'Where's the storytelling factory?' A social enterprise blueprint for our older people's last 1000 days

  • David Law

Student thesis: Doctoral Thesis


Problem Statement : If each of us knew that we had only 1,000 days left to live, I wonder how we might like to spend such time? The chances are that we might like to spend our time along with our families and engaged, should we so choose, with pursuits that we may find fulfilling. If this is the case, then perhaps a public strategy for the social care for older people might configure the resources that may be to hand in order to best enable these outcomes for us. My thesis examines how a strategy can be configured as to achieve these outcomes better.;That people are living longer worldwide is to be celebrated, but along with this success comes significant challenges for individuals, families and society. To illustrate the scale of this challenge, consider that in the UK, one person in six born today are expected to live to be 100 years old, some 10 million people,rising from some 13,000 today. Such rapid growth has been evident in Northern Ireland where the Northern Ireland Statistics and Research Agency found that between 2007 and 2017, the number of people aged between 90 and 98 grew by 55% from 1,956 to 3,029 (NISRA, 2019).;In this cohort, a great many find themselves at the 'interface' between care-at-home and care home, torn between their deep-seated desire to maintain their quality of life through remaining in control, and their capability to do so. Many are forced to trade in their independence in return for the security and standardised interventions of institutional care.;Regrettably, such care is not well suited to maximise the individuals' quality of life. Nor is it financially sustainable. Mean care costs for 65-year-olds are £2,000 per year, whereas costs for 85-year-olds are closer to £12,000 per year (Bengoa et al., 2016). Such expense is partially due to unplanned acute care events by older people living at home at this interface, as well as the costs relating to the number living their last 1,000 days in institutional care.;Demographics, costs of institutional care, plus non-elective and extended stays in acute care are significant reasons behind the health and social care system finding itself on an unsustainable trajectory. The resulting pressures on the acute care system mean that a different strategy is sorely needed. Such a strategy may well be an approach that enables older people's autonomy, but with security. It may likely take the form of a housing-with-care environment that enables the well-being contributions of the home, autonomy and relationships.;Accordingly, it has been long recognised that for those older people at the interface between care-at-home and care home, enabling them to remain in control via housing with care both maximises their quality of life and constitutes cost-effective care. Indeed, as I detail within Section 1 of my enclosures companion document, in Northern Ireland, there have been successive policy initiatives for over 30 years that have advocated creating more clusters of housing-with-care.;Therein, it has been long recognised that older individuals and older couples may retain control and pursue their own happiness in ways that suit their idiosyncratic needs and desires. As such, housing-with-care has always seemed a promising way to addressing the longstanding strategic problem of spiralling care costs. However, the problem is that there has been no conceptualisation of an integrated public/private policy nor strategy to procure these clusters of care. My thesis aims to contribute to filling that void.
Date of Award8 Apr 2020
Original languageEnglish
Awarding Institution
  • University Of Strathclyde
SupervisorAlec Morton (Supervisor) & Viktor Dorfler (Supervisor)

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