers marched and reminisced without him.

Fortunately, Jim's relatives heard about Wesley's HomeCare service and enlisted the support of staff to provide temporary care for him. Not only did they help him with his basic needs, such as showering and housework, but, most importantly, they provided him with company.

Having the service meant Jim could finally get out to the Anzac Day march and join his mates and former comrades in arms in the annual parade.

…the faces of health

• Australia's first census was taken in 1911. At that time, 4% of people were aged 65 years and over. By 1996, this figure had risen to 12% in NSW, and is expected to be 14% by 2011.64
• As an ageing population, Australia has one of the highest rates of life expectancy in the world, 75 years for men and 81 years for women.

Healthy ageing is about the absence of disease and ill health. Healthy ageing keeps all older people involved in society and enables their ongoing independence, participation and quality of life. Healthy ageing involves factors such as:

• community attitudes to ageing, and older peoples' attitudes to the ageing process,
• appropriate housing, safe neighbourhoods and communities,
• accessibility to transport, health and community services, housing and recreational facilities.

Contrary to the general belief that all older persons are high consumers of medical goods and services, it has been found that around 90% of Australians over the age of 60 are free of any significant disability that would require help with personal care or mobility.65 Further, of those over 70, 80% do not use any aged care services, and of those over 60 only 5% are affected by dementia, rising to only 20% of those over 80.66, 67 A 1993 report by the Australian Bureau of Statistics revealed that only 7% of older Australians were in residential care.68 These types of figures can help dispel the myth that all older persons are dependent.

Older people now have a great deal of information about mental and physical health issues and are generally more active than previous older age groups. They are also exposed to the idea that many afflictions which were previously thought to be unavoidable in old age can be either postponed, lessened or avoided altogether through mental and physical exercise and good nutrition. It has even been suggested that older people's health awareness exceeds that of young people.69 Studies have found that, "those elderly who are active and close to support structures self-report a high level of wellness".70 When a group of older persons involved in the Wesley Mission School for Seniors program were asked for their advice on healthy ageing they made the following comments:

• Keep your head and your feet active.
• Keep your sense of humour.
• Optimism - its no good looking on the dim side of everything is it?
• You've got to avoid loneliness. I see these little old ladies and I say to them 'you've got to get out of the house - come down to School for Seniors'. But they're too afraid to leave the house!
• Isolation is a life sentence.

A study in the United States has found that, "older adults [men and women 55 to 91 years] who engaged in at least 1¼ hours of strenuous exercise per week 'performed better on tests of reasoning, memory and reaction time than did the older adults who exercised little if at all. These results occurred regardless of the age, education level, and health status of the older adults."71 A similar study conducted in Australia has found that intensive weightlifting by those over 60 can lead to "less disturbed sleep, fewer bodily aches and pains, and a better quality of life."72 Other benefits are lower constipation and depression, higher self-esteem, improvements to balance and muscle tone, and the prevention or limiting of certain conditions such as arthritis, heart conditions and osteoporosis.73 Evidence has also been found that moderately vigorous exercise, even in those who have never exercised before, can reduce deaths from all causes by 23%. Exercise focusing on strength and balance in women over 80 has also helped reduce injuries from falls.74 Not only physical exercise but also mental activity, such as playing games like chess, backgammon and bridge or engaging in further study has been reported to delay the onset of dementia and related illnesses like Alzheimer's.

Ongoing sexual health contributes to the maintenance of physical health but is often problematic for older persons who find that the community, community care facilities and even their doctor, does not recognise this aspect of their life. Just as young people need to feel emotionally close to others, this need does not diminish with age.75

In fact many doctors have a lack of understanding that throughout our lives we face dynamic emotional, social and sexual lives. This is true of all age groups but when these issues are broached by an older person they are less likely than a younger person to be listened and responded to by a health care provider.76

Jean lived in a small apartment block by herself. Twice a week, her son would come to visit her and check if she needed anything done around the home.

One afternoon, one of her neighbours suggested to a Wesley Mission Home Care worker to check in on Jean, as she had not left her home for a couple of days. She had not left her apartment after her son had visited two days ago and she always walked to the shop for her paper each afternoon.

The worker visited her home and found Jean had bruises on her face and arms. She was immediately taken for treatment. Upon returning from the hospital, Jean revealed her son had inflicted the injuries after she asked him to fix the legs on her chair. Although it was a task he carried out regularly, this time he became angry and blamed her for breaking things and being incompetent.

Jean was supported by Wesley Mission following her trauma. She underwent counselling and, before moving into a complex with a neighbour, continued to use the Mission's services to maintain the house…and her favourite chair.

RECOMMENDATIONS

• Establish a separate Department for Older Australians. Aged care should not be controlled by the Health Department, because their scope does not include healthy, well, older persons.

…the faces of spirituality

Spirituality may be described as a particular world view, a way of looking at and responding to the world of experience and other people, which generates meaning and purpose for living. Every person has a spirituality, not just 'religious' people. While many people express their spirituality through organised religion of some form, there are even more who do not. For some people, their view of spirituality is the basis for their attitudes, values, beliefs and actions, but it is not necessarily expressed in a formal system of belief. Others may hold to a formal belief structure, either religious, psychological or political. Either way, the acquisition of a resilient belief system can be an important contributor to health, and a connection which sustains people through times of personal hardship, enabling them to accept and make sense of what is happening in their life. Spiritual development often grows out of struggle, throughout the various stages in a person's life.

Spiritual care should not be seen as simply maintaining a person's religious beliefs or introducing such beliefs to a person who has no religious affiliation. It involves helping people to become more aware of the underlying assumptions by which they live, so they may re-evaluate or adjust them in the light of their present circumstances.

While each person's spirituality is unique, it can still be shared. Spiritual well-being gives value to an individual, which in turn allows them to value other people.

Some researchers have found a connection between health in the elderly and religion. Studies which looked at religiosity and life satisfaction came to the same conclusion - those persons who attend church, experience greater life satisfaction and are better adjusted than those who do not. Some possible reasons for this are:

• religion provides a support network. The church community becomes a focal point of social integration and activity for the elderly, providing a sense of well-being;
• spirituality provides a source of strength and control in adversity and may foster a sense of optimism;

Problems with the research include religion often being conceived of simply as attendance at worship services. This may exclude people with mobility difficulties and does not account for individuals' level of private religion, such as praying outside of church.77 Although caution must be exercised in saying that religion definitely causes good health, the findings linking religion and health are strong and consistent.78

Wesley Mission's Pastoral Services

Our pastoral and chaplaincy services are provided to older persons within a variety of settings and our ministry varies to meet specific needs. Some older people develop a much stronger Christian faith and a deeper relationship with God, some start to question the meaning and purpose of their lives, some get quite angry because of the loss they feel in their situation, and doubt the existence of God altogether. Some church communities often forget about their older people, once they are less mobile, or suffering dementia or live with failing eyesight and hearing.

Wesley Mission's chaplaincy to older people affirms that the church is interested in people where they are, in whatever personal situation they are and regardless of whether society has pushed them to the margins. It is a vital ministry which confirms that God is a God who longs for a personal relationship with people, that He loves us regardless of what we do or achieve and in spite of our age and our ability to function effectively. In this way, the gospel message becomes real in everyday lives.

Our Home Care chaplain has found that as some people age they question religion and church practices, looking for a personal relationship with God. While some see their long, inactive days as a burden, with increasing uncertainty about what they once believed, others welcome the time for greater reflection and prayer. This time allows them to see their experiences and events in a different perspective, often re-prioritising issues in their life, so that more precise goal setting is a part of the spiritual journey.

Part of the ministry in Home Care has been the tape-recording of individual journeys, the memories which stand out for older people; the lessons they learned which they would like to pass on to future generations of their family and how they faced life's challenges. The tapes are given to the clients and also to their families. Spiritually, this reminiscing is important, helping the older person to see themselves as a person of worth, and to look on their life with perspective, seeing a beginning, a middle and an end.

Spirituality is about personal care, personal serenity and it is about having a faith that sustains a person through times of crisis and personal trauma. It can be about struggle, it can also be about deep peace. Spirituality and ageing has to do with the ability to cope with the process of dying, and 'dying well'. It is in our learning to let go, in accepting our diminishing independence, that we can give ourselves to trust completely to God, realising we are loved for who we are, thereby witnessing to the grace of God.

Within Wesley Mission, there are ten distinct congregations, meeting both within the Wesley Centre and also in Ashbury, Sylvania and Darlinghurst. In addition, seven worship services are held each Sunday within Mission centres and more than 25 weekday worship services and devotionals are held. This ministry is undertaken by our own Ministers and Chaplains who provide pastoral care to both clients and staff.

Each week Wesley Mission receives many phone calls and letters from older people as a direct response to our Sunday Night Live radio program (2GB 8pm to midnight) and Turn Round Australia, our television program screening on Channel 9, Sunday 6 am and Thursday morning.

Many people with health problems are no longer able to attend church and so eagerly look forward to the sermon by Rev Dr Gordon Moyes. One person wrote, 'I am 84 and a shut-in so appreciate your program very much.'

Others video Turn Round Australia to watch later in the day at a more suitable time and many gather a group together in their home or retirement village and use the program as a Bible study.

The subscription list for Word Talks (printed sermons) is growing weekly and again many older people find them extremely helpful for their own personal study or as the basis for talks to the groups they meet with regularly.

One gentleman has been an avid radio listener for years. He often rings to express thanks for a helpful sermon, to talk through some of the issues raised, to disagree with a comment or just to let us know he's still there enjoying the program. Many older people have come to rely on these Wesley Mission programs for most of their spiritual input and are very much a part of the mission's wider family. We enter their homes on a regular basis as friends and helpers who offer support and a channel for God's love.

RECOMMENDATIONS

• Increase the allowance for Community Care Packages (CCP) to address social and emotional needs of older persons - pastoral care, counselling, outings, occupational therapy.