Jill Ball - speaking up for older people in Powys

After 4 years working in PAVO’s Powys Befrienders’ team, Jill Ball recently started a new role at Age Cymru Powys as an Independent Advocate. Age Cymru Powys is the largest voluntary sector organisation providing support to people over 60 in Powys, Mid Wales, covering the old shire counties of Montgomeryshire, Radnorshire and Brecknockshire.

The organisation works to sustain and improve the quality of life of vulnerable older people in Powys. It believes that older people should be respected and valued as individuals in terms of their dignity, status, personal autonomy, diversity of needs, aspirations and expectations.

I caught up with Jill at her base in Newtown to find out more.

Tell us about your new role with Age Cymru Powys

My role as an advocate is to take action to help people say what they want to say, secure their rights, represent their interests and obtain the services they need. I meet with people daily and listen to the issues that are of concern to them, provide them with information, and discuss with them the options that are available to them. If required I assist them with contacting third parties and written correspondence. As an independent advocate my role is impartial and non-directive. 

What is joyful about the role is that in supporting others to access the services they may need, or by them resolving an issue that has been of great concern to them, they then can continue to enjoy happy and fulfilling lives.

Which areas of Powys do you cover?

My base is at the Age Cymru Powys Centre, Parkers Lane in Newtown. The area I cover is the North of Powys and my colleague Louise Hicks covers the South of the county. I have an advocacy drop-in session every Tuesday 9 - 12.30 at our Newtown Centre. If required I visit clients at home or in a care home, wherever they reside.

How is the new job going so far?

I am enjoying it tremendously; the work is varied and interesting, people consult the advocacy service for many different reasons. They may wish to investigate what other accommodation is available to them now that their own needs have changed, which may be due to bereavement or an escalation of care needs. A client may be unhappy about the care they are in receipt of, and need assistance with knowing who to contact and may need assistance with getting their voice heard. I support clients when there may be conflict in their family, to reinforce their wishes.

Who can be referred to the Age Cymru Powys service and how?

The service is free, independent and confidential and is for people over the age of 60 living in Powys. People can self refer into the service or can be referred into the service by a third party, with their consent. 

North/Mid Powys telephone 01686 623707, email : support@acpowys.org.uk 

South/Mid Powys telephone 01597 825908, email : enquiries@acpowys.org.uk 

If people have been living alone and isolated for a long time what kind of support might they need?

Someone who can listen to what their needs are, and then to provide them with up to date and accurate information on what is available to them. They are then able to make informed choices whether that be in relation to their health, care, finances or social needs. If they need support to access a service, whatever that may be, Age Cymru Powys is able to guide them through this process.

How can the kind of support Age Cymru Powys offers impact on people’s physical and emotional wellbeing?

People are less anxious and more confident because they have the support and knowledge to face whatever problem they may be experiencing. The service is accessible. People say they enjoy the face to face contact and build up a good rapport with staff members. 

Age Cymru Powys also offers a toenail cutting service throughout the county which is a much needed and well supported service. 

The information and advice service provides benefits' information and assistance in completing forms and with financial security comes peace of mind. Age Cymru provides an extensive range of literature on all subjects relating to older people, from adaptations to their home, to power of attorney information. When people are informed they are then able to make decisions about their future which impacts on their wellbeing.

If people don’t receive the support they need, what can happen to them?

People can become socially isolated which can impact on their physical and mental health. Worst case scenarios could be that people become impoverished as they may not access the financial assistance that is available to them, which could affect their tenancy. They may become neglected as their personal care needs are not being met.

Which other organisations do you work closely with, either locally in Powys, or in the rest of the UK, to provide support to people?

Mind Cymru, Community Mental Health Team, Ponthafren, GP practices, other health professionals, Occupational Therapists, Social Workers, District Nurses, Speech and Hearing Loss teams, Care Agencies, Abacare, Red Cross, Action for Hearing Loss, RNIB, Powys Association of Voluntary Organisations, Credu Connecting Carers, Powys County Council, Department for Work & Pensions, Environmental Health, Disability Powys, Citizens Advice, Kaleidoscope, Alzheimer’s Society, Parkinson’s UK, Age UK, Stroke Association, Care and Repair... a long list!

Tell us what an “age friendly Wales” looks like to you personally

One in which all people feel valued. Communities provide services dictated by those who reside there. Where there are no barriers to services. Where everyone has someone to have a chat with and spend time with and where all individuals are celebrated and cherished.

What are the main challenges of the role?

Very long waiting times on the telephone to get through to some services. The distances one has to travel; less travelling time would enable me to see more people.

Tell us about some of the most rewarding work you have done at Age Cymru Powys so far

I have enabled a very elderly lady to stay in the care home of her choice. Supported a lady with hearing loss to solve her internet problems, so that she can email her family in South Africa and keep in touch with her grandchildren. Helped someone to understand all the care and accommodation options available to them, as they were given notice on their rented property. They are now living independently within a complex that has someone on the premises 24 hours a day and should they require a greater level of support in time this will be available to them.

When you are not working for Age Cymru Powys, how do you enjoy spending your time?

I enjoy spending my time in my garden and greenhouse and with my two little grand-daughters, and whenever possible I love a trip to the seaside, particularly our beautiful Welsh coast.

Many thanks to Jill for updating us about her new role. If you want to find out more about the Age Cymru Powys service you can contact Jill by emailing: jill.ball@agecymru.org.uk or ring 01686 623707.

When I grow up

by Suzanne Iuppa, Community Connector — Llanidloes (2nd from left)*

I grow old … I grow old … 

I shall wear the bottoms of my trousers rolled. 

Shall I part my hair behind? Do I dare to eat a peach? 

I shall wear white flannel trousers, and walk upon the beach.

The Love Song of J. Alfred Prufrock, by T.S. Eliot

    

What do you want your older age to feel like, sound like, look like?

I’ve spent much time thinking about this on my long drives working around the very beautiful countryside of Powys. I’ve worked for Powys Association of Voluntary Organisations (PAVO) now for six months as a Community Connector, linking older people in the county with services to improve their health and wellbeing. 

I moved here from Flintshire in September 2016, where I lived for 25 years and raised all three of my children as a single mother. My boys now live in the four corners of the planet and we joke (well, it is my favourite fantasy) that when I get older I will wing in with my Mary Poppins umbrella, all sprightly and fun, right when my beloved daughters-in-law can’t face another meal prep or load of washing, to look after my many grandchildren in turn, in different countries. My loving offspring will have a very small but beautiful granny flat in each of their houses for me to make magic in during my regular, seasonal visits. When I am not on Nainey duty I will be in my stunning but tiny (ie: low maintenance) cottage with the view at the edge of the Snowdonia National Park. I’ll have dinner parties, write stories, make crafts, feed the birds, and still make the long walks to the pub or garden centre. Or perhaps even take my trusty bike. I’ll thrive. I’ll be happy.

That’s if: if in future I’ll be able to travel easily to see my family, if I develop no long-term health conditions which sap my energy, if my children do indeed have children, and if my daughters-in-law will want my help on a regular basis.

I’m good at being flexible, but, with my family living at a distance and most of my friends being a good ten or fifteen years older than me (I was a young Mum, and my friends and I raised our children together) chances are, if my fantasy does not play out, my older age could be at risk of feeling lonely. In Powys there are plenty of places like my village, small tight-knit rural communities where children are living at a distance from parents and many people are of an aging population, all developing complex health problems as their age advances, in tandem. We might all want to be social! But for one reason or other, it may be hard to do. 

I help many people in Powys whose friends are not able to assist and whose family are not present, by linking them to befriending groups or ‘good neighbour’ schemes. It’s very important these schemes are well supported with funding and volunteers. Because — loneliness is not a condition we want to allow in our communities. The Older People's Commissioner for Wales, Sarah Rochira says: "Loneliness is a major Public Health problem here in Wales. We can all help — one day it could be us."

Loneliness has an effect on mortality that is similar to that of cigarette smoking. It is associated with poor mental health and conditions such as cardiovascular disease, hypertension and dementia.

Loneliness has a much wider Public Health impact too: it is associated with a number of negative health outcomes including mortality, morbidity, depression and suicide, as well as increased health service use.

Most of my work is centered around helping people feel listened to, and responding to people’s individual needs, particularly older people living with a sensory loss, cognitive impairment or dementia, those who are carers or who have mobility issues. It seems in Powys these older people are most socially isolated. In addition, the people I have worked with have reported:

• Loss of trusted relationships.
• Loss of privacy and dignity.
• Being a full-time carer with little social mobility.
• Poor access to a car or public transport.
• Not being able to run a home by oneself anymore.

The answer is not the NHS to any of these problems; either primary or secondary care. But… quite often that is where lonely older people end up. If we think of primary healthcare, we can also think of primary health and social services for older people. These should be first in line for funding and support for to prevent hospitalisation. These are: appropriate housing (including residential and nursing care) day centres, personal care, befriending, community transport, practical services such as shopping, cleaning and gardening, and social links.

We need to listen better to older people’s life stories and their wishes to create an enabling environment for all, so we can work together to provide the primary social services. Understanding the sense of loss would be a start. Veronica Jarman, day hospital sister at Llanidloes Day Hospital and a Wales Nurse of the Year, explains: "It’s grief — loss of partner, social position, income, friends… the grief can be overwhelming."

Active and reflective listening are keys skills in grief therapy, and could be an early response to people asking for help with loneliness, before accessing NHS services at a crisis moment.

The Royal College of Speech and Language Therapists, for example, has emphasized the link between the ability to communicate clearly with an individual’s ability to make informed decisions, to access services, enjoy their rights and overall, the dignity and respect that they experience.

Of course the older people in our society have lived through unprecedented change. For all the developments in communications and technology, the needs at the start and end of life are still best met through personal interactions. 

Our society is ageist — the only people really admired and in the driving seat in our society are from age 25 — 60 years. Like puberty, older age is a time of radical transformation for many; complete change. Whereas in previous societies elders had specific roles as guides, healers, mediators, correspondents, even dispute resolution specialists, because their amassed life experience was held in great esteem, now we tend to disrobe older people of roles and responsibility, in our families and in society generally. I’ve no doubt this disengagement has an effect on cognitive function. What would happen if we were able to advertise for older people to fill specialist roles in our community — designers, garden and horticulture, childcare, farming practices with wildlife conservation, flood prevention, town planning, holistic healing, dance events, history projects, clothes manufacture, community transport, language classes? What if people 65 years+ were the only ones to fit the bill, because of their wealth of experience, their time and their care?

Perhaps the Nainey duties and the dinner parties could keep me at the top of my game, for longer. I’m joining some craft guilds just in case — oh and my local town choir! I’ve even started an online course in herbal medicine. Still, I wonder if my daughters-in-law will be able to recommend a really good hairdresser in each country? I hope so!

To contact Suzanne for further information about her work as a Community Connector, please email suzanne.iuppa@pavo.org.uk or ring 01597 828649.

* The photograph also features (L-R) Carla Rosenthal — Community Connector in Knighton, and Melissa Townsend — Volunteer Officer PAVO.

World Mental Health Day 2015

Saturday 10 October 2015 is World Mental Health Day, which is organised by the Mental Health Foundation in partnership with the World Federation of Mental Health and the World Health Organisation. This year’s theme is Dignity in Mental Health. The MHF states:

“We believe that effectively supporting people experiencing mental health problems is on target to become one of the greatest public health challenges of our time. Stigmatising and discriminatory treatment can be particularly distressing when a person is experiencing a health crisis.

We all have mental health, and by failing to treat people with mental health problems with dignity we make it more difficult to ensure that everyone takes steps to safeguard their wellbeing and to seek help, as it can lead to self-stigma, low confidence, low self-esteem, withdrawal and social isolation.”

The World Federation for Mental Health has published a collection of papers under the heading "Dignity in Mental Health" from "expert authors who show that dignity in the mental health context can have many meanings and can be applied to every aspect of care." There are contributions from all around the world - including for the UK - Professor Mike Pringle CBE on "Mental Health for All: Mental and physical health parity - the role of General Practice".

The definition of dignity, according to one of those handy online dictionaries, is: “being worthy of honour or respect”. In our day-to-day lives we all expect to be treated with dignity, and it follows on from that – so we would too if in contact with any services we seek in relation to our mental health.

But provision of mental health services is complex and linked in to the laws of the land. Staff are often desperately firefighting due to cuts and increased paperwork, sometimes they barely have time to even talk to their patients…. The very fact that this theme has been chosen for World Mental Health Day 2015 suggests that there are issues around being treated with dignity whilst distressed.

Mental Health Foundation Tea & Talk initiative
for World Mental Health Day

What does it feel like, not being treated with dignity? It might feel that:

I am not being listened to

My colleague Jane Cooke says: “I think the fundamental thing for me is the quality of listening - and acknowledging that I am saying what I am saying - I think my dignity is affected when people reply with something like “So it’s about…” and then telling me what I said. It means that I am not heard - I’ve been put into a box.”

I have been labelled

Perhaps I have been told I have a specific diagnosis or disorder. I might not agree, but I might need the diagnosis to access further support or other services. I have to compromise to make a step towards recovery. In North Powys young people are fighting back against being labelled – those involved in the Young Adult Peer Support project at Ponthafren Association made a video called – “I don’t let mental health define me” in which young people challenge stigma with the powerful message: “Everyone has mental health.”

I am just a number, an entry on a list, without individuality or identity

It is all-too-common anywhere in Wales, not just in Powys, to be on a waiting list for psychological or talking therapies if support of this kind is considered appropriate. People in this situation can feel isolated, forgotten, and helpless. They don’t know where to turn. But just communicating with people can be helpful, as Jane found out at an event she helped organise earlier this year specifically to look at issues relating to the waiting lists.

I might lose my freedom

I no longer have control over my life – perhaps I am forced to take medication against my wishes or engage in activities which don’t interest me. Ultimately I may lose my freedom if I am detained under the Mental Health Act. Derek Turner and Jan Rogers wrote about the value of Advance Statements for crisis planning recently, whereby people are able to make their wishes clear in a written statement which could be referred to in times of mental health crisis. In this way someone experiencing mental distress in a public place could be supported with dignity rather than arrested and perhaps “bundled into a police van.”

I am not valued – by family, friends or staff with whom I come into contact… My self-esteem has hit rock bottom…

On Maple Ward at the Longley Centre, Sheffield Health & Social Care NHS Foundation Trust has developed ‘Dignity Steps’ which translate the views of people using the service into actions for improvement. It’s a lot like the approach taken by Powys Patients Council here, where mental health inpatients meet with experienced volunteers to talk about improvements they would like to see on Felindre Ward at Bronllys Hospital in South Powys. Rhydian Parry, who is a rep on the National Mental Health Partnership Board, wrote about his experience of volunteering on Powys Patients’ Council.

Together for Mental Health is the Welsh Government strategy for improving mental health and a vision for mental health services across Wales. Objective 13 of the national outcomes states:

“Service user experience is improved, and safety, protection and dignity are ensured and embedded in sustainable services.”

The ambition is there, but what is the reality actually like? Identifying the problem, in some ways, is easy. Much harder is thinking of solutions… but there are lots of ideas on the Social Care Institute for Excellence website – take a look and see what you think.

If you have been in contact with mental health services, do you feel you were treated with dignity? If yes, great, tell us about it and we can spread the news of some good practice! If not… why do you think this was so, and what could be done to improve things?

Brecon & District Mind is hosting a Mental Health Awareness Morning to mark World Mental Health Day this Saturday 10 October, 10am - 2pm at Brecon Guildhall. Tea and coffee available. All welcome.