Older people outcomes

Older people are independent for longer.

Older people are able to stay in their own homes if they wish.

How do adult social care services affect these outcomes?

Adult social care offers a range of different support which enables older adults to be safe and stay independent for longer and to meet the increasingly complex care and support needs presented within Scotlands ageing population.

The provision of services to support older people is a major priority for councils and accounts for around a quarter of total council spend. Social care services are undergoing fundamental reform as council services integrate with services from the National Health Service to create new Health and Social Care Partnerships (HSCPs), Community provision and an increasing role for social/micro enterprises could help partnerships manage demand around new referrals, improve choice and sustainability and strengthen the local market for provision.

Examples of services councils provide to meet the care and support needs of older people and promote independence include:

• Councils provide care assessments for older people to identify risks to an individual's independent living or health and wellbeing and ensure appropriate packages of care are available to meet the needs identified.  The care and support available ranges from advice and information about options and financial support available, care at home, residential or nursing care, and support for carers.

• Councils support those eligible for social care to exert more control and choice over the support they receive via Self Directed Support. This enables service users to choose services that suit and improve their lifestyle, control their support at the level that works best for them, and provides more choice and flexibility.

• Care at home services may be in the form of ongoing support to promote independent living at home, or may be arranged to support a safe return home after a stay in hospital (re-ablement).  It may involve the following support:
  • Personal and nursing care (personal hygiene; continence management; food and diet; immobility problems; counselling and support; simple medication/dressing treatments; personal assistance e.g. with dressing/getting in and out of bed; nursing care involves administering injections or managing pressure sores
  • general cleaning, heavy housework and gardening
  • shopping
  • meals on wheels or frozen meals delivery
  • collecting pensions and prescriptions
  • paying bills
  • laundry, like washing and ironing in your home or a laundrette
  • equipment and adaptions like telecare and home improvements to help older adults remain mobile, independent and safe in their own homes
  • Care and repair services
  • Day care centres that offer an opportunity to socialise in the community, do activities not available in the home and provide skills that promote independence
  • Energy assistance to provide help paying fuel bills or keeping an affordably warm home.
  • Transport advice on a range of options to help older adults get help with travel to continue to access activities and services they need
  • Access to Physiotherapy and Occupational therapy
  • Preventing falls at home
  • Supported or sheltered housing to support older people to live independently, in a smaller and easier-to-manage home with accessibility features, and with the reassurance of having someone to call on if there's an emergency.
  • Dementia services including intimate personal care as the ability for self-care declines, increasing levels of supervision, emotional support, decision-making, behaviour changes, coping with the risks to safety, personality changes and changes within the relationship.
  • Support for carers, including short breaks, also called respite care

• Residential care homes offer personal care when care needs cannot be met in an individual's own home, and as a result, they are at risk
• Nursing care homes offer similar facilities to residential care homes, with the additional support of qualified nurses who can assist if the individual requires nursing care on a frequent basis.

Adult social care indicators and descriptions

• SW1: Home care costs per hour for people aged 65 or over
• SW2: Direct Payments + Managed Personalised Budgets spend on adults 18+ as a percentage of total social work spend on adults 18+
• SW3: Percentage of people aged 65 or over with long-term care needs receiving personal care at home
• SW4b: Percentage of adults supported at home who agree that their services and support had an impact in improving or maintaining their quality of life
• SW4c: Percentage of adults supported at home who agree that they are supported to live as independently as possible
• SW4d: Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided
• SW4e: Percentage of carers who feel supported to continue in their caring role
• SW5: Residential costs per week per resident for people aged 65 or over
• SW6: Rate of readmission to hospital within 28 days per 1,000 discharges
• SW7: Proportion of care services graded 'good' (4) or better in Care Inspectorate inspections
• SW8: Number of days people spend in hospital when they are ready to be discharged, per 1,000 population (75+)

Older People Outcomes

Older people are independent for longer.

Older people are able to stay in their own homes if they wish.

How do corporate services affect these outcomes?

Corporate services directly and indirectly improve the lives of older people both through their role as an employer and through their role in providing services to the local community.

In the community:

• Efficiencies within Corporate Services can release money for other services such as culture & leisure services specifically aimed at older people, for example, exercise classes or improvements to local parks which make them more attractive/safer to use.
• Ensure back office processes are in place so that older people can access a variety of care options either via the council or by overseeing it themselves.
• Corporate Services lead on transformation within councils and support the re-design of services that better meet the needs of users, for example, online services for libraries.
• Corporate Services help services make the most of data and intelligence that they may hold or gather to improve individual services and increase efficiencies within services.
• Through well-designed procurement processes, corporate support enables the release of community benefits such as improvements to local parks/crossings, which could enable older people to stay independent for longer.
• Good practice procurement processes including monitoring, which ensures high quality care is delivered by external agencies.

As an employer, corporate services:

• Offer well-designed corporate HR policies and accompanying IT that enables staff to work flexibly and remotely, which can lead to better work-life balance and thus better care for aging relatives
• Support the recruitment of high quality staff in their home help teams and residential services
• Offer good training opportunities so that their staff can develop their practice.

Corporate services indicators and descriptions

• CORP 1: Support services as a % of total gross expenditure
• CORP 3b: Percentage of the highest paid 5% employees who are women
• CORP 3c: The gender pay gap (%)
• CORP 4: The cost per dwelling of collecting council tax
• CORP 6a: Sickness absence days per teacher
• CORP 6b: Sickness absence days per employee (non-teacher)
• CORP 7: Percentage of income due from council tax received by the end of the year
• CORP 8: Percentage of invoices sampled that were paid within 30 days

Older People Outcomes

Older people are independent for longer.

Older people are able to stay in their own homes if they wish.

How do culture and leisure services affect these outcomes?

Participation in culture and leisure has a demonstrably positive impact on the physical, mental and emotional wellbeing of older people as well as promoting social inclusion, independence and community cohesion. For example:

• Older adults who exercise exhibit better cognitive function which helps them to stay independent for longer.  They also have higher overall levels of functional health and lower risk of falling.  Regular exercise also reduces all-cause mortality and diseases.

• Leisure centres provide a range of targeted services for older people, including fall prevention schemes to minimise time in hospital due to falls and activities such as walking groups to prevent social isolation

• Libraries and Museums provide courses and groups tailored for the interests of older people to help promote inclusion, stimulate learning and improve cognitive function.  In addition, they offer technology literacy which helps older people develop their digital skills, stay in touch with relatives, and manage their finances and stay independent for longer

• Regular attendance at leisure centres, libraries and/or museums result in positive social connections

Culture & Leisure indicators and descriptions

• C&L1: Cost per attendance at sports facilities
• C&L2: Cost per library visit
• C&L3: Cost of museums per visit
• C&L4: Cost of parks & open spaces per 1,000 population
• C&L5a: Percentage of adults satisfied with libraries
• C&L5b: Percentage of adults satisfied with parks and open spaces
• C&L5c: Percentage of adults satisfied with museums and galleries
• C&L5d: Percentage of adults satisfied with leisure facilities

Older People Outcomes

Older people are independent for longer.

Older people are able to stay in their own homes if they wish.

How do environmental services affect these outcomes?

Older adults deserve to live in an environment that makes them feel safe, and enables them to stay independent and active for as long as possible. Environmental services contribute to these outcomes by for example;

• Providing street lighting and safe footway networks for older adults
• Improving the quality of roads and pathways to reduce falls and accidents for older adults
• Street cleansing and waste services which create clean and healthy local neighbourhood environments
• Consumer protection which helps protect citizens from scams and fraud
• Money and debt advice to help older people manage their money and maximise their income
• Ensuring a healthy and save living environment for residents, including food safety (licences); pollution; private water supplies; public health nuisances (noise; dirty houses/gardens; dog issues; fly tipping; litter; graffiti)

Environmental Services indicators and descriptions

• ENV1a: Net cost of waste collection per premise
• ENV2a: Net cost of waste disposal per premise
• ENV3a: Net cost of street cleaning per 1,000 population
• ENV3c: Street Cleanliness Score
• ENV4a: Cost of maintenance per kilometre of roads
• ENV4b: Percentage of A Class roads that should be considered for maintenance treatment
• ENV4c: Percentage of B Class roads that should be considered for maintenance treatment
• ENV4d: Percentage of C Class roads that should be considered for maintenance treatment
• ENV4b: Percentage of U Class roads that should be considered for maintenance treatment
• ENV5a: Cost of Trading Standards, Money Advice & Citizen Advice per 1,000 population
• ENV5b: Cost of environmental health per 1,000 population
• ENV6: Percentage of total household waste arising that is recycled
• ENV7a: Percentage of adults satisfied with refuse collection
• ENV7b: Percentage of adults satisfied with street cleaning

Older People Outcomes

Older people are independent for longer.

Older people are able to stay in their own homes if they wish.

How do housing services affect these outcomes?

Suitable housing offers older adults a safe environment where they can age and stay independent for longer. For example;

• Councils have a legal duty to assess and respond to housing need for their area, which against a backdrop of an ageing population has an increasing focus on meeting the needs of older people.  Councils also have specific legal requirements to tackle sub-standard housing and homelessness, distribute housing benefit, license houses of multiple occupancy and keep a register of all private landlords. Most councils (26 out of 32) also act as a social landlord, that is, they manage and maintain a stock of council homes for rent. They also provide supported and sheltered housing, and financial support and advice in relation to private housing
• Well-designed housing, including adaptions, modernisation and improvements, and effective repairs services promote independence and reduce falls and accidents.  This reduces emergency admissions to hospital and the reliance on residential care.
• Thermally efficient housing reduces the likelihood of cold related death or illness.  Older people who live in cold damp houses are at greater risk of arthritic symptoms & rheumatism which leads to prolonged immobility. Heart and circulatory diseases are the largest causes of mortality in adults over 65, and are particularly affected by winter temperatures.  For older people, the effects of cold housing are evident in terms of higher mortality risk, poorer physical health and mental health.  Older people are more vulnerable and less able to cope with winter
• Well-designed housing and neighbourhoods ensure access to local communities and community facilities, promoting higher levels of activity and social inclusion.
• Councils offer sheltered housing that gives support and security without taking away independence.  Most offer an alarm system linked to a 24-hour monitoring service and/or a warden within the complex.
• Housing services provide support and advice to council and private tenants, and to home owners, which is particularly important for older people who may have specific needs or who may be on lower incomes. They provide help and advice around appropriate housing options and money, debt & benefits advice to help maximise income.

Housing indicators and descriptions

• HSN1b: Gross rent arrears (all tenants) as at 31 March each year as a percentage of rent due for the reporting year
• HSN2: Percentage of rent due in the year that was lost due to voids
• HSN3: Percentage of council dwellings meeting Scottish Housing Standards
• HSN4b: Average number of days taken to complete non-emergency repairs
• HSN5: Percentage of council dwellings that are energy efficient

Older People Outcomes

Older people are independent for longer.

Older people are able to stay in their own homes if they wish.

How do economic development and planning services affect these outcomes?

Communities should be built and planned around securing positive outcomes and prolonged independence for older adults. Economic development, procurement and planning services contribute to this by for example;

• Supporting a thriving and sustainable local market for the provision of social care services for older people, including the development of community led approaches, and increasing use of social/micro enterprises
• Supporting the development of thriving local businesses that enable older adults to access the services they need in their local area
• Supporting the development of age friendly communities, with appropriate housing, access, transport, local services and amenities
• Strategic planning to deliver the quantity and type of housing (and associated services) required to meet demographic projections in relation to the growing numbers of over 65's, over 75's and over 85's.

Economic Development and Planning indicators and descriptions

• ECON1: Percentage of unemployed people assisted into work from council operated / funded employability programmes
• ECON2: Cost per planning application
• ECON3: Average time per business and industry planning application (weeks)
• ECON4: Percentage of procurement spent on local small / medium enterprises
• ECON5: No of business gateway start-ups per 10,000 population