Intergenerational care

Intergenerational Care

Sharing is Caring? How intergenerational projects can improve quality of care, and help solve the increasing social care crisis in the UK

everyLIFE Intern, Katherine Maule, spent her first few days in the office digging deep into the ‘new’ style of care that has excited the media and governments from Britain to Tokyo. What follows are, we think, the insightful views of a young adult’s research into the global care trend that is producing amazing outcomes…

In recent years, occasional whispers about intergenerational care in the UK have strengthened to an audible buzz – largely due to Channel 4’s documentary series ‘Old People’s Home for 4 year olds’. The documentary follows a study of the interactions between a group of elderly people and a group of nursery children to determine the effects of such interaction. Their first series, based in a St Monica Trust care home in Bristol and aired in 2017, tested the elderly participants to measure mood, memory, and mobility over a 6-week programme with the children. Following success and a warm public reception, they began a second study with new groups in Larkfield (a Care Home in Nottingham), expanding the time frame to ten weeks and this time monitoring both age groups.

This was the first time this sort of study came to public attention in the UK, however schemes like this have  been around for decades in other parts of the world. The earliest record of this is found in Japan, where in 1976 Shimada Masaharu merged a nursery school and home for the aged in Edogawa Ward, Tokyo. The success of this centre sparked the creation of several other similar centres; according to the health, labour and welfare ministry by 1998 there were 16, and at present it is believed that there are over 100 such facilities.1 Other such centres can be found in Singapore, America, Australia, Canada and in some parts of the UK:

  • In Singapore, the Ministry of Health has planned ten new co-location intergenerational projects in the next decade, as well as encouraging existing elderly care facilities to introduce programmes allowing interaction between the young and the old.2
  • Providence Mount St Vincent in Seattle, America, has been home to the Intergenerational Learning Centre since 1991. Based in an elderly care home, five days a week children from the onsite nursery join the residents for a variety of planned activities such as music, dancing, art, lunch, storytelling or just visiting. Since starting, it has expanded from one classroom with 12 children, to 6 classrooms and 125 children (and a 2-year waiting list) in 2017, and currently is believed to have over 400 families on their waiting list.3
  • In Australia, the growing Eden Alternative movement in Australian aged care has moving children into facilities as one of its basic tenets.
  • In Canada, Columbia Garden Village retirement home in Invermere has a full-time kindergarten classroom, where planned activities with residents take place.
  • In the UK the Apples and Honey Nursery in Wimbledon opened in September 2017 on the grounds of the Nightingale House care home, where children and residents participate in planned activities.4 Similarly, in Scotland the Little Deers Nursery in Aryshire was built at Buckreddan Care Centre over a decade ago with the intention of providing childcare for staff, but recently started a programme of intergenerational interaction twice a week.

However, the sharing of care between the elderly and the young are not the only type of intergenerational projects on the rise. Other include Live-in Student programmes and Homesharing.

Live-in Students:

These projects can be seen in Europe and the USA, and have gradually been increasing in number.

  • Humanitas, a care home in Deventer, the Netherlands, has been offering students free accommodation since 2012. The terms of agreement include giving 30 hours of activities with residents per month, and not being a nuisance! Since its start, two more nursing homes in the Netherlands have followed suit.5
  • The scheme ‘The House that Fits” was launched in Helsinki, Finland, drawing inspiration from Humanitas. Part of this scheme places people in their twenties in care homes. They pay a low rent and give five hours a week to residents.6
  • Judson Manor retirement community in Cleveland, the USA, has been accepting students from the Cleveland Institutes of Art and Music since 2010. In exchange for living rent free, they participate in the musical arts committee, assist staff therapists, give performances, and volunteer at events.7

Home-sharing:

Various schemes operate across fourteen countries, offering a housing option for elderly people who need care help, but want to stay at home. In exchange for low or no rent to live in their home, a younger person gives up to ten hours per week to help with daily tasks like shopping, cooking, cleaning, companionship, security and social activity.8

  • French charity “Ensemble2Generations” has been organising such arrangements for ten years. It has placed over 3,000 students nationwide with retirees.9
  • In Spain these arrangements have been organised by regional authorities. In Barcelona, the City Council launched the project in 1996, and it has since become a consolidated programme across Spain, operating across 27 cities.
    • The Municipal Project for Intergenerational Housing and Community Services in Alicante addresses the specific housing needs of low-income older persons over the age of 65 (78% of residents) and young people under the age of 35 (22% of residents) through the provision of 244 affordable, intergenerational housing units in central urban areas. Each young person oversees the care of four older people in the building, offering a few hours of their time each week to spend with the older residents.10

So, what exactly are the benefits of these intergenerational projects?

All of these schemes benefit both sets of participants. The effects of the combination of elderly and nursery care has been analysed in many studies and at the projects that are currently running. Looking back to the documentary that inspired this discussion, the study shown in ‘Old People’s Home for Four Year Olds’ saw massive improvements across a number of measures.  102-year-old Sylvia ended the experiment with an addition of 3 points to cognitive health (attention, focus and memory) and shed her classification as ‘medically frail’. Nine out of ten of the participants improved their grip strength (which is a general indicator of health) and half the group increased their balance scores. Mental health was also improved, with one participant, Victor, seeing improvements on the depression scale of 3 points.

These results are mirrored in observations in Nightingale house (home of the Apples and Honey nursery, see above), a Welsh university study from 2017, and a 2013 Japanese study, which noted seniors exhibiting a delayed mental decline, lower blood pressure and reduced risk of disease and death in comparison with seniors in non-participating facilities.11 These schemes all also noted changes in the children taking part. Apples and Honey have noted that the children mature more quickly and were more responsible, being actively concerned for the elderly people’s wellbeing.12 Similarly the Japanese study recorded a development of respect and empathy which enhanced the children’s’ social and personal development. The Canadian scheme at Columbia Gardens retirement home has also noted a boost in student’s standardised test scores in reading, as well as lowering medication rates for residents.13

The other intergenerational projects see similar benefits. There is research that show that loneliness and social isolation, especially in older adults can lead to a host of mental and physical disorders.14 Conversely, the NIA also reports that “Positive indicators of social well-being may be associated with lower levels of interleukin-6 in otherwise healthy people.” (Interleukin-6 is an inflammatory factor implicated in various age-related disorders such as Alzheimer’s disease, osteoporosis, rheumatoid arthritis, cardiovascular disease, and some forms of cancer).15 All intergenerational projects help to tackle the problems stemming from loneliness. Humanitas and Judson house have both noted a distinct positive effect on residents after starting the schemes.16 Vice President of the Reims branch of Ensemble2Generations’ Valérie Ernerwei even claims that on average when a student goes to live with the elderly it can defer the need to go into a retirement home by about two years.17

Practical help and the strong bonds created between the young and the old in these situations can also improve care at the retirement homes. Jurrien Mentink, a student living at Humanitas, remembers being woken in the middle of the night by a staff member. One of the residents, that Mentink had grown close to, had attacked a nurse and they were struggling to calm her down. According to Mentink, when the resident saw him ‘it was like 180 degrees around’ and ‘she was instantly relaxed and happy to see me’.18

How can intergenerational care improve quality of care, and help to solve the social care crisis?

The CQC measure quality of adult social care by 5 key question ratings: whether it is safe, effective, caring, responsive and well-led.19 Due to their integrational nature, intergenerational projects could affect each of these categories. The current statistics for adult social care key question ratings show that between 74-91% are rated “Good”, and only 0.5-4% are rated “Outstanding”. Given the above benefits seen in intergenerational projects above, introducing more of these projects could help more achieve a higher rating. Nightingale house, home to Apples and Honey nursery since September 2017, recently improved their CQC inspection rating from “Good” in 2016 to “Outstanding” in May 2018. No doubt this improvement was down to the staff at the home, but it seems like there may be a correlation between the addition of the nursery, which the CQC specifically mentions in the report, and the improvement.20

If the benefits of the intergenerational projects mentioned above aren’t persuasive enough reasons for their promotion, their implementation could also help solve the mounting social care crisis. There is no denying that social care in the UK is encountering many problems. These problems include increasing demand and limited capacity, funding, and staff retention and recruitment.

Increasing demand and limited capacity:

We live in a rapidly aging population. The office of national statistics shows that the number of people aged 90 and over living in the UK in 2016 was the highest ever: 571,245, compared with 416,368 in 2006.21 The CQC report that in two years, the number of older people living with an unmet care need has risen by almost 20%, to nearly one in seven older people. The number of beds in nursing homes and residential homes has also decreased over the period April 2017 to April 2018. The number of nursing homes decreased by 1.4%, with a drop of 0.2% in the number of beds and the number of residential homes decreased by 2.4% also with a reduction of 0.2% of beds.22 Considering these issues, the intergenerational schemes of house-sharing could help. If it could push back the need for some to go into a residential home by up to two years, as Ernerwei from Ensemble2Generations believes, promotion of these projects could help alleviate some of the pressure. Tackling issues like loneliness and the evidence that intergenerational projects can reduce health risks and improve health in the elderly would also help reduce pressure.

Funding:

Social care in the UK is suffering from a lack of funding. The Local Government Association estimates that adult social care services in England face a funding gap of £3.5 billion by 2025.23 In 2017 between 160,000 and 220,000 care workers are paid below the national minimum wage, while the number of unpaid carers has increased by 16.5 per cent between 2010 and 2014.24 Intergenerational projects, particularly the integration of the care of the young and old, can generate financial benefits from cost savings arising from sharing staff and space. Cheryl Hadland, managing director of Hadland Care Group, which includes both nurseries and care homes, says there are logistical and financial benefits to running both from one business. Although Hadland Care Group do not currently run intergenerational programmes, Hadland states that she thinks it is a ‘great idea’ and the financial benefits seen in her business should be replicable in intergenerational initiatives.25 Simon Pedzisi, director of care services at Nightingale House, also suggests there could be further savings due to the health benefits for the elderly gained from intergenerational projects.26

Staff retention and recruitment:

The CQC reports that in adult social care, the highest vacancy rates in all regions in 2017/18 were for the regulated professions that include registered nurses, allied health professionals and social workers. They reached 16% in the East of England and 15% in London. There is evidence that intergenerational programmes can help to alleviate this due both by providing the advantage of flexible on-site childcare and increased job satisfaction in the new variety of roles. This has been seen particularly in Australia.27

So, will the number of intergenerational projects grow or will the enthusiasm fade?

Thanks to ‘Old People’s Home for Four Year Olds’, intergenerational projects have been put into the spotlight, and subsequently many new projects have been springing up throughout the UK. Schools and nurseries have since been setting up programmes with local care homes including the Russets, a home in the St Monica trust, which has linked up with Sandford primary after the trust hosted the first series of the documentary.28 Other schemes have equally been inspired by the programme, like Downshall primary school in east London which has begun hosting a day centre for older people with depression and dementia and Fulbrook Nursery school in the West Midlands which has been linked with its local residential home Delves Court.29 To keep up with the times, Ofstead has issued guidance to its inspectors on registering and inspecting shared sites with childcare and elderly care services.30

In government, secretary of State for Health and Social Care Matt Hancock has also given backing to the creation of more co-located care homes and nurseries, and local authorities have been considering and planning intergenerational projects. Torbay Council in Devon has plans for an intergenerational care site, and Scotland is leading the way with Fife council’s plans for a £10.6 million integrated care home and nursery development opening in 2020.31 Newbyres nursery in Edinburgh is also hoping to open Scotland’s first intergenerational care centre soon.

All of this action to promote and create more intergenerational projects is promising.One organisation that has been promoting intergenerational projects since its creation in 2010 is United for All Ages, a ‘think-do tank’ founded by Stephen Burke and Denise Burke. It recently ran a crowdfunding appeal for the creation of 500 new centres for all ages that they want to create by 2023, which will hopefully do a great deal to promote knowledge and popularity of these projects.32 Apples and Honey nursery are similarly furthering the cause by running intergenerational workshops for those interested in setting up something similar, policy makers and researchers.33 If this sort of promotion and engagement continues, it may help to shape a very different future landscape of social care. Of course, there are challenges involved in creating and maintaining these projects, and it certainly won’t be a ‘quick fix’ for the mounting social care crisis in the UK. It could however help to solve many of the problems already present in our social care system, and as individuals, make growing old slightly more appealing!

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Sources:

  1. http://www.childresearch.net/chief/33.html, https://www.japantimes.co.jp/opinion/2016/03/13/commentary/japan-commentary/interaction-benefits-toddlers-elderly-alike/#.W-lS9nr7QnM
  2. https://www.moh.gov.sg/docs/librariesprovider3/action-plan/action-plan.pdf
  3. https://www.kiro7.com/news/local/preschool-inside-west-seattle-nursing-home-brings-together-old-young/644699163, https://washington.providence.org/services-directory/services/i/intergenerational-learning-center, https://www.theatlantic.com/education/archive/2016/01/the-preschool-inside-a-nursing-home/424827/
  4. https://docs.wixstatic.com/ugd/b14a3d_957175a9f0844aa1b863594b6f64c5b4.pdf – Their own report.
  5. https://www.citylab.com/equity/2015/10/the-nursing-home-thats-also-a-dorm/408424/
  6. https://www.csmonitor.com/World/Europe/2016/1230/How-adding-youth-to-a-Dutch-old-age-home-is-improving-life-for-all
  7. https://www.judsonsmartliving.org/judson-manor/intergenerational-programs/student-residents/
  8. https://www.wcmt.org.uk/sites/default/files/report-documents/Garland%20E%20Report%202017%20Final.pdf
  9. http://ensemble2generations.fr/, https://www.csmonitor.com/World/Europe/2016/1230/How-adding-youth-to-a-Dutch-old-age-home-is-improving-life-for-all
  10. https://www.housinglin.org.uk/blogs/Intergenerational-living-its-scope-and-potential/
  11. https://www.independent.co.uk/news/uk/home-news/elderly-children-intergenerational-care-home-nightingale-house-a8271876.html, https://www.sundaypost.com/fp/charities-hail-groundbreaking-initiatives-bringing-together-young-and-old-by-mixing-nursery-youngsters-with-retirees/, https://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-13-111)
  12. https://www.ageukmobility.co.uk/mobility-news/article/intergenerational-care
  13. https://www.theglobeandmail.com/news/national/kindergarten-in-a-retirement-home-proves-a-hit-with-young-and-old/article4103165/
  14. https://www.nhs.uk/conditions/stress-anxiety-depression/loneliness-in-older-people/
  15. https://www.nia.nih.gov/about/living-long-well-21st-century-strategic-directions-research-aging/research-suggests-positive
  16. https://www.smithsonianmag.com/innovation/college-students-are-living-rent-free-in-cleveland-retirement-home-180956930/
  17. https://www.csmonitor.com/World/Europe/2016/1230/How-adding-youth-to-a-Dutch-old-age-home-is-improving-life-for-all
  18. https://www.citylab.com/equity/2015/10/the-nursing-home-thats-also-a-dorm/408424/
  19. https://www.cqc.org.uk/sites/default/files/20171011_stateofcare1718_report.pdf
  20. https://nightingalehammerson.org/wp-content/uploads/2018/08/Inspection-Report-May-2018.pdf
  21. Office for National Statistics, Estimates of the Very Old, including centenarians, UK 2002 to 2016, September 2017
  22. https://www.cqc.org.uk/sites/default/files/20171011_stateofcare1718_report.pdf
  23. Local Government Association, Local Government funding: Moving the conversation on (Technical annex), July 2018
  24. https://www.telegraph.co.uk/science/2017/03/30/private-care-home-residents-pay-nearly-10000-a-year-extra-subsidise/
  25. https://www.nurseryworld.co.uk/nursery-world/news/1160195/intergenerational-care-bringing-old-and-young-together
  26. https://www.theguardian.com/social-care-network/2017/sep/06/care-home-toddlers-nursery
  27. https://www.agedcareinsite.com.au/2012/02/its-on-for-young-and-old/
  28. https://www.stmonicatrust.org.uk/our-expertise/news/2018/generation-games-unite-school-kids-with-russets-residents
  29. https://www.housinglin.org.uk/_assets/Resources/Housing/OtherOrganisation/Mixing-Matters-how-shared-sites-can-bring-older-and-younger-people-together-and-unite-Brexit-Britain.pdf, https://www.nurseryworld.co.uk/nursery-world/news/1161855/tv-show-aims-to-prove-benefits-of-bringing-young-and-old-together
  30. https://www.unitedforallages.com/
  31. https://www.sundaypost.com/fp/charities-hail-groundbreaking-initiatives-bringing-together-young-and-old-by-mixing-nursery-youngsters-with-retirees/
  32. https://www.thecourier.co.uk/fp/news/local/fife/635426/10m-combined-nursery-and-care-home-for-methil-hailed-as-groundbreaking/
  33. https://www.unitedforallages.com/
  34. https://www.applesandhoneynightingale.com/media, https://www.applesandhoneynightingale.com/events
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