Funding for research into living well in later life

Nearly 80 years ago, as one of its first major projects, the Nuffield Foundation set up a commission headed by Benjamin Seebohm Rowntree.

His 1947 report ‘Old People: report of a survey committee on the problems of ageing and the care of old people’ documented the conditions in which older people lived and worked, including the public assistance institutions in which an estimated 5% of the ‘aged population’ lived and the often damp, cold dwellings, many without plumbing, of the ‘aged poor’. He made practical recommendations, with a stress on quality of care, about how more ‘independent living’ might be encouraged and suggested the need for continuing research and policy co-ordination if matters were to improve.

Since then, living standards and life expectancy have both improved, but concerns about the welfare of people in later life and the quality of their care endure. Older people make up an increasing proportion of the UK population, with projections suggesting that by 2050 one in four people will be over 65 and one in twenty will be over 85. For many people, living longer means experiencing more years of poor health towards the end of their life. As a society, the value we place on longevity is reflected in the practice of our healthcare system. But there has been much less focus on what it means to live well and with dignity in later life.

What support and care might older people need to draw on?

In line with Benjamin Rowntree’s recommendations, the Nuffield Foundation remains committed to funding research designed to improve the lives of older people and their families. In the past, much of this research has focussed on the financial aspects of later life. But in keeping with our broader welfare agenda, we would also like to focus on the support and care, defined in the broadest sense but with the exception of medical care, that older people might need to draw on. From early help with maintaining independence when facing the onset of disabilities and functional limitations, right up to the moment of death. Analysis of current policy debates around the financing of social care clearly fits in to such a remit, but so does broader work on the care needs, and preferences, of older adults and their families in the last years of their lives.

How do people experience care and quality of life in the final stages of life?

Surprisingly little is known about the dynamics of later life situations and outcomes for those who need or draw on support, ranging from occasional help with shopping or technology through to assisted living and care home settings. There is a lack of high-quality data on people in different types of formal care setting and little knowledge of the experiences of care and quality of life in the final stages of life for the older population more generally. These are significant gaps that need to be filled if we are to improve understanding of the effects of the current system on the well-being of older people.

In addition, we want to encourage investigation into people’s autonomy, their preferences for the way they want to live in later life and exploration of the factors that determine their need for support (our Oliver Bird Fund has a specific focus on the experience of those living with musculoskeletal conditions). For older people with family, how do family members want to spend time with and care for their loved ones? This will differ enormously and depend on emotional ties and physical proximity, along with other commitments such as work and childcare. We also want to understand more about the experiences of older people without the support of family to draw on. And as a society, how do we want to provide for the dignity, care, and well-being of people in the latter years of their life?

What combination of support will best meet the needs of older people?

Equally important is consideration of how these preferences might be met, and how risks of adverse outcomes might be mitigated or insured against. We know that support will come from a range of sources, from a person’s own resources, accumulated as a result of decisions and experiences across their lifetime, but also from family, community, the private sector, and/or the state. We do not know how these supports might be best combined to meet the needs of older people and their families and the trade-offs therein. We also lack a holistic picture of the interdependence between the pensions, health, and social care systems and their effects on people’s outcomes.

This will vary across the four nations of the UK. In England, by capping the amount that people will need to spend on their personal care, recent reforms to adult social care funding have moved some of the risk for some individuals to the state. But these reforms will still leave a major pillar of welfare support being provided privately – through private care services and homes – and paid for by individuals, for whom the total costs are uncertain, making it difficult to plan.

What support and care policies and practice, or finance innovations, might improve well-being for older people and meet society’s aspirations for supporting people in later life? And, on the supply side, what are the barriers that need to be overcome if we are to rely on the private sector to provide for increasing care needs around the country. How might this depend on, or interact with, the way in which such care is financed? And how are these debates likely to play out in the other nations of the UK?

Can you help answer some of these questions?

Answering questions like these is essential if we have an aspiration to fit the social care system into other formal and informal institutions that support older people, both now and in the future. We want to fund research that can help answer these questions around the future of care for older people in the UK and are seeking proposals from a wide range of academic disciplines. Not just from traditional fields such as social policy, economics, and finance, but also from disciplines such as philosophy and ethics, law, anthropology and ethnography, or any other fields that study the preferences, choices, and constraints of older people. We also welcome applications that bring an interdisciplinary, and particularly a multidisciplinary, perspective.

If you have an idea that responds to these interests, please submit an outline application to our Research, Development and Analysis Fund for consideration.