INTRODUCTION

This paper is based upon two major qualitative research projects undertaken by the Brotherhood of St Laurence over the past eighteen months. The first project, funded by VicHealth, was a general exploration seeking to determine whether low-income older people living in insecure accommodation were gaining access to the support services they needed. Thirty in-depth interviews were conducted. (Leveratt 1998) One outcome of this project has been a further grant from VicHealth to establish a pilot outreach programme for older persons living in rooming houses in South Fitzroy.

The second project, funded by the Department of Human Services and still in progress, seeks to understand the complex relationship between individually held notions of independence and service usage. As with the previous project, the focus is exclusively upon low-income older people and fifty in-depth interviews are being conducted.

This research is not intended to be representative of a particular section of the population; rather, its main emphasis is upon understanding how current social attitudes towards, and policies on, ageing, when conjoined with life experiences, affect the way older people relate to the service delivery network.

This work has highlighted a number of key points which may enhance our knowledge of disadvantaged older people and contain some pointers to improving service delivery.

An extensive review of the relevant literature, including policy documents, found two dominant discourses of ageing prominent in current debates. On the one hand, there is the demographic 'time-bomb' discourse which emphasises the growing burden an ageing population will place upon future health and welfare expenditures. On the other hand, there is the 'healthy, productive, successful or positive' discourse which seeks to enhance the capacity of the individual to maintain an active and meaningful life-style and which also seeks to promote a more positive view of ageing in our society. Australia is not unique in this respect, both Canada and the United States, for example, have developed national policies on positive ageing. (See Teshuva, Stanislavsky & Kendig 1994: 6, 102-103)

These two discourses are, of course, not unrelated; health promotion is now widely regarded as an important strategy in the containment of burgeoning health costs.

The first discourse, that of the demographic 'time-bomb', has been around for many years. Its crudest expression is to be found in the age dependency ratio predictions produced by demographers. These predictions are problematic for a number of reasons as McFee and Rowley have said:

Notwithstanding their crudity as a tool for policy analysis and initiatives, the idea of the nation being swamped by an unsustainable number of dependent older people lay behind the Coalition Government's attempts to introduce up-front accommodation bonds in nursing homes. This policy initiative had its origins in the recommendations of the National Commission of Audit in 1996 who had argued for cost recovery from the deceased estates of pensioners who were asset-rich but income poor. (National Commission of Audit 1996: 140) The NCA had also sought to bring into question the GDP growth figures produced by EPAC two years earlier. (ibid: 135; Clare & Tulpule 1994: 41)

Whatever the relative merits of this policy initiative, it was the language used in public debates which reinforced the image of older people as dependent and needy and, perhaps more damaging, as a burden upon society. It is this use of language that has led Nick Fox to argue that "how we see elders, however, will also frame the social contribution they can make; thus the damaging ageist notion of an uncontainable upsurge of demand needs to be considered critically". (Fox 1995:99)

The second discourse is of much more recent origin and, as I said earlier, is part of a broader thrust within health policy towards health promotion and prevention. The extent of government commitment to positive ageing strategies may perhaps be gauged by the publication of the Victorian Government's Inquiry into Planning for Positive Ageing. This massive tome of more than 500 pages states explicitly that it "does not consider older Victorians and the ageing of the population as being a 'burden', either socially, politically or economically." (Parliament of Victoria 1997: 38) Precisely how this document's many recommendations will translate into practice is currently the subject of a large inter-departmental effort.

Whilst the aim of presenting older people in our society as vigorous and valuable citizens is laudable, it is not without its dangers. As John McCallum has written:

Part of the difficulty with perceiving positive ageing as a radical paradigm shift in public policy on ageing, or as an antidote to the burden thesis, lies in its emphasis upon individual responsibility for health outcomes. This resonates with neo-liberal arguments about the size and scope of government which, in Victoria at least, we are seeing being worked out through increased targeting and tighter eligibility criteria for publicly-funded services, such as those provided through Community Health Centres, and through entrenchment of the funder/purchaser/provider split as exemplified in the Department of Human Services' recent proposal to amalgamate services to create a large Primary Health and Community Support platform at a sub-regional level. (Department of Human Services 1998a)

The advantages to governments of this approach are two-fold. On the one hand, it allows government to distance themselves from responsibility should service quality or funding levels decline. On the other hand, it allows governments to restrict the use of public services only to those members of our community deemed incapable of accepting individual responsibility or risk for their own health status.

The implications for low-income and disadvantaged older people are clear. Because low-income status in later life frequently mirrors a life-time of low paid employment and poor self-esteem, this group of older people is precisely those who are reliant upon publicly-provided pensions and services. Thus, when policy makers, demographers and politicians speak of the growing burden of older people, it is those who cannot exercise choice who may feel themselves to be the target of this discourse. At the same time, lack of resources, when combined with a life-time of disadvantage, also translates into a lack of choice when it comes to positive ageing. This is particularly true for those older people who are living in the private rental sector, including rooming houses, where high rents - Rent Assistance notwithstanding - can consume as much as 50% of their income. It is perhaps unfortunate that a recent Ministerial Taskforce has chosen to refer to this form of tenure as 'low-cost accommodation'. (Department of Human Services 1998b)

In the context of these two discourses, how low-income older people construct meanings of independence is complex and often contradictory. For not only are they the explicit subjects of the ageing as burden or dependency discourse but they are also those who cannot attain the idealised notion of independence promulgated by the positive ageing discourse.

Implicitly, both these discourses assume independence to be coterminous with financial status. To be an independent person is to be reliant upon your own resources. By contrast, of course, to be a dependent person is to possess no resources.

Dean and Taylor-Gooby have argued that dependency has been fetishised by both sides of politics. As they have written:

The key point they are making is that by stressing independence as an ideal state to which all should aspire, commentators from both the right and the left have obscured both the dependence and exploitation involved in certain valorised states of independence, such as wage labour for example, and the fiction of autonomy as an ontological state.

A number of those interviewed for the two projects did make a strong connection between independence and their financial situation. When asked what would improve their lives and why, several expressed the desire for more money or a win on Tattslotto so that they could buy a home of their own and not be dependent upon landlords or the Office of Housing.

However, most of those interviewed had a more complex notion of independence which, whilst related to their low-income status, was also integral to their sense of identity as working-class people. In a recent article on her experiences living in the East End of London, Sara Maitland reported:

Maitland concludes that, in Britain at least - and I suspect also in Australia to some extent - "class plays a fundamental role quite other than the function of wealth". (ibid: 29) In other words, it is the cultural basis of class that is critical.

One example of this was Dulcie. She is seventy-six years old and cares full-time for her husband who has had a number of strokes. They are both reliant upon the pension and pay $180 a week in rent for their two-bedroom house. Dulcie was adamant that she would not let anyone help her.

Dulcie also used her own experiences as a yardstick against which she measured others. She was particularly scathing towards those who sought help from charitable agencies.

Dulcie's experiences had produced a strong sense of ambivalence towards using Home and Community Care services that might ease her load. She reported that a worker at her local Community Health Centre wanted her to take up these services but so far she had refused. Dulcie said that when the time came "I would ask...It would take me a long time to get around to it".

Similarly, Lilian, a woman of ninety who is also caring for a sick husband, defined independence as "doing for myself". "I never depend on my family, they've got their life...I've never expected them to. While I can do for myself, I'll do for myself."

Lilian receives home help once a week but no other services, apart from the nurse who comes round with her husband's medication. Whilst she had no qualms about using the home help, Lilian was very unhappy with the quality of the work done. She reflected upon the time before the service was contracted out when she had known the workers over a period of several years. She was prepared to forgive the poor quality of the work today, though, if she felt she could trust the worker. Thus, for Lilian the relationship she could establish with the worker was more important than the work itself.

When it came to possibly being more dependent upon services in the future, Lilian was quite philosophical, saying "You've got to take what comes along", even though the prospect was clearly unpleasant.

Both Dulcie and Lilian had constructed their lives around managing. They had never been in debt and both women were proud of the fact that they could pay their way on a pension. For Dulcie, managing also meant wanting to be in control of determining if and when she would use HACC services. Lilian, however, interpreted this as not relying upon her extensive family. Despite their difficult cirumstances, both women were implicitly rejecting the discourse of older people as needy and dependent, to the extent that they were under-utilising the services to which they were entitled.

Dulcie’s refusal of services mirrors the results of research conducted overseas. Dant, for example, concluded that: "The complexity of the power relationship involved in dependency is relected in the refusal of services and benefits by elderly people - often in a way that is at one level clearly not in their interests." (Dant 1988: 184-185)

Governments appear unable to grasp the complex way in which low-income older people interpret independence. From a governmental perspective, independence is increasingly being defined as not being dependent upon the state. Even where government programmes such as HACC are available, its main purpose is to maintain independence at home; in other words, older people are not to become an additional burden through costly institutional care. Whilst this, perhaps fortuitously, coincides with older people’s own wishes it nonetheless sends out mixed messages.

The fact that one of the few ways low income older people can exercise independence or choice is through either refusing services or only using a bare minimum presents serious problems for the service delivery system.

One solution proposed by the Victorian Department of Human Services, that of a single entry point and streamlined assessment system under the PHACS, is only likely to alienate this group further. This one-stop shop approach is not a consumer focused system as the Department claims, but a simplistic administrative solution to complex human needs and desires. A truly consumer-focused system would be one which caters for the cultural diversity of the client group in a flexible manner, taking into account client preferences. The City of Yarra, for example, is currently experimenting with its meals on wheels service, including the possibility of using vouchers at local cafes.

More importantly, however, is the need for services to incoroporate community development in their work. Through this means, relationships of trust - rather than that of ‘the authorities’ and recipient - can be established between providers and client.

This may turn out to be the crucial factor in determining whether low-income older people enter the service network.

Clare, R. & A. Tulpule, Australia’s Ageing Society. Economic Planning Advisory Council Background Paper No. 37. AGPS, Canberra January 1994.

Dant, T. "Dependency and Old Age: Theoretical Accounts and Practical Understandings". Ageing and Society 8, 1988.

Dean, H. & P. Taylor-Gooby, Dependency culture: the explosion of a myth. Harvester Wheatsheaf, New York 1992.

Department of Human Services, Towards a Stronger Primary Health and Community Support System: A Discussion Paper. Melbourne 1998a.

Department of Human Services, Ministerial Taskforce on Support Services for Tenants in Low-Cost Accommodation. Melbourne 1998b.

Fox, N., "Charging Elders: Perverse Incentives and Poverty". Critical Social Policy 44/45 Autumn 1995.

Leveratt, M. "there’s always someone worse off than you..." A research project investigating whether low-income older persons living in insecure accommodation in the City of Yarra are able to gain access to the support services they may require. Brotherhood of St Laurence, Melbourne 1998.

Maitland, S. "The do things differently in the East End". New Statesman. 11 September 1998.

McCallum, J. "Health and Ageing: The last phase of the epidemiology transition" in A. Borowski, S. Encel & E. Ozanne, eds., Ageing and Social Policy in Australia. Cambridge University Press, Cambridge 1997.

McFee, G. & N. Rowley, "Developing a Positive Aging Agenda" in V. Minichiello, N. Chappell, H. Kendig & A. Walker, eds., Sociology of Aging. International Perspectives. International Sociological Association Research Committee on Aging, Melbourne 1996.

National Commission of Audit, Report to the Commonwealth Government. AGPS, Canberra June 1996.

Parliament of Victoria Family and Community Development Committee, Inquiry into Planning for Positive Ageing. December 1997.

Teshuva, K., Y. Stanislavsky & H. Kendig, Towards Healthy Ageing. Literature Review. Collins Dove, Blackburn 1994.