Black, Asian and Minority Ethnic Older People: How does the crisis in care affect them?

Accompanying our annotated bibliography, this blog by Anna Killick sets out some of the key policy issues relating to the care of older BAME people in England.  This is part of a new phase of research that will over the course of 2019/2020 seek to engage with BAME older people and their carers in the Coventry area. Should you have comments or insights that you would like to share then please contact us at this link.

The 2016 PSA Commission on Care report highlighted the neglect of the needs of BAME older people within the current social care system. Here we bring up to date some of the research that has been done into their needs and how the care system treats them. For further detail on the links in this blog connect to our more detailed selective annotated bibliography [INSERT LINK].

The proportion of the older population who are BAME is rising, with the Centre for Policy on Ageing (CPA) estimating there may be 1.3 million BAME people over the age of 65 by 2026 (Lievesley 2013; Age UK 2019).

Black, Asian and ethnic minority older people tend to be poorer, with lower quality housing and pensions, and in poorer health than their white counterparts. However, BAME older people face additional disadvantages which older white people in similar economic circumstances do not face. First, particularly if they are Asian, some healthcare professionals may assume they do not need help because their families will look after them (Rai and Elias 2017). Second, social care is complex to navigate at the best of times, but some providers still do not make the effort to explain it to those for who English is not a first language. Third, when an older BAME person is able to access social care, it sometimes does not meet their needs in the way it might for a white person; they experience racism or culturally inappropriate practices which undermine their dignity.

Research into the care needs of older BAME people clearly identifies how their needs are not currently met by the care system. Although this is an under-researched area, the evidence base that has emerged from the studies that we surveyed indicated that urgent steps need to be taken to better support the needs of BAME older people and their carers. There is a danger that if we do not put this right, then BAME older people may have even less dignity in old age compared to their white counterparts.

In this blog we outline some of the existing research on the problems facing BAME older people and their carers. We link each piece of research to a more detailed annotated bibliography. We want this bibliography to be helpful to those researching and would welcome any suggestions for additions or changes to it.

We divide the research into three sections:

  • problems facing BAME older people,
  • problems facing those caring for older BAME relatives,
  • and quality of state and voluntary sector support.

The studies we link to mainly relate to England with some excellent local studies, such as a recent study on problems of social isolation in Manchester.  In December we will publish a second blog that highlights problems facing BAME older people in the Coventry area.

Problems facing BAME older people

As was pointed out in the PSA Commission on Care report (p. 17), deep seated socio-economic and structural inequalities have meant that BAME people are disproportionately affected by poor health and high rates of life-limiting illness. They are also less likely to have the savings or inherited wealth needed to cover care costs. These findings are borne out in a number of studies. For example, Vlachantoni et al. (2015) review the lower pensions BAME people tend to receive, which in turn impacts incidence of poverty and quality of life into old age. De Noronha (2019) reviews the housing situation for older BAME people, identifying similar issues. Lipman (2014), while primarily concerned with the impact of spending cuts on BAME support groups, also overviews levels of poverty.  Lewis and Cotterell (2018) highlight the problem of social isolation for some BAME older people – an issue that frequently goes unrecognised by policy-makers. The Care Quality Commission (2016) highlight barriers to accessing good personalised end of life care.

There are also many qualitative studies of individual BAME groups that further highlight the differential impacts of the UK’s crisis in adult social care. Victor et al. (2012) explore the views of male and female people over 50 of Pakistani and Bangladeshi origin, Jutlla (2015) the experiences of Sikh older people who have dementia, Liu et al. (2016) the experiences of those from Chinese backgrounds. Older south Asian women are the focus of Bailey et al.’s 2018 report. These reports tend to have in common that state services are not meeting their needs, either because of lack of information or because they are not culturally appropriate.

Problems of those caring for older BAME relatives

In this blog we focus on the carers who are unpaid or ‘informal’, looking after family and friends, rather than care workers. Those who care informally for their BAME older relatives often do not get a voice either about their relatives’ or their own needs. Many of the reports that we came across sought to address this lack of voice. However, it also appears to be the case that these studies tend to focus on what the carers want for the people they care for rather than what they want for themselves.

Carers of BAME elderly have less access to state funded support than their white counterparts (National Black Carers and Care Workers’ Network and Afiya Trust, 2008, Carers UK (2019:6). Carers UK found little improvement in their 2011 report. Greengross (2013) highlights the problem of assuming BAME families will ‘care for their own’. Greenwood et al (2015) review the literature on this subject.

Quality of state and voluntary sector support for BAME older people and their carers

When BAME older people do receive support from the state then, according to the Care Quality Commission (2016) and Greenwood et al. (2017), they are less satisfied with it. These findings are despite the fact that there is other evidence that BAME older people are less likely to come forward to complain (Care Quality Commission and Race Equality Foundation 2019), indicating that there may well be a lack of trust in institutional complaints procedures.

The reasons for lack of satisfaction with state support can be divided into language related (Manthorpe et al. 2009, Ellins and Glasby 2016, Willis et al. 2016, Cooper et al. 2018), being ‘hard to reach’ in the services’ eyes (Manthorpe et al. 2009, Care Quality Commission 2016) and discriminatory assumptions or practices such as cultural inappropriateness (Manthorpe et al. 2009, Blake et al. 2017).

Given the problems with state funded care the voluntary sector organisations that support BAME older people are important. The Afiya Trust (2012), Lipman (2015) and Warwick University (n.d) provide evidence of the precarity of funding for such services.

There is urgent need for the needs of BAME people and their carers to be better recognised within the current care system, as well as within any coming proposals for reform to the care system. Increased pressure on the government to significantly bring down the costs of care for individuals and their families could have a significant positive impact on those groups such as women and BAME populations that have been hardest hit by the care crisis….  But ultimately policy makers tasked with the job of tackling the care crisis will need to ensure that they find ways to directly tackle the many forms of racial inequality that are at work within the UK care system.

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