Leave no-one behind: Action for an age-friendly recovery

Contents

Foreword

Margaret’s story

Social care and health services in Wales

The economy and older people

Stopping the abuse of older people

Strengthening our communities

Improving communication and inclusion

Next steps

References

‌Foreword

During the pandemic I have been talking and listening to older people, carers, community organisations, volunteers, care home workers and many more about their experiences. There are two things that stand out.

First, that many older people have been enduring extremely difficult circumstances which have taken their toll, and left some feeling worried about what the future holds and are not yet confident about leaving their homes and going out and about.

Second, that we have seen some of the best of who we are. I have heard so many inspiring stories of how people have been helping each other, of the way in which community organisations and many public bodies have responded quickly to what is needed and been creative in finding new ways to reach, connect and help.

In setting out what I believe needs to happen next, I have drawn extensively on evidence from 16 engagement sessions held with older people and those who work with and support them across Wales. We discussed what the challenges are, what has and hasn’t worked, and heard directly and movingly about older people’s stories and experiences of lockdown.

I am enormously grateful for the time that people took to share their experiences and ideas about what should happen next with me. A special thank you goes to ‘Margaret’ who shares her story in this report. It is clear from all the discussions that quick action is still needed in fundamental areas to ensure that older people who need to be are protected and supported, as well as to enable older people to contribute their skills, energy and ideas to how we all navigate the path ahead. There can be no successful recovery without engaging and enabling older people to play their part in it. We need to harness the experience and expertise of each and every generation and take the next steps together.

This dreadful pandemic has laid bare the systemic inequalities and discrimination that exist – especially the disproportionate impact that the pandemic has had on particular groups, such as people from BAME communities. It has also revealed the ageism that exists in societies and the devastating consequences that can flow from this.

In this report I set out short term actions that I believe need to be taken now and over the next three months, and longer-term actions which need to start as soon as is practicable but will take some time to be fully realised. I will continue to take action as the Older People’s Commissioner – in some cases supporting and contributing to work led by others; working together with other organisations to bring about change, and where necessary scrutinising and holding public bodies to account for the action or lack of action they are taking to protect older people’s rights. Throughout all this I will continue to engage with and listen to groups and individuals across Wales, so that what I do is informed by the current experiences of older people and their ideas and insights about what needs to change.

A time of uncertainty and challenge lies ahead, and we need to ensure that lessons are learnt from the experiences of the last few months. Older people’s rights need to be better protected, and where they have been removed, reinstated. The exclusion that many older people have experienced and felt must not be allowed to continue. Those that have suffered loss of loved ones need to be supported as they grieve, and those who have been kept apart from loved ones re-united. As plans are made across Government and public bodies to transition from this phase of the pandemic, the pledge must be to ‘leave no-one behind’.

Heléna Herklots CBE // Older People’s Commissioner for Wales

Margaret’s Story

‘Good things also happened against expectation’

I am writing this on my 88th birthday. I have shared lockdown with my husband who has dementia. I am his sole carer, have a neurodegenerative disease and use a walking aid, but between us we make one good one. Sometimes! Lockdown pulled the rug from under us overnight, taking away the secure network of support I have cobbled together to keep us safe in our own home.

It so happened that as lockdown approached, our wills had just been redrawn, with the appointment for signing in the diary. My solicitor rang and informed me that he was obliged to close the office, but would get me the paperwork if I could find suitable witnesses. While the rest of the country was queueing for toilet rolls, I asked my Chapel Secretary and the youngest deacon to step in, set up the hall and porch as a temporary office, turned a dinner wagon into a desk which could be rolled forward for 6ft distancing, and just hoped everything would come to time. Strangely it was a very solemn occasion, and our youngest deacon took the finished documents by hand back to the office. Next day I received a call to say everything was finished securely. Only then did either party express the fear of not having our affairs in order as we faced the increasing pandemic.

Such innovation set the scene as we two set about housekeeping on our own. Neither of us can use the Hoover safely, or hang clothes on the rotary line without falling over, so our working days got longer and longer. Lunch moved to 3pm (we found Escape to the Country), supper at 8pm, to fit in with medication.

Our lovely Girl Friday was happy to be employed as our shopper and gopher. She supplied washable carrier bags which I boil washed, drilled us on the latest safety measures, and was our only contact with the live world, except for the Well delivery drivers, (who we call our drug runners). I stopped watching any news programme featuring Coronavirus news, the distress my husband was suffering trying to understand the situation was too pitiful.

So we plodded on until the end of April when two awful things happened in my life. My husband began to lose his toenails for no apparent reason, with dramatic blood loss because of prolonged aspirin treatment. He has lost 7 to date, has bled anywhere and everywhere at each occurrence. Into bedding, on carpets, tiles, towels, through slippers, in the shower and all over my hands and clothing. I am fortunate in that I taught First Aid so that I could stop the bleeding given time and strength to apply strong pressure. But I am not qualified to diagnose the cause of the problem, nor spot infection, and It was then I saw the unseen side of the NHS, because it was only on nail 3 that any doctor was willing to call in a district nurse to support me, and even now at nail 7 no doctor will see him for a diagnosis. What saddens me is that none of the doctors I have spoken to has asked how I am coping, confirming my long-held opinion that Carers are just another tool to be used by the doctor until the patient’s problem resolves itself. The nurses are a joy and delight, however, and I bless each one. We all agree that salt solution is best for bloodstains, my expertise has been hard earned. I live with the dread of 3 more toes.

The other awful thing was that, despite having been in remission, my very dear friend of many years suddenly suffered a resurgence of lung cancer and over a period of 6 weeks faced the end of her life isolating, eventually with care support and end of life nurses, she spent her final four days in hospital. We, her circle of friends, will regret the manner of her death for the rest of our lives, and each one of us is finding it difficult to come to terms with the manner of her passing. Her family asked me to write part of the eulogy and choose a hymn for her funeral, which was so difficult and emotional for me. I couldn’t understand my reaction because I am such a tough old bird. The gathering to see her to her final rest took place in the pouring rain, with so many friends standing lining the route that her nieces were completely taken aback. On that day, Monday 13th July, I was taken in my wheelchair, my husband at my side, four houses along to the hearse. I came out of lockdown to see one of the saddest sights of my life to date, and realised my world had changed forever. Everyone looked older, their hair had grown, they were masked and gloved, weary and subdued. Unrecognisable. no zest left, all of their passion for life had ebbed away.

But good things also happened against expectation.

Firstly I have become far more connected through knuckling down with my iPad. When my niece ran out of bedtime stories for her grandsons, I wrote them a serial that went on for weeks, with their father as the superhero and occasional appearances of themselves. I had no idea I could write for children. That led to me writing them poems about pirates that they copied out for Key stage 2, and then illustrated. This treat was allowed after their set schoolwork. Wonderful feeling to be useful at my age.

I have been surprised at the number of younger people who have turned to me for emotional support, some I barely knew but were obviously deeply affected by such a sudden adverse course of events. The first question was always… ‘Was it like this in the war?’ My answer was always to tell them not to worry until their call up papers came, and the underlying anxieties came out slowly after a laugh. An odd way to form a friendship.

By the VE day celebrations, I had been too long away from my brother, who was 85 on 6th May. We are very close, having endured bad war experiences as children together. Losing our home, being buried under the rubble which came down on the air raid shelter, evacuation, going from one school to another had forged a link that has taken us through life. My husband also lost his home in the Swansea blitz, and we three needed to be together. So I planned a Victory tea, we put flags up in the garden, obeyed all the rules and reminisced about it all. The paste sandwiches, scones and trifle were as near as I could do, and went down surprisingly well. I put together wartime selections on YouTube and ended the party with Noel Coward singing ‘Dont let’s be beastly to the Germans’ in a poignant memory to the childhood we never had.

We had a whole week of celebration starting 31st May, my husband’s 88th birthday, followed on 4th June by our 65th wedding anniversary. I planned a birthday cake and he was really spoiled with cards, parcels, a balloon (which he loved). We did not think anyone would remember our anniversary, as there are only 3 of the guests still alive. But we suddenly were asked for a photograph because S4C wanted to include us in Prynhawn Da, and we found ourselves in the middle of a three-day event! Blizzards of cards, some beautifully home-made, arrived by post and by hand. We had so many flowers that at our age we might well have been in a Chapel of Rest! Cakes galore, some with freezing instructions by home bakers wanting to save me work, and to cap it all a lady, now in her seventies who had been a 7 year old in my Sunday School class and sat with her aunt in the congregation, turned up with a bouquet for THE BRIDE. Such a day of laughter and tears only came about because of lockdown. Then for days following phone calls from people who knew us and had been watching the programme.

We were so grateful and uplifted. When you don’t have your own children, it is emotionally touching to receive the kindness of unexpected remembrance.

I have found during lockdown that my membership of the chapel has been my mainstay, and the ingenuity shown by our Minister and the deacons in keeping us together through Zoom services and volunteers has brought out the best in individuals, and moulded us as a family.

Early on in lockdown I registered with Dr Mike Ward, Senior lecturer in Sociology at Swansea university as a diarist using the Mass Observation technique This involved writing a daily diary of the events in my life as they occurred under lockdown. I realised that the bulk of the evidence he collected would come from lower age groups and there could be a danger of the voice of my generation going unheard. To my surprise I was up and running in a couple of days.

I have found the experience cathartic. I have also liked the discipline of submitting my work for appreciation, as it has returned me to academic rigour and disciplined my mind. Dr Ward’s attitude throughout has respected the ME that I was before I became a carer. At last I am in the swim again and shall be the participant observer on the record and speaking for the age group with the weakest voice. Very good for me. BUT what an unfitting end of life it is proving to be to those of us who have had our lives topped and tailed by catastrophic national crises. I trust that we shall be remembered for being the last of the best.

‌Social care and health services in Wales

“We are all feeling that if we do get ill, as older people, whether we will get the treatment that we deserve, or if we would be seen as ‘dying soon’, and if that would result in poorer treatment.”

Older person at engagement event

The Covid-19 Pandemic has created significant challenges for our social care and health services, and those who work within them.

Whilst we have seen countless examples of inspiring dedication and commitment from staff and volunteers, the pandemic has also highlighted problems with the current social care and health system in Wales. It has demonstrated the need for urgent change, in particular the need for social care to be given parity with the National Health Service and to invest significantly more in services and support to enable healthy ageing.

It is vital that action is taken immediately and in the longer term to tackle these issues and ensure that older people can access the health and social care support that they need. Older people’s voices, must be heard and at the heart of decision-making as we move forward. We must ensure that a truly person-centred approach is taken to support older people, protect their rights and avoid scandalous actions, such as the blanket distribution of Do Not Attempt CPR notices by some GP surgeries, which made people feel that their lives were not valued. We must also ensure that the tragedy that unfolded in care homes, never happens again.

Immediate actions

Publish and implement an action plan for care homes ahead of the winter

Tragically, 694 of the 2503 deaths from Covid-19 in Wales occurred in care homes1. Many of these deaths could have been prevented had there been a better understanding of the risks faced by care home residents and the action required to ensure they had the protection and support they needed.

An action plan for care homes is therefore critical in this regard and the Welsh Government’s announcement of the development of a plan is welcome. It needs to ensure that lessons have been learnt from what has happened and that the right action is taken, at the right time, to ensure that older people living in care homes are safe, can access the wider health services and support they may need and are able to exercise their rights, all crucial to ensure they have the best possible quality of life. The experiences, views and voices of care home residents must be part of this, as set out in the Commissioner’s recently published Care Home Voices report.

Repeal sections of the Coronavirus Act that risk limiting older people’s rights

The Coronavirus Act, passed in March as an immediate reaction to the pandemic, gave local authorities the power to limit people’s rights to have their needs assessed and access the social care support they require. Whilst no local authority has formally enacted these measures to date, the Act put older people’s right to care and support at risk. At the same time the ability of older people to choose a care home to move to from hospital was removed. This ability to choose must also be reinstated.

At times of crisis, upholding people’s rights is particularly important. The Act should therefore be reviewed and these measures repealed at the earliest opportunity to ensure that older people’s rights are upheld should there be any future outbreaks.

Reinstate the social care support that has been suspended during the lockdown

Fears and concerns about Covid-19 entering the homes of those receiving domiciliary care meant that some older people and their families felt they had to stop their support packages and have been increasingly reliant on family and friends to provide some of this support, with the number of unpaid carers in Wales increasing by 196,000 during the pandemic2. For some older unpaid carers, and those caring for people living with dementia the combination of the closure of respite facilities such as day centres, combined with lockdown restrictions, has pushed them towards breaking point.

Given the vital role that domiciliary care and respite plays in supporting older people’s health, well-being and independence, and the impact on the health and well-being of unpaid carers of providing additional care, social care support and respite should be reinstated as a matter of urgency by local authorities. In cases where people’s needs may have changed, new assessments must be undertaken for new packages of care, including assessment and support for carers.

Preparing for the winter

All ‘non-urgent’ surgery and outpatient appointments were suspended in March and many older people, afraid of the risk of contracting Covid-19, have stayed away from GP surgeries and hospitals. This means that many older people throughout Wales will not have been able to access the healthcare services and support they need.

Immediate action is required to support those who have missed out on this support and to build older people’s confidence to access health services again, which is especially important as we approach the winter. It is positive that the eligibility criteria for the flu vaccine has been extended to everyone over 50, and this needs to be supported with a campaign to maximise take up, to protect individuals and reduce pressures on services.

Alongside this, the Welsh Government should provide additional financial support to local government and the NHS to facilitate effective early planning and preparation, and they should work closely with and support the third sector to ensure an integrated response to future outbreaks and winter pressures.

Establish a rehabilitation programme for older people

The restrictions put in place as a result of the pandemic have meant that many older people, particularly those who have been shielding or self-isolating, have been unable to participate in activities that support their health and well-being or fully engage with their communities.

Older people have told the Commissioner about the impact of isolation and of staying indoors, experiencing a loss of confidence and being fearful about going back out again. Many older people have experienced physical and mental health deterioration as a result, with consequences for their ability to live independently and for their future health and well-being.

The Welsh Government should work with health boards and other key partners to establish and deliver a rehabilitation programme for older people who have been affected physically and/or mentally by Covid-19 to ensure that the right support is available to improve people’s health and well-being and prevent any further decline.

Longer-term Actions

• Establish a major healthy ageing programme focused on supporting older people and helping people to age well.
• Expedite work to reform social care funding and ensure long-term investment in the social care sector, which properly rewards social care staff, increases the availability of services and drives up quality.
• Improve engagement with older people in the development of services, including those living in care homes, and embed and spread good practice.
• Appoint a Chief Social Care Officer in the Welsh Government to act as the head of the profession in Wales and to ensure that social care expertise is at the heart of decision making, on a par with the NHS.
• Conduct a review of spending on social care to determine whether the allocation of social care resources is age discriminatory, and take action on the findings.

‌The economy and older people

“I believe that there will be a growth in unemployment in the older age and we need to ensure that services are in a position to help.”

Community stakeholder at engagement event

The Covid-19 pandemic has brought with it a great deal of economic uncertainty and has exacerbated the financial insecurities faced by many older people in Wales.

The pandemic will have been an especially difficult time for the 1 in 5 older people in Wales living in relative income poverty3 – a number that has been rising in recent years – who will have felt the greatest impact of increased living costs, changes to usual shopping habits and a lack of access to cash.

This period has also caused great uncertainty for older people who are still in work, with research showing that around a third of older workers have seen their income fall during the pandemic.4 In addition, many older workers fear that their jobs will be at risk as the economic consequences of Covid-19 become clearer over the coming months. For women in particular, who have seen their state pension age rise, there is a risk of unemployment and consequent poverty in retirement.

People aged 65+ contribute over £2.19bn to the Welsh economy every year, while those over 50 make up over a third of the workforce in Wales.5,6 Older people must not be excluded as Wales rebuilds its economy, and it is vital that they are recognised as being key participants in Wales’ economic recovery from the pandemic.

Immediate Actions

Invest in a targeted campaign and assistance to increase the take-up of Pension Credit

Every year, thousands of older people in Wales who are struggling financially miss out on millions of pounds of entitlements and financial support, with unclaimed Pension Credit alone totalling as much as £214 million during 2018/197. In addition to the positive difference this form of financial support can make to older people’s incomes – Pension Credit is worth an average of £58 per week to those who are eligible – it also unlocks a range of other entitlements, such as council tax discounts, free dental care and help with housing costs, which provide further financial support for older people.

Increasing the take up of Pension Credit and encouraging older people who are eligible to claim what they are entitled to is essential, something that could be achieved through a targeted national campaign delivered by the Welsh Government, combined with assistance provided to older people at a local level. This will not only help to bring older people out of poverty it will also benefit local economies through increasing what is spent locally by older people.

Establish an emergency grant fund to make improvements to older people’s home environments to support those most at risk of fuel poverty

The increased living costs caused by Covid-19 are likely to be further exacerbated should Wales experience a second wave during the winter, particularly for the 67,000 older households already living in fuel poverty.8 For older people in fuel poverty increased fuel costs during a further period of lockdown, self-isolation or shielding could force them to choose between keeping themselves warm or keeping themselves fed.

Capital funding should therefore be made available immediately by the Welsh Government to deliver a programme of home improvements for older people living in energy inefficient homes throughout Wales, who are amongst those most at risk of being trapped in fuel poverty.

Establish a dedicated programme to support older workers to remain in work or retrain if they are facing redundancy

We know from previous recessions that the greatest financial impact is felt by those at the younger and older ends of the workforce. Following the financial crash of 2008, for example, unemployment amongst older workers almost doubled, and fell more slowly compared to other age groups.9 Older workers are also more likely to be made redundant, and often find it more difficult to find work following a job loss or redundancy, particularly as the support available

to help them find work is often not suitable to meet their specific needs.10 Without the right employment support for older people, there is a risk that an entire generation of people in their 50s and 60s, who may never find another job before reaching State Pension Age, will be written off, something that will result in a significant loss of knowledge and experience.

It will be crucial to invest in older workers and ensure they can remain part of the workforce as Wales seeks to rebuild its economy and increase its productivity following the pandemic. A dedicated support programme should be developed by the Welsh Government to ensure that older people can easily access tailored support that meets their needs and have opportunities to retrain and learn new skills, either when facing redundancy or when looking for work. This kind of investment could bring significant returns: increasing the level of employment amongst 50-64 year olds (currently 68.7%; the third lowest of all the nations and regions of the UK) to match that of other age groups (currently around 75%) could be worth nearly £4bn a year to the Welsh economy.11

Promote the toolkit due to be published by the Wales TUC on tackling age discrimination in the workplace

Many older people face ageism and age discrimination in the workplace, and myths and stereotypes that portray older workers as being less productive are still common12. These issues, together with wider issues that may particularly affect older people, such as a lack of flexible or carer-friendly working practices (the ages at which you are most likely to be caring for a loved one is 50-64), can prevent older people from remaining in or securing employment.

Older workers have also been particularly affected by the changes to working practices caused by the pandemic, with research indicating that they are least likely to be working from home during the pandemic and are least likely to expect to work from home in the future.13

With working practices likely to change significantly following the pandemic, action to tackle ageism and discrimination, as well as action to ensure older workers can combine work with caring responsibilities, is needed to ensure that older people are not excluded from the workforce as we move forward. A toolkit due to be published the Wales TUC in the next few weeks, developed with support from the Commissioner and other key stakeholders, is a particularly useful resource for organisations that wish to take action to end ageism and age discrimination, and should be promoted as widely as possible.

Longer-term Actions

• Invest in an ongoing programme at national and local level to increase the take up of financial entitlements for older people with targeted interventions and support at a local level.
• Review the support available to older workers and how interventions could support older people to remain in, or regain, employment, or take up self-employment.
• Establish the right to lifelong learning, to enable people of all ages to access education and training opportunities.
• Commit to eliminating age discrimination in the workplace and support employers to adopt flexible working and carer-friendly policies.
• Extend current programmes to improve the energy efficiency of all homes in Wales to tackle fuel poverty.

‌Stopping the abuse of older people

“Where these individuals can go is an issue as refuges may not be the best environment for people with complex needs. There is a lot of training that needs to be done for professionals as understanding of older people experiencing domestic abuse is lacking.”

Community stakeholder at engagement event

Lockdown will have been a particularly difficult time for the thousands of older people in Wales who experience abuse – a single or repeated act, or lack of appropriate action, which causes harm and distress, such as physical abuse, domestic violence, sexual abuse, psychological or emotional abuse, financial or material abuse, neglect and coercive control.

Many organisations working throughout Wales to protect and safeguard older people have raised concerns that the prevalence of abuse will have increased during the period of lockdown, as older people have been spending more time confined to their homes and have seen significant changes to their normal routines.

Criminals are also using the current situation to exploit and defraud people, often targeting older people specifically due to their perceived vulnerability, and we have seen a number of Covid-19 related crimes and scams, such as impersonating government officials to steal money or personal data, or convince individuals to purchase goods or services that don’t exist.

At the beginning of the pandemic, the Commissioner brought together a group of over 30 organisations and individuals who formed an Action Group working in partnership to raise awareness of the issues faced by older people experiencing or at risk of abuse, and ensure they can access the help and support they need. The group has produced and is taking forward a strategy focused on ending the abuse of older people, and has identified action needed in a number of areas to protect and safeguard older people.

Immediate Actions

Raise awareness of the risk of abuse and where to go for support through the media and via public bodies and networks

Despite some progress in recent years, there is still relatively little public understanding of the abuse faced by older people, and the particular issues and barriers that may prevent older people who are experiencing or at risk of abuse from accessing help and support. These issues are compounded by significant gaps in data and evidence relating to older people’s experiences of abuse, which can lead to assumptions that older people are not affected and, in turn, means that the policy, resources, and actions needed to stop the abuse of older people are not put in place.

In order to tackle the abuse of older people effectively, it is essential that practitioners and policy-makers, as well as the wider public, understand its scale and impact, and the ways they can support older people to access the help they need, which could potentially be life-saving.

Further action needs to be taken, building on the work of the Abuse Action Group and recent Welsh Government communications, to raise awareness of the abuse of older people, potentially through a large-scale national campaign, delivered in partnership with public bodies throughout Wales, to raise awareness of the risk of abuse and highlight and promote the support available for older people, in particular services that are tailored to meet their specific needs.

Roll out and promote training to professionals and key workers so they can identify abuse and know what help and support is available

Under the lockdown rules, many of the usual opportunities to identify abuse – through contact with professionals at routine appointments, for example – have been lost, meaning that older people could be missing out on vital help and support. Restricted contact with family, friends and the wider community has also made it more difficult to spot changes in behaviour or routines that could indicate an older person is experiencing or at risk of abuse.

It is crucial that professionals and key workers are able to recognise potential signs of abuse, in order to maximise opportunities to connect older people with the help and support they may need. A short training course focused on older people, specifically the ways that older people may experience abuse, the barriers that may prevent them seeking help, and sources of help available would be an effective ways to grow knowledge and understanding of these issues.

For example, Aberystwyth University’s Dewis Choice project has developed a training course of this kind, which has already been completed by over 300 professionals to date. Support should therefore be provided by public bodies to roll out and promote this and other training courses more widely to professionals and key workers throughout Wales.

Assess the availability of suitable accommodation and support for older people needing to leave abusive relationships and put in place what is needed

The pandemic has exposed the many challenges that face older people if they are attempting to escape an abusive domestic relationship, something that is often made more difficult due to the lack of suitable refuge and accommodation available that would meet their needs. This is a particular issue for older people who require accessible accommodation, and those in receipt of care and support. As lockdown eases, we may see an increase in the number of the victims of domestic violence seeking to leave their relationships and it is vital that they have somewhere they can go to live in safety and get the support they need.

In order to ensure that suitable accommodation is in place for older people who need to leave abusive relationships, a rapid assessment should be undertaken by the Welsh Government to determine what services and facilities are currently available, what the gaps are, and action taken to ensure that the right support is put in place for older people.

Longer-term Actions

• The Abuse Action Group is taking forward a strategy to tackle the abuse of older people, including: Mapping the wider services and support available for older people who are experiencing or at risk of abuse; identifying gaps and good practice; use this as a basis for putting in place the services and support required.
• Ensuring that data and evidence on abuse includes older people including by removing the age limit of 74 on England and Wales crime data.
• Enabling and empowering older people to feel confident to share their experiences of abuse encouraging others to speak out.
• The Welsh Government should draw upon on the work of the action group to develop and publish an all-Wales action plan to stop the abuse of older people and ensure appropriate resources are available to support its delivery.‌

Strengthening our communities

“A lot of people are heavily reliant on their neighbours, friends and family to support them.”

Older person at engagement event

The Covid-19 pandemic has shown some of the best of our communities throughout Wales as people have come together to support one another. The efforts of volunteers, community groups, charities, local businesses and local government has been vital; their work together has delivered a huge amount of help and support to older people and those who may be vulnerable, and ensured that they could access essential supplies and information.

We need to build upon the positive action we have seen during the past few months and continue to harness the community spirit that has delivered so much for so many in such a short space of time.

But until older people are able to fully participate in our communities again, a key part of our communities will be missing and we must ensure that older people are not excluded as the rest of the population returns to a semblance of normality.

This means reopening the community venues, libraries and day centres that older people value so much (with appropriate safety measures in place). It means re-engaging older volunteers who had to give up their roles to self-isolate and shield, harnessing their knowledge, experience and dedication as we move forward. And it means making sure that the physical environments within our communities support older people to re-engage, confident they can maintain social distancing while accessing the services and facilities they need.

As we begin to move forward, it is more important than ever for Wales to demonstrate its commitment to making our communities age-friendly, and take the action required that will enable everybody to age well.

Immediate Actions

Ensure older people can access essential supplies, including establishing a register of people that may require support to access food and cash during emergencies

Access to food and cash has been particularly challenging for many older people during the pandemic, and during its early stages many older people struggled to access community-based support or were left without access to priority delivery slots (many supermarkets implemented prioritisation policies based on data about England, without sufficient provisions to enable older people in Wales to access those slots).

It is crucial that older people do not face similar issues in the future, particularly if a second wave occurs in the winter, and that support to access supplies is available should they need it. This kind of support will be particularly important for older people whose circumstances make them particularly vulnerable, as well as those who have been shielding, as the provision of food parcels is due to end on 16 August.

Using the lessons learnt during the past few months, and building upon the work already undertaken, the Welsh Government should work with supermarkets to increase the number of priority delivery slots for older people to ensure they are able to access them should they be needed. Alongside this, a register of people that may require support to access supplies should be established, which would allow targeted support to be delivered quickly and efficiently should this be needed.

Significantly increase the provision of seating/benches to encourage and enable older people to walk to local amenities and access local high streets and businesses and use local parks and green spaces

Getting out and about and engaging with the wider community plays a vital role in supporting older people’s health and well-being and in preventing loneliness and isolation. The welcome push towards ‘active travel’ needs to include measures to enable people who may have restricted mobility or not be able to walk long distances to benefit.

Older people have highlighted the need to significantly increase the availability of public seating, something that can be done quickly and at relatively low cost, and will enable more people to be able to walk to services and facilities, get back to the high street, and enjoy green spaces.

Local authorities to work with older people to undertake age-friendly audits of their local communities and continue to work towards becoming recognised as age-friendly communities

Age-friendly communities are places that enable people of all ages to be able to live healthy and active lives. Prior to the pandemic many local authorities had started working with the Commissioner to examine how to make their communities age-friendly and become part of the World Health Organisation age-friendly communities network. This work is more important than ever to ensure that older people do not get left behind as communities adjust in response to the pandemic.

Improving the physical environment to make it more age-friendly will not only benefit older people, but will benefit people of all ages by removing the barriers that prevent them from getting out and about. Investment is needed to ensure that there are sufficient and safe public toilets available and that areas such as pavements and shops provide enough space to allow for social distancing.

Being age-friendly is not just about the physical environment, it is about enabling the participation and inclusion of older people. A positive step forward would be for older people, together with other generations, to work with local authorities to audit their communities and together take actions to make them more age-friendly.

Provide financial support for community groups and local community venues to re-open safely

Social and support groups play a key role in the lives of many older people throughout Wales, supporting them to get out and about, spend time with their friends and peers, develop new friendships, learn new things, and access information, advice and support. Many older people also play a more active role in these groups, taking on a wide variety of roles as volunteers.

However, many of these groups have been suspended as the venues in which they are hosted have been closed throughout the Covid-19 pandemic, and will need to overcome a number of challenges to re-open.

Given the crucial role that these groups play in supporting older people’s health and well-being, and preventing issues such as loneliness and isolation, financial support should be provided by the Welsh Government to help community groups and community venues to re-open with measures in place to ensure social distancing and hygiene measures can be maintained.

Longer-term Actions

• Invest in intergenerational approaches, such as mentoring between older and younger generations, bringing generations together to solve common problems, and building connections between schools, colleges and universities and older people’s groups to strengthen the sense of community and solidarity.
• Launch a programme to encourage physical activity amongst older people, including investment in exercise equipment in parks.
• Legislate to place a duty on local authorities to ensure an adequate provision of toilets for public use.
• Ensure that the new Wales Transport Strategy reflects the circumstances of the diversity of the older population and results in improved and integrated transport provision for older people.‌

Improving communication and inclusion

“So many feel disconnected, mainly because so many don’t use social media. As many times as my Group have been shown even basic use of tablets, phones, they don’t feel confident to use them when alone. This of course makes many feel discriminated against as they don’t get vital information.”

Older person at engagement event

One of the most important elements of an effective response to a pandemic is ensuring that information and advice is communicated clearly to the public and that a sense of trust is built between those leading the response and those at risk. However, many older people have told the Commissioner that they have struggled to access the information they need during the past few months, and have been left feeling confused and anxious about what they needed to do to keep themselves safe and well.

This has been a particular issue for older people who are not online, and the pandemic has highlighted a stark digital divide in Wales, as well as the significant impact that digital exclusion can have on many aspects of people’s lives. This is particularly concerning given that many public bodies have been forced by the pandemic to accelerate the introduction of digital services for the public. Whilst these kinds of services can provide better experiences for those who can access them – reducing the need to travel to an appointment, for example – they risk excluding a significant number of older people. It is therefore crucial that non-digital options remain available and accessible. Alongside this, the financial gains resulting from the reduced costs

of delivering digital services should be invested into maximising digital inclusion across our communities by supporting older people to get online.

Immediate Actions

Public bodies should take action to ensure that public health messaging is communicated more effectively to older people

Older people have told the Commissioner that the messaging relating to Covid-19, has at times been unclear and confusing, particularly during the early stages when stricter advice was given for the over-70s and reports emerged that everyone in this age range may be told to stay at home. This confusion was further exacerbated when shielding arrangements were put in place for those most clinically vulnerable to Covid-19, as some older people thought they should be following that advice and remaining indoors entirely.

Accessing key information and public health messages was a particular issue for older people who are not online, and those whose first language is not English or Welsh also faced difficulties in finding the advice and guidance they needed.

Effective communication with older people is crucial, and will be particularly important if there is a need for further lockdown measures, self-isolation or shielding should a second wave occur. Public bodies should therefore take action to ensure that public health messages and information are communicated to older people in a clearer, more accessible way, and will reach those who are not online or use other languages.

Undertake community-level audits of vulnerable older people who have been digitally excluded during the pandemic and provide user-friendly devices with access to the internet

For many older people, the anxiety and isolation they have experienced during the Covid-19 pandemic has been compounded by not being online. Without access to the internet, it can be difficult to find information, get answers to questions, and verify what is being reported. Internet access also brings wider benefits that have been particularly important for many older people during the pandemic, such as helping them to stay connected with family and friends and access useful online services including the delivery of food or medication.

Whilst not being online is a choice for some older people, others are prevented from getting connected due to a number of barriers, including a lack of digital skills or a lack of confidence in using digital technology; financial barriers, such as the cost of connectivity and devices; and a lack of access to places that offer free internet access, such as libraries, something that has not been possible at all during lockdown. A lack of digital infrastructure can also be a barrier to older people getting online, which can be a particular issue in rural areas.

This period has shown that urgent and radical action is needed to increase digital inclusion in Wales. Digital access now needs to be considered as a right and as an essential utility in the same way we consider the need for gas and electricity. Action must therefore be taken by the Welsh Government to remove the barriers that prevent older people from getting online.

The starting point for this should be identifying potentially vulnerable older people who have been digitally excluded during the pandemic and providing them with tailored support to get them online, including providing user-friendly devices with access to the internet where required.

Longer-term Actions

• Establish a right to digital connectivity – viewing digital infrastructure as an essential service that the whole population needs affordable access to
• Introduce a social tariff for internet access and work towards the provision of free universal access to the internet
• Place a duty on public bodies in Wales to demonstrate how they will engage with and serve citizens that are not online
• Health boards and local authorities should establish outreach programmes to build digital confidence for older people to access digital public services, building upon the work being delivered by Digital Communities Wales‌

Next steps

“A society that does not value its older people denies its roots and endangers its future.”

Nelson Mandela

As we move forward in the coming months, it is crucial that the actions outlined in this report are delivered to ensure that older people are supported as they rebuild their health, well-being and confidence, have their rights reinstated and protected, and are engaged as participants in the recovery from the health and economic crisis that we are all living through.

Many of the actions outlined above will be for the Welsh Government to consider and it is vital that the forthcoming Strategy for an Ageing Society takes account of the impact of the pandemic on older people and the implications for our ageing society. The strategy must recognise both the need for and opportunity to take radical action to enable the full participation of all older people in our local communities and wider society based on rights that are understood and upheld. I will be working with the Welsh Government to ensure that the action I have called for is taken forward to ensure that older people can participate and get the support they need as Wales begins its recovery from Covid-19.

Local authorities, health boards and other public bodies also have a key role in delivering these actions as part of the recovery and I will continue to work constructively with them as they carry out this work.

Strengthening intergenerational understanding and solidarity, demonstrated in so many of our communities over the last few months, must be the cornerstone of our approach. Together we have the opportunity to demonstrate that we value all generations, and that all generations are part of our future. Together we can ensure that no-one is left behind.

‌References

1. Office for National Statistics. (2020). Deaths registered weekly in England and Wales, provisional. 04 August 2020. Accessed on 4 August 2020. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/ birthsdeathsandmarriages/deaths/datasets/weeklyprovisionalfiguresondeathsregisteredinenglandandwales

2. Carers Wales. (2020) Carers Week 2020 Research Report: The rise in the number of unpaid carers during the coronavirus (COVID-19) outbreak. Accessed on 4 August 2020. Available at: https://www.carersuk.org/images/ CarersWeek2020/CW_2020_Research_Report_WEB.pdf

3. Welsh Government. (2020). Relative income poverty: April 2018 to March 2019. Accessed on 4 August 2020. Available at: https://gov.wales/relative-income-poverty-april-2018-march-2019

4. Resolution Foundation. (2020.) Younger workers in the coronavirus crisis. 19 May 2020. Accessed on 4 August 2020. Available at: https://www.resolutionfoundation.org/app/uploads/2020/05/Young-workers-in-the-coronavirus- crisis.pdf

5. Edwards, R. T et al. (2018) Living well for longer: The economic argument for investing in the health and wellbeing of older people in Wales. Accessed on 4 August 2020. Available at: https://cheme.bangor.ac.uk/ documents/livingwell2018.pdf

6. Welsh Government. (2020). Coronavirus and employment: analysis of protected characteristics. Accessed on 4 August 2020. Available at: https://gov.wales/coronavirus-and-employment-analysis-protected-characteristics

7. Independent Age. (2019). Credit where it’s due: Ending the £3.5 billion Pension Credit scandal. Accessed on 4 August 2020. Available at: https://www.independentage.org/pension-credit-a-closer-look

8. Welsh Government. (2019) Fuel poverty estimates for Wales, 2018: revised. Accessed on 4 August 2020. Available at: https://gov.wales/sites/default/files/statistics-and-research/2019-12/fuel-poverty-estimates-wales-2018. pdf

9. Wilson, T et al. (2020). Getting back to work: Dealing with the labour market impacts of the Covid-19 recession. Institute for Employment Studies. Accessed on 4 August 2020. Available at: https://www.employment-studies. co.uk/system/files/resources/files/541.1.pdf

10. Ibid

11. Edwards, R. T et al. (2018) Living well for longer: The economic argument for investing in the health and wellbeing of older people in Wales. Accessed on 4 August 2020. Available at: https://cheme.bangor.ac.uk/ documents/livingwell2018.pdf Swedish rate of 75.5%

12. Resolution Foundation. (2020.) Younger workers in the coronavirus crisis. 19 May 2020. Accessed on 4 August 2020. Available at: https://www.resolutionfoundation.org/app/uploads/2020/05/Young-workers-in-the-coronavirus-crisis.pdf