We need radical approaches to supporting relationships, not criticism of social care

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Andrew Balfour

CEO - Tavistock Relationships

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With life expectancy in the UK increasing, and the number of people aged over 65 set to increase by 51% between now and 2030, social care systems will increasingly encounter the kinds of difficulties which relationship support services are set up to address.

Recently, there was a story in the national press about a couple –one of whom suffers from dementia - who, despite 30 years of marriage, had been sent to live in separate care homes. We don’t know all the details of this story of course, and the Health and Social Care Partnership in question has confirmed that, whenever feasible, it tries to keep couples together.

The fact that such cases are picked up in the national media reflects society’s growing acknowledgement, I believe, that the challenge we now face therefore is how, in the context of increasing longevity, we support couples – very often in the context of one or both partners experiencing one or more long-term health condition – to support each other for as long as possible. When the person with dementia is admitted into residential care, the experience of their partner can be that it is difficult to have a link and continued role with them, and this can greatly compound the emotional difficulty of the situation for both partners.  Services are not, on the whole, set up to take account of couple relationships To this end, the couple relationship needs to be thought about at different levels – at the policy level and at the level of local service provision.  We need our policy makers and local commissioners to act to avoid both the monetary waste that neglect of the older couple entails, but also to address the human cost of this neglect, which is most starkly illustrated in the case of the separation of couples, who may have been together a lifetime, when one or other of them becomes unable any longer to be cared for at home.

After all, the number of people in England with moderate or severe long term health conditions is projected to increase by 32% by 2022 (Nuffield Trust, 2012)  and there will be over 50% more people with three or more long-term conditions in England by 2018, compared to 2008 (House of Lords, 2013). Both of these factors have a significant impact on couple relationship quality and functioning.

At Tavistock Relationships we believe relationship support services should be available to couples starting out in life together (support which we might, in terms of its preventative potential, think of as supporting couple relationships for later life) as well as those along with other important life and relationship stages such as challenges with family life, sexuality and mental health.

However, we all think it is fundamentally important that we support couple relationships in later life itself.

After all, personal relationships are a key factor in determining how happy our later years will be, with 9 out of 10 people believing that their relationship with their partner is very important to their happiness in retirement, a national study has shown (Relate, 2013).

How does our failure to support relationships during adulthood and in later life manifest itself?

While it is important to acknowledge that not everyone who lives alone is lonely (and, indeed, that not everyone who is lonely lives alone), research nevertheless shows that the absence of intimate relationships in particular fosters loneliness, but also highlights that it is the quality of relationships, not the quantity, that matters most to people.

By 2033 4.8 million people over 65 will live alone (Communities and Local Government, 2010). Given that the rate of divorce in the over 65s has doubled in the decade 2001-11, it is clear that significant numbers of people over 65 are projected to be living alone due to relationship breakdown. So why not run this dilemma on its head and try and help couples work through their problems before they become too advanced?

We are running, in collaboration with Age UK a 50 year old plus ‘couple MOT’, the kind of service that gets couples who are looking ahead to what is a major transition, retirement, to work together to plan and think about their partnership and this next stage of life together.

If couples are given greater encouragement to use relationship support services – this has the potential to reduce the numbers of older people who are lonely by lessening the incidence of relationship breakdown earlier in life.

A second pillar of this should be a greater emphasis on training in the social care sector, especially on working with ‘the couple’ in mind. Ensuring that this kind of thinking is the norm seems to be what lies behind the concern of the press and many commentators about the Glasgow couple referred to above. As a post script to their story, it has been subsequently been reported that great efforts are being made to keep them together, that is testimony to the very ‘common sense’ nature of our message.

Widening the uptake of relationship support services by people of working age and in later life may not only reduce the numbers of elderly people living alone however. It could also – given that relationship quality is associated with improved health in a range of areas – result in reduced levels of illness for those suffering from long-term physical health conditions and, as a consequence of this, improved well-being for their partners. It also reduces stress on extended families and saves money from the public purse.

That is the real power and potential, and the upside of us adopting a strategy to help us grow old together.

For more informaton on our services in later life, visit our 50 plus service page or access information on our Living Together with Dementia Programme.

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