Rural areas have a unique set of circumstances that can exacerbate the social isolation of older residents, leading to poor health, loss of independence and lower quality of life. These factors range from lower per capita expenditure on social care to greater reliance on car ownership, particularly for visiting family or the getting to the shops.
This is the argument presented in Social isolation experienced by older people in rural communities, the new report from the Commission for Rural Communities. The report examines how social care, transport and housing services can be ‘rural-proofed’ and used to address the issue of social isolation in older age.
The report includes a range of best practice for avoiding social isolation in older age, such as:
Shoreline Companions, Cornwall
“Shoreline Companions is a private company in Cornwall, set by up a young woman with work experience and qualifications in caring. It provides mobile outreach to older people in the Penwith area, where day centres are hard to access for many people living in rural areas.
A tailored service is provided to each individual, ranging from arts and crafts, to trips to the beach. The service also provides valuable respite to full time carers. Clients pay for the service either privately or using funding from personalised budgets. Most initial contact with clients currently comes via word of mouth.” [Page 36]
Call Connect and ShropshireLink
“Lincolnshire’s ‘Call Connect’ enables residents to call a central number, and a bus is despatched to the area to collect groups of people where there is a viable level of demand. This service has been expanded recently to cover some settlements where service buses have been withdrawn.
A similar approach, ShropshireLink was launched in Shropshire in 2008 and offers 100% coverage of rural households. Since its introduction passenger trips have more than trebled compared to those undertaken on the outgoing rural services.” [Pages 55-6]
Lessons for local government
Although most of the report’s recommendations are for national government departments, there are some particular points of interest for local government, including
1. Paid volunteer coordinators will ensure community transport and low-level support capacity in rural areas is maintained
The voluntary and community sectors (VCS) play a significant role in providing services that helping older residents stay independent and connected. The report highlights how befriending, lunch clubs, dementia cafes and transport schemes all play a critical role in countering social isolation.
The CRC argues again for protecting grants to the VCS in rural areas but also recommends funding community coordinator schemes or volunteer coordinators. This is a relatively low cost but can make a significant contribution to the sector’s ability to continue low-level support.
2. Funding the training of minibus drivers is a small investment that could lead to savings or expansion of existing charitable transport services
The report states that community transport providers often need for more trained minibus drivers, for example to utilise spare bus capacity for older people. However, the cost of putting someone through the relevant training course is around £1000 – which can deter volunteers or charities. A small investment by the local authority could create extra community transport for rural areas.
Our suggestions for improving the argument to tackle loneliness and isolation
Although the Commission for Rural Communities gave a comprehensive analysis of social care, transport and housing needs for older people living in rural areas, any future work on reducing isolation should consider the following two elements of the argument for tackling isolation and loneliness:
1. Recognise the need for quality not just quantity of contact
Although often used interchangeably, loneliness and social isolation are distinct concepts and should be treated as such to ensure the most successful, and efficient, interventions are recommended. Loneliness is a subjective and unique experience: unhappiness with the quality as well as quantity of social relationships.
Social isolation is the more objective measure, looking only at a quantifiable number of contacts per day, week or month. This means that an older person with carers visiting 3 times is not isolated, but could still be chronically lonely – lacking the quality for relationship they need. In reverse, an individual with few friends may not feel lonely despite being isolated – but is at risk of insufficient help in a time of crisis, such as a fall. Both people need different things.
One of the case studies does illustrate this. On page 21, we read the story of Geoffrey, caring for his wife Sue, who had dementia. Despite a decent level of social support from a daughter, short-term respite services and formal carers, Geoffrey lost the majority of his friendships. He was not technically isolated, but chronically lonely and in need of something to help him to keep a social life outside of caring duties.
Social isolation is a trigger of loneliness but, as experts such as Professors Christina Victor and Mima Cattan make clear in their work, it is not a guarantor of loneliness.
2. Make the health case for action as clear as possible
It is also important to reiterate how addressing social isolation (and loneliness) will reinforce the prevention agenda and help rural councils save money, as a benefit of improving the health and independence of older populations.
Research demonstrates that loneliness has an effect on mortality that is similar in size to cigarette smoking. It is linked to depression and conditions such as hypertension, cognitive decline and increased risk of Alzheimer’s disease.
Crucially, social isolation and lonely adults are more likely to be admitted into residential or nursing care early. To reiterate the pressing need to act on isolation and loneliness, the report could have shown more clearly how investing in VCS services or volunteer coordinators could leave to savings further down the line.