Care for the elderly��a Fire and Rescue Service problem? As our elderly population continues to grow, a leading fire safety expert addresses the potential difficulties of caring for this group and the effect it will have on the Fire and Rescue Service and fire prevention activity

THE PROBLEM WITH GROWING OLD is that it seems to creep up on you so that you only realise it is happening when things which you never gave much thought to now take more time and effort and a good walk induces aches and pains in places that you never knew you had. Unfortunately, the ageing process is one that catches up with us all irrespective of individual circumstances. You may be able to offset and reduce the rigours of the ageing process, but it is a certain fact that you cannot halt it.

I'm from the generation known as the "baby boomers"--people born in the years immediately following the end of the Second World War. Due to advances in medical science and care, allied to improved living conditions and greater social and personal awareness, my generation can generally look forward to a longer lifespan than previous generations. It is also an issue which is concentrating minds in governments, where terms like the "grey vote" and "pensioner power" are often to be heard in the corridors of power as the collective voice of the increasing numbers joining those groups becomes increasingly robust.

Caring for the elderly

One of the potential issues that this longevity brings for the governments and assemblies of the countries making up the UK is the long-term question of caring for a growing elderly population. It is also a question that has concerned me for some time and some readers may have heard me express my concerns before in public forums over what it may mean for the fire and rescue services.

My concern is how government will care for the increasing numbers of elderly people so that they can live out their lives in dignity and safety, and the effect that the policies of government in this matter will have upon the Fire and Rescue Service.

We can get an insight into the thinking of the current government in Westminster from a recent article in the January 2005 edition of Saga magazine, where their reporter, Rachel Carlyle, interviewed Dr Stephen Ladyman MP, Parliamentary Under Secretary of State at the Department of Health. (1) In his interview Dr Ladyman MP referred to his vision of care for the elderly as being a two tiered system; the first tier being one of a series of options:

* Firstly, adaptations to the person's home to allow them to stay there for as long as they are able with care being provided from an external source as necessary, or

* Secondly, to move or even buy into a sheltered housing scheme with care and communal facilities available, or

* Thirdly, an "Extra Care" scheme consisting of super sheltered flats or bungalows with central communal facilities including nursing and medical care on site.

The second tier of care, which would be for the most care dependent persons and at their choice, is to move into a residential care home.

The options that Dr Ladyman envisages offer choice and enable people to stay in their own homes if they wish to, or move to sheltered homes or extra care homes where they have their own front door and their privacy, but have care and communal facilities to hand. I have noticed that a number of local authorities are now moving to the monitored sheltered housing approach and also introducing 2417 staffed central call centres to monitor the health and safety of the residents and provide assistance to them. Some have converted and improved redundant multi-storey blocks of flats to this purpose which have also proved very popular.

Extra Care

The concept of "Extra Care" schemes is still fairly new to the UK, but is already developing in the USA where they are referred to as "care villages". The Saga article refers to the Joseph Rowntree Foundation's Hartrigg Oaks development near York which has 52 bungalows set around a community block which includes a library, restaurant, hairdresser and IT room. Each dwelling has access to home helps and nursing care, but there is also a 42-bed care home on site if residents can no longer cope atone. (2)

If these are the potential options for the care of the elderly that government is considering and the Fire and Rescue Services may be presented with (although some are already happening) then perhaps we need to start considering now how we might deal with them so that the threat of fire is not something that the elderly need to worry about in the future. Certainly, it is something that the FBU is very conscious of and was one of the factors that influenced our ongoing NO2 Fire Deaths campaign.

In the case of the elderly who choose to remain in their own home and have it improved so that they can remain there with assistance from external service providers then we need to consider the fire protection of these properties very carefully. There also has to be a remote monitoring facility by which assistance can be summoned, automatically if necessary.

The home improvement process has to include funding for safety issues to enable the elderly to improve the safety and security of their home as well as its accessibility and usability. If this is not so then we create the risk of people living in their own homes who may not be able to afford to provide the necessary degree of safety that they will require. They should be at no more risk than people who have chosen to move into sheltered accommodation and their homes should have the same safety facilities present.

Alarms and sprinklers

In the case of purpose built sheltered or extra care accommodation units I believe that the implications of designing for an ageing occupancy moves us into the realms of advanced and integrated electronic fire alarm, safety and security systems which are remotely monitored and linked to personal alarms carried by residents that would actuate the safety system if they fall, or collapse, or wish to summon assistance for whatever reason, looking at a defence against a fire in such premises in addition to the provision of effective fire separation measures surely we must now also be contemplating the mandatory provision of residential sprinkler systems in such premises. The Scots have already made this connection, which will become a requirement of their Building Regulations in April of this year for all new build sheltered accommodation. How long will it be before England and Wales follow suit?

I do not believe that we should be talking about trade offs in fire safety measures for premises which are being designed and built purely for occupation by the elderly, but one of a combined and full on safety approach because the potential frailty of the residents dictates that it must be so even if they are not frail when they enter such accommodation. I can say that with some experience because as a result of the length of time that I spent as a fire prevention officer I was able to observe at first hand the effects of the passage of time upon residents of all types of sheltered accommodation.

After 10 to 15 years had passed, of those residents who were still alive some were having difficulties coping with the everyday tasks that they had managed perfectly adequately when they first moved in. Some were still just about capable of caring for themselves with assistance from on site staff or other residents. A very strong sense of community had also developed so that residents who perhaps should have moved to a residential care home became very distressed and upset if this was suggested, a situation which is completely understandable.

What was dearly needed was a careful consideration of the long-term needs of the elderly in planning the buildings they would live in, the level and provision of services that they would need to maintain their quality of life and the life safety protection that would be built in for their protection. This can be summed up as I said above by the security provided for residents by access to on site or externally monitored 24/7 care services backed up by electronic safety and security systems properly integrated with a combination of structural fire safety measures and automatic fire suppression systems.

Finally and by no means least, when the need arose, which it did on a number of occasions, there is the absolute need for the surety of an effective Fire and Rescue Service safety net response to ensure that residents do not become yet another fire statistic.

Whatever we do we have to address the twin issues of user friendly long term care for the elderly and protecting them from fire because they will not go away and every day that passes brings you and I closer to experiencing them at first hand. I hope that if nothing else this article starts you thinking about these matters.

Glyn Evans is Fire Safety Adviser to the Fire Brigades Union

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