Planning for retirement and later life Ref no.: OS138 Jill Manthorpe Kritika Samsi EVIDEM...

Planning for retirement and Planning for retirement and later lifelater life

Ref no.: OS138Ref no.: OS138

Jill ManthorpeJill ManthorpeKritika SamsiKritika Samsi

EVIDEMwww.evidem.org.uk

__________________________________________________________________________________________NIHR: Programme Grant for Applied Research

Hosted by Central and North West London NHS Foundation TrustIn collaboration with University College London, King’s College London, St. George’s, University of London, Kingston University, London

School of Economic and Political Sciences and The University of Hertfordshire

http://www.evidem.org.uk/

Study contextStudy context

o EviDEM: Evidence-based interventions in EviDEM: Evidence-based interventions in DementiaDementia

o Five year research programme funded by National Five year research programme funded by National Institute for Health ResearchInstitute for Health Research

o www.evidem.org.uk

o EviDEM-MCA nested within programme of EviDEM-MCA nested within programme of researchresearcho One sub-sample presented todayOne sub-sample presented today







BackgroundBackground

o Current legislation (i.e. Mental Capacity Act 2005) Current legislation (i.e. Mental Capacity Act 2005) encourages older people to plan in advance for later encourages older people to plan in advance for later lifelife

o Among other things, encourages appointment of proxy Among other things, encourages appointment of proxy decision-maker and pre-specifying preferences in case decision-maker and pre-specifying preferences in case of future loss of capacity to make one’s own decisionsof future loss of capacity to make one’s own decisionso Encourages Encourages advanceadvance planningplanning and decisions, and decisions,

including refusal of treatmentincluding refusal of treatmento Enables the granting of a Enables the granting of a Lasting Power of Lasting Power of

AttorneyAttorney, capable of making decisions on financial , capable of making decisions on financial and personal welfare issuesand personal welfare issues

o Studies show people value autonomy and retention of Studies show people value autonomy and retention of independence for as long as possibleindependence for as long as possible






Research QuestionsResearch Questions

o What are the planning patterns of older adults living in the community?

o How do they approach planning for later life?

o What issues do they take into consideration prior to setting out formal arrangements?

o What sources of support and information assist with this?



Methodology & RecruitmentMethodology & Recruitment

o Recruitment was through established community groups (social clubs, lunch clubs) and flyers put up at these venues

o Following introduction of the topic by moderator of group, information sheet handed, study explained and permission to set up an appointment sought

o Most visit were in people’s homes, some in day centres too

o Capacity assumed and consent sought o Snowballing technique also used



SampleSample

o Qualitative interviews with 37 participantso Mean age 71.4 years (range – 53 to 86 years)o Mostly female (30 people; 81%)o Ethnic group described

o White British: 21o Black Caribbean: 6o African origin: 3o Indian origin: 3o Guyanese: 2o Irish: 1o Scottish: 1



FindingsFindings

o Types of plans

o Individual inclination to plan

o Irrelevance of planning

o Advice and support with planning



Types of plansTypes of plans

o A will was common and been fairly straightforward to draw up

o Funeral plans also fairly common

o Absence of consideration of health and social care plans


Individual inclination to planIndividual inclination to plan

o Lifelong personality habito Religious beliefso Family reliance

““I don’t care if I am dying tomorrow, I said I don’t care if I am dying tomorrow, I said to people look, if it is my turn that God to people look, if it is my turn that God said I should come and join Him, I said I said I should come and join Him, I said I am prepared, what is the use of going to am prepared, what is the use of going to plan, what is the use of worrying?” – plan, what is the use of worrying?” – Female, age 65Female, age 65


Single people living alone

““This is one of the problems I have been dealing with to This is one of the problems I have been dealing with to do with Power of Attorney for personal health and do with Power of Attorney for personal health and welfare, well I don’t know what you feel about that, to me welfare, well I don’t know what you feel about that, to me it is just a load of rubbish. I have got all those it is just a load of rubbish. I have got all those documents from a solicitor, but it just does not work for documents from a solicitor, but it just does not work for people with no families. What the Government has to people with no families. What the Government has to realize is that as I get older my friends get older. No way realize is that as I get older my friends get older. No way can I ask a friend my age. Younger friends lead very can I ask a friend my age. Younger friends lead very busy lives and they have got family problems of their busy lives and they have got family problems of their own.” - Female, age 74 own.” - Female, age 74


Irrelevance of planningIrrelevance of planning

o Perceived and enacted support from family

o Perceived support from medical professionals

o Nothing to leave to future generations


Perceived and enactedsupport from family

“Yes”

Families would be left with difficult choice

““Yes, [I have] a Living Will, Yes, [I have] a Living Will, my doctor, my lawyer, the my doctor, my lawyer, the children know, the point of children know, the point of my doing that is, say I was my doing that is, say I was like a cabbage somewhere, like a cabbage somewhere, do we pull the plug? Well do we pull the plug? Well which one [of my children] which one [of my children] has to decide? I don’t want has to decide? I don’t want any of mine to do that, I any of mine to do that, I would hate to have to do it would hate to have to do it myself..” myself..”

– – Female, age 85Female, age 85

“No”

Family could be relied upon to make decisions

““Well I have got children, I Well I have got children, I have two daughters, two have two daughters, two sons, and they will look after sons, and they will look after me, well they are looking me, well they are looking after me at the moment you after me at the moment you know.”know.”Interviewer: What about if Interviewer: What about if you had to move, or if you you had to move, or if you needed treatment?needed treatment?““I don’t know, my children I don’t know, my children would decide, yes. Well, I would decide, yes. Well, I know my children don’t want know my children don’t want me to move out of my home me to move out of my home at all, they know what I want at all, they know what I want with treatment.” with treatment.”

– – Male, age 80Male, age 80

Perceived support from medical

professionals

“No”

Medical professionals could be trusted to ‘do the

right thing’

““I have a very good doctor, I have a very good doctor, there is a group of doctors, there is a group of doctors, and they are very good and and they are very good and the hospital is very good. Well the hospital is very good. Well my plan is – I have to work my plan is – I have to work with my doctor and consultant with my doctor and consultant – yeah that is the only plan, to – yeah that is the only plan, to work with my GP. And I mean work with my GP. And I mean if I need treatment, I wouldn’t if I need treatment, I wouldn’t want them to say don’t give want them to say don’t give her treatment or not because I her treatment or not because I am not one of those. I would am not one of those. I would leave it to them.”leave it to them.”

– – Female, age 78Female, age 78

“Yes”

If diagnosed with a debilitating illness

““If I made plans in the If I made plans in the future, well I could think of future, well I could think of an event immediately that an event immediately that would save me the trouble would save me the trouble – if my doctor tells me I – if my doctor tells me I have only six months to have only six months to live, something like that. Or, live, something like that. Or, I think if a doctor told me I think if a doctor told me that I had dementia, then that I had dementia, then yes I would be making yes I would be making plans in that case”plans in that case”

– – Male, age 70Male, age 70

Awareness & Understanding of MCAAwareness & Understanding of MCA

o Mixed levels of awareness of health and social careo ‘Common-sense understanding’ of its principles, rather than

legal definition

““Oh now, is it while you are still alive… choices about your house Oh now, is it while you are still alive… choices about your house and all that… in case you go into care and somebody has to pay and all that… in case you go into care and somebody has to pay the bills? Yes, that’s it” – Male, age 60the bills? Yes, that’s it” – Male, age 60

o Planning conceptualized entirely in terms of finances, not health or social careo ‘Living Wills’ ‘Advance Directive/Decisions’ inaccurately understood– Associated with euthanasia; aware that it was against the law in UK


ImplicationsImplications

o Level of planning is specific to each individualo Not part of everyone’s culture or personality

o Financial advice more widely available; health and social care advice more event-driven

o Reliance on family and other situational factors may result in disinclination to plan

o Plans usually made in best interest of surviving family

o Information might be targeted towards single people



DisclaimerDisclaimer

This study has received financial support from the National Institute for Health Research (NIHR) Programme Grants for Applied Research funding scheme. The views and opinions expressed therein do not necessarily reflect those of Central & North West London NHS Foundation Trust, the NHS, the NIHR or the Department of Health.

Thank you!Thank you!

For further information, please contact:Jill Manthorpe, [email protected] Samsi, [email protected]

www.evidem.org.uk

Planning for retirement and later life Ref no.: OS138 Jill Manthorpe Kritika Samsi EVIDEM...

Documents

Transcript of Planning for retirement and later life Ref no.: OS138 Jill Manthorpe Kritika Samsi EVIDEM...