A Portrait of Jews in London and the South-East: a community study:
10/ Care for older people and the infirm

Introduction

The Jewish population is ageing. Not only are people living longer, but older people have also become an increasingly large proportion of the population. As such, a declining number of younger people will need to support an increasing number of those older (and, indeed, younger) people who will require care services in the future. Add to this an increase in the proportion of secular Jews--who, note, are less likely to give to charities and to volunteer and, moreover, who are under-represented in the sample--and we have an inkling of the task facing the Jewish voluntary sector over the next two decades.

Older people are generally more isolated than the population at large, and this is true in the United Kingdom, even though most continue to live healthy, active lives. There is a higher proportion of single-member households among those aged 75 and over and they have higher levels of physical infirmities that restrict their movements. In addition, they have less freedom of movement than the rest of the population. Almost 1 in 3 does not have access to a private automobile and, although more than two-thirds of them can get about with relative ease, over 30 per cent noted that they had degrees of difficulty using public transport. Moreover, as they age, they are more likely to become dependent on others, needing help with activities ranging from going shopping to bathing to getting in and out of bed.³³

Illness and disability among household members

As reported in Chapter 4, 20 per cent of respondents had an illness or disability that limited their activities in some way and, for those aged 75 and over, the figure was 50 per cent. In addition, 15 per cent of respondents indicated that someone else in their household had such an illness or disability. When the answers to these two questions are combined, a total of 28 per cent of households emerged as containing at least one person with a

limiting illness or disability. This figure varied across the different London areas: Redbridge had the highest incidence of households with illness/disability (40 per cent) while South Hertfordshire had the lowest (18 per cent), as Table 10.1 shows. These variations reflect the age-profile of the different areas.


Table 10.1: Households with at least one ill or disabled person, by London area

Annual household income also correlates with the proportion of households with an illness or disability. Those households with a lower income had a much higher incidence of illness or disability than households with a higher income. For example, 46 per cent of households with an income of under £20,000 contained at least one person with a limiting illness or disability. The equivalent figure for households earning over £200,000 was 11 per cent.

Unsurprisingly, the age-profile of the household was also a factor, with older households reporting higher levels of illness and disability. In households without anybody over 65, the proportion containing at least one person with an illness or disability was 16 per cent. This rose to 38 per cent among households in which the oldest person was aged over 65 but under 75 years. The highest figure represented households containing someone 75 and over: 59 per cent of these households reported that illness or disability limited the activities of at least one household member.

Care for household members, relatives and friends

One in 10 respondents (10 per cent) were providing care for an older or disabled relative or friend. This was true for slightly more women than men (12 per cent versus 9 per cent). Middle-aged respondents were most likely to be providing this type of care (14 per cent of those aged 45-54 and 15 per cent of those aged 55-64) while the figure was lowest among those aged 18-34 (3 per cent).

Seven per cent of households contained someone who was receiving care at home because of old age, illness or other infirmity. Differences according to area followed the pattern found for illness and disability: South Hertfordshire was lowest at 3 per cent while Redbridge was highest at 11 per cent. Similarly there were differences according to annual household income (12 per cent of those in the under £20,000 group had a household member receiving care at home compared with 6 per cent of those in the over-£200,000 group). Among those households in which someone was receiving care at home, that person was usually a parent or parent-in-law (36 per cent), the respondent (29 per cent) or his or her spouse or partner (26 per cent).

Around 1 in 5 respondents (19 per cent) had a relative who was in care outside the home, i.e. in residential care. Again this was most usually a parent or parent-in-law (30 per cent). Of these respondents, 68 per cent indicated that the care facility was Jewish. Where the respondent had a relative in residential care in a non-Jewish facility, the following were the most common reasons given, although 27 per cent said that none of these reasons applied.

· There were no suitable Jewish facilities in the area (28 per cent).

· There were no places available in a Jewish facility (28 per cent).

· The standards at the Jewish facilities did not match those of the non-Jewish ones (15 per cent).

· A Jewish facility cost too much (14 per cent).

Respondents' future care needs

Respondents were asked to imagine a hypothetical time in the future when they could no longer manage on their own and needed help with daily tasks such as getting up, going to bed, feeding, washing or dressing, or going to the toilet. They were asked how they would most like to be cared for in this situation. The most popular options were:

· paid professionals in my own home (28 per cent): more women (33 per cent) chose this option than men (24 per cent);

· mix of relatives and paid professionals in my own home (28 per cent): again, chosen by more women (32 per cent) than men (25 per cent);

· my relatives in my own home (24 per cent): more popular among religious respondents (33 per cent) and among men (31 per cent compared to 17 per cent of women), perhaps reflecting gender differences in who provides care.

Overall it was clear that respondents had a strong preference for staying in their own homes whoever provided the care, although 24 per cent stated 'nursing or residential home' as a second choice.

Respondents were asked which type of care provider (Jewish or non-Jewish) they would prefer if they did need to be looked after in a nursing or residential home. Most (67 per cent) said they would prefer a Jewish care provider. Religious respondents were by far the most likely (96 per cent), and secular respondents the least likely (36 per cent), to voice a preference for a Jewish care provider, as Figure 10.1 and Table 10.2 show.

Respondents were then told that the average weekly fee for a private non-Jewish residential home in London was £430, and were asked how much extra they or their family would be willing to pay for a Jewish residential home, over and above that amount. Over half (53 per cent) replied that they did not know, and 20 per cent said they would not be willing to pay any extra on top of this, while the other 27 per cent were willing to pay something. Secular respondents were less likely than religious respondents to be willing to pay anything extra for a Jewish service, as Table 10.3 shows.


Figure 10.1: Preference for future care

Table 10.2: Preference for Jewish or non-Jewish care provider for own future residential care, by religious outlook

Table 10.3: How much extra respondent was willing to pay for Jewish residential home, by religious outlook

Older and infirm respondents

Anyone aged 75 and over, or who was infirm, was asked to complete a separate questionnaire about their health, care and support networks. These 552 completed questionnaires will form the basis of the forthcoming JPR report already noted above. Consequently, only preliminary findings are presented here.

Social networks and social support

Around 6 in 10 older respondents (62 per cent) lived with others, while the remaining 38 per cent lived alone.

Respondents were asked how long, in the case of an emergency, it would take a family member or friend to reach them, using the quickest means of transport available. Two in 5 (39 per cent) lived with a family member or friend, while nearly as many had a friend or family member who could get to their home within 15 minutes (31 per cent) or 15 minutes to an hour (25 per cent). Only 5 per cent said that it would take more than an hour or that they had no family or friends to call on in case of an emergency.

Respondents were also asked how often they visited friends or relatives, how often they received such visits and how often they spoke to neighbours. Responses to these questions are shown in Table 10.4.

Table 10.4: How often respondent visited friends and relatives, was visited by friends and relatives, and spoke to neighbours

Respondents were also asked how safe they felt at home, and most felt very safe (47 per cent) or fairly safe (50 per cent). When it came to going out and about in the neighbourhood near their home during the daytime, 40 per cent felt very safe and 52 per cent felt fairly safe.

Health and disability

More than 6 in 10 respondents (62 per cent) who filled out the supplementary questionnaire had a longstanding illness, disability or infirmity. Of these, 76 per cent reported that this illness or disability limited their activities in some way.

In the previous three months, most respondents had visited a GP once (33 per cent), two or three times (34 per cent) or more than three times (17 per cent), and 16 per cent had not been to a GP at all. Of those who had been to a GP, more than 9 in 10 (91 per cent) said that at least one of their visits had been on the NHS. However, 16 per cent said that at least one of their visits had been paid for by private health insurance; this was highest in North-west London (19 per cent compared with 11 per cent in North-east London and 3 per cent in South London, although the latter group was very small).

Respondents were also asked whether they had visited any specialist in the previous three months. Four in 10 (40 per cent) had not, but 33 per cent had done once, 22 per cent had done two or three times and 6 per cent had done more often than that. Of those respondents who had been to a specialist, around half reported that at least one visit had been on the NHS (49 per cent), almost as many as reported paying for at least one visit by private health insurance (46 per cent). A smaller proportion (14 per cent) had had their visit paid for by a friend or relative. Again respondents from North-west London appeared more likely to have had treatment paid for by private health insurance (54 per cent compared with 25 per cent of those from North-east London).

Around half of respondents (49 per cent) had been a patient at the casualty or outpatient department of a hospital in the previous three months: 23 per cent once and 26 per cent more than once. Again most (84 per cent) had been paid for by the NHS, although 20 per cent had at least one visit paid for by private health insurance (this latter figure was 24 per cent in North-west London and 13 per cent among respondents in North-east London).

Just over 1 in 10 respondents (12 per cent) had been on the waiting list for an operation or surgical procedure in the previous year. This was higher in North-east London than in North-west London (19 per cent and 7 per cent respectively).

Home facilities and help

Respondents were asked whether they had a variety of facilities within their home and, if they did not, whether they were planning to get any of them in the future. Responses are summarized in Table 10.5 overleaf. It is worth noting that, if the reported plans to install stair lifts and wheelchair ramps were realized, it could double the amount of use of these facilities.


Table 10.5: Home facilities

* Percentages here are based only on respondents who answered these questions. It is likely that
many of those who left these questions blank did so because they did not have the facilities in question.
Levels of non-response to these questions were relatively high (between 21 per cent and 38 per cent),
thus the percentages given here are probably an over-estimate.

Respondents were asked how easy or difficult they found it to manage everyday tasks. Most respondents could manage tasks alone very or fairly easily (Table 10.6). However, 17 per cent could not travel on public transport at all, and shopping was also reported as being difficult (see Figure 10.2 at the end of the chapter).

Respondents were also asked if they had access to assistance with any of these tasks. More than 6 in 10 respondents (64 per cent) said they did not have anybody to help them regularly with these tasks, although 24 per cent had one person and 12 per cent had more than one person. Women were more likely than men to have at least one person to help them with these tasks (43 per cent compared with 31 per cent of men).

Of those respondents who did have someone to help them regularly, almost 4 in 10 (38 per cent) said at least one of the 'helpers' lived with them. In addition, nearly 3 in 10 (29 per cent) of those with help were receiving it from an outside organization: 8 per cent from a Jewish organization only, 12 per cent from a non-Jewish organization only and 8 per cent from a combination of both. These respondents were also asked to say how much time carers spent helping them each day. Nearly half (47 per cent) said 'none', 26 per cent said 1-3 hours, 8 per cent said 4-6 hours and 6 per cent said 8-16 hours. However, 13 per cent said carers spent at least 20 hours a day helping them.

All respondents who completed the supplementary questionnaire on care for older people and the infirm were asked how many times in the previous month they had received help from various sources, such as home help, a district nurse, meals on wheels or a lunch club. The most frequently used was private domestic help, used by 60 per cent of respondents, most commonly once a week (33 per cent) or more than once a week (20 per cent). The next most common was a district nurse or health visitor (or other nurse), used by 11 per cent.

The vast majority of respondents (96 per cent) lived in a private household. These respondents were asked whether they would consider moving to sheltered housing or residential care in the next two years. One in 10 said 'yes'; the remainder either did not know (30 per cent) or said 'no' (60 per cent). Those who were not considering a move to sheltered housing or residential care tended to say this was because they were satisfied and had no need to move (98 per cent gave this reason).


Table 10.6: Ability to manage everyday tasks

Summary

The findings relating to the older people in the London Jewish population are of major relevance to London Jewry's planners and decision-makers, and may also have some relevance for other ethnic minority communities.

Many lived alone and a sizeable proportion had mobility problems, particularly in regard to using public transport and going shopping. Over 30 per cent reported difficulty with public transport and 1 in 6 older people could not use it at all (Figure 10.2). Add to this the fact that this group had the lowest rates of access to a private vehicle and we have a picture of people who are very dependent on others for getting about, as well as for other tasks.

Figure 10.2: Ability to use public transport

Nevertheless, most older Jews lived in their own home, which they owned outright or with a mortgage. Fully 10 per cent of the older Jews reported a desire to move to sheltered housing within the next two years, which puts a considerable strain on the already stretched Jewish care services.

Notes

33 In this context, a forthcoming JPR report will focus specifically on older Jewish people in Greater London. In addition, Chapter 5 of Oliver Valins's Facing the Future deals with older Jewish people in Leeds. [back]