OPJSNA Factsheet 2: Wider determinants of Health in Older People (Income, Benefits and Poverty) Summary Having sufficient income is a key factor in older people maintaining health, well-being and independence. In 2010, one in four people aged 65 or over in Southwark were in receipt of pension credit- a means tested benefit, and indicator of income deprivation. One in four eligible older households in Southwark may not claim means- tested benefits they are entitled to. The local picture The 2010 map for income deprivation affecting older people (IDAOPI) shows significant deprivation in all wards other than the most southerly wards of College, Village, East Dulwich and Peckham Rye. The data is generated from the numbers of claimants of guaranteed pension credit. It covers geographical units called middle super output areas (MSOAs). MSOAs have a minimum population of 5,000, with an overall mean of 7,200 and fit into the local authority boundaries of 2003. About a quarter (45) of Southwark s 165 Super Output areas fall within the 10% most deprived nationally, and 129 (four fifths) of Southwark s Super Output areas fall within the 30% most deprived areas. Although IMD 2010 suggests that overall Southwark is relatively less deprived than in 2007, the IDAOPI 2010 suggests deprivation among older people is increasing compared to 2007. This means that fewer older people in Southwark who are in a position to purchase their own social care, than nationally. Southwark Older People s JSNA 2012 1
Southwark Index of Multiple Deprivation 2010 Income Deprivation Affecting Older People Index (IDAOPI) Cathedrals Riverside Chaucer Grange Rotherhithe Surrey Docks East Walworth South Bermondsey Newington Faraday Livesey Camberwell Green Peckham Brunswick Park The Lane Nunhead South Camberwell Peckham Rye Village East Dulwich College Income Deprivation Affecting Older People Index 2010 by Lower Super Output Areas and Wards 80 to 90% (Least deprived) 70 to 80% 60 to 70% 50 to 60% 40 to 50% 30 to 40% 20 to 30% 10 to 20% 0 to 10% (Most deprived) Southw ark Boundary Wards Low er Super Output Areas Note: percentages (deciles) calculated by ordering England's 32482 Super Output Areas by rank and splitting into 10% intervals. As a result, the above map show s Southw ark's Low er Super Output Areas that are w ithin the 10%, 10-20%, 20-30% etc most deprived compared to the rest of England Produced by NHS Southw ark Public Health, N. Jani, 2011 Contains Ordnance Survey data Crow n copyright and database rights 2010. Southwark Older People s JSNA 2012 2
Income deprivation may limit quality of life and affect their mental and physical wellbeing and may lead to social exclusion. Many older people are unable to afford to get out and about, or socialise, yet staying active helps build and maintain social networks and boosts self-esteem. Being housebound can often lead to severe loneliness or depression. For older carers, finances are a major source of anxiety /depression and income deprivation may prevent them from taking the active role they would like to in supporting others. Coping strategies in order to manage on their low incomes include Cutting back on regular outgoings such as food, heating and clothing Nutritional deprivation, for example buying food past its sell-by date, skipping essential meals or making items such as canned soup last for several days. Help the Aged 2008 Benefit and pension recipients As at May 2011, 20,890 people over the age of 65 in Southwark received the state pension. (More detail is shown in the Appendix). Small numbers of people receiving state pensions will also receive second state pensions or occupational or private pensions. In May 2011, 10,290 people over the age of 65 (41% of all people aged 65 and above) were beneficiaries of a means- tested benefits such as pension credit 1 guarantee, savings or both. 8,730 (34%) were beneficiaries of guaranteed pension credit only, 10,522 people across all housing tenures over the age of 65 were in receipt of Housing Benefit and/or Council Tax benefit as at 27.11.11. The 2008 Southwark Housing Requirements Survey estimated that over 60% of all older households have an income of less than 10,000, compared to less than 30% for other households. A single person who gets a state pension topped up by guarantee pension credit has an income of 7,142 per annum. This indicates there is a group of older people within Southwark living on very limited budgets, if not in actual poverty. In 2010-11, 148 Southwark residents over the age of 65 came to the 1 Pension Credit Guarantee is a means tested benefit which tops weekly income up to 137.35 for single people and 209.70 for couples. These sums may be increased for people who are disabled, have caring responsibilities or certain housing costs, such as mortgage interest payments. Savings Credit is available to those who have a small amount of savings/additional private pension and amounts to a maximum of 20.52 a week for single people and 27.09 a week for couples. Southwark Older People s JSNA 2012 3
Citizens Advice Bureau for advice about debt about 7% of all such enquiries by Southwark residents. Disability-related benefits In addition to pension and pension credit income, 6, 660 people over the age of 65 receive disability related benefits. As at May 2011, 2,260 people received Disability Living Allowance (DLA) and 4,400 received Attendance Allowance (AA). DLA - is a tax-free benefit initially claimed before the age of 65 by people who need help with personal care or have walking difficulties because of physical or mental disability. Payments vary according to need, starting at 19.55 per week rising to 125.00 for the highest level of care and mobility needs together. 2 Attendance Allowance is a tax free non means -tested allowance payable to people over the age of 65 who are severely physically or mentally disabled, and need significant help with personal care or supervision. As at May 2011, 4,665 people over the age of 65 received AA, the largest number of recipients are aged over 75, 64% are female, 63% of claimants received the higher level award, indicating severe disability within the group. This bias towards higher levels of needs suggests that there may be under-claiming at lower levels of the allowance. More detailed information is available in Table 3 in the Appendix. Being eligible for any disability related benefit can increase the amount of other benefits such as Pension Credit; Housing Benefit; Council Tax Benefit, eligibility for Blue Badges etc. This may have a significant impact on the welfare of the older person s household over and above the cash value of the benefit involved. This complexity of the system around disability related benefits underlines the need for older people to be able to get easy access to benefits and financial advice, especially where there are changes in circumstance such a spouse becoming ill. Under-claiming of benefits There is evidence that many people fail to claim benefits to which they are entitled. The DWP produces an annual report estimating take- up of income -related benefits at national level. There are no similar estimates for disability related benefits. The current estimates of take- up of means- tested benefits relevant to older people nationally are: Pension Credit - 62% to 73% of those eligible are currently claiming Housing Benefit 77% to 86% of those eligible are currently claiming Council Tax Benefit 63% to 70% of those eligible are currently claiming 2 2,820 people aged between 55 and 64 receive this benefit indicating a cohort with some degree of disability moving into later life. Southwark Older People s JSNA 2012 4
We do not have local data on those under-claiming. National data suggests that a higher proportion of owner-occupiers fail to claim the pension credit they are entitled to, and this is a smaller proportion of older people in Southwark. Reasons for under-claiming may include Not being aware of entitlements to financial help or that a change in health status or living circumstances may trigger eligibility; Being put off applying for benefit by the extra rules, procedures and the complexity of the application form; Language or literacy problems Not being an internet user and unable to make use of online information Dislike of visiting official premises; A culture of stoicism and self-reliance with reluctance to ask for handouts Unwillingness to disclose details of their income and savings due to the perception of the government prying into private matters Poor previous experience of applying for benefit e.g. lengthy claim process or being refused (this may happen for instance at an early stage of a disability or illness) Lack of support or personal contact during the claim process; An assumption that if the customer claims a DWP state benefit that Housing / Council Tax benefit will be dealt with automatically; Physical disability which makes visiting offices difficult; Mild cognitive impairment and memory problems which make keeping appointments etc. confusing and difficult Sight/ hearing problems creating difficulties in handling forms, telephone calls etc. What we know works The proposal for a flat pension worth 140 per week in future would mean an end to pension credit means-testing. This is likely to benefit Southwark residents who qualify for pension credit but fail to claim it. It may also bring a modest rise to those who are just above the pension credit threshold. Older people and their carers benefit from: Access to seamless, timely financial advice which addresses income maximisation, debt, and welfare benefits, housing- related benefits and grants and home energy efficiency. Systematic identification (across health, social and housing services and the voluntary sector) of vulnerable people who may need advice and support in maximising their income and benefits. Informed support to help older people get the most from personal budget schemes, particularly the cash direct payment option. Systems that ensure those self-funders and their carers can still access the full range of information, advice and assessment services and/or are signposted to Southwark Older People s JSNA 2012 5
accredited advice services such as those run by Council and Care of the Elderly Accommodation Counsel. (http://www.counselandcare.org.uk/, http://www.housingcare.org/ and http://www.firststopcareadvice.org.uk/). Many self funders have limited assets and will require future local authority funding once their means fall below 23, 250 and good financial planning (e.g. Attendance Allowance, Home Equity release) will prolong their independence. (LGiU Independent Aging) Local Action In 2005 the New Policy Institute estimated that 24-25% of eligible older households in Southwark were not claiming the means- tested benefits that they were entitled to. Southwark Welfare Benefits Hub works in partnership with the local DWP office, Southwark Housing Benefit and Council Tax Benefit services, Social Workers, the Charging team and the Hospital Discharge team (a major source of referrals) ) and local voluntary and community groups, to improve uptake of benefits. It offers advice sessions in one stop shops and two GP surgeries. Since 2004, it has raised over 25 million in benefit maximisation. However many people remain unaware of their potential entitlement to means tested or disability related benefits. Examples of current activity are: Making home visits to people who are over 80 and not claiming Attendance Allowance, to see if they are eligible and help them apply. (300 currently on the list) Offering benefit maximisation checks to people without mental capacity for whom the Local Authority acts as Corporate Appointee List, Targeting community groups, Including the Alzheimer's Society, Sheltered accommodation and Age Concern Day centres. Economic activity 3,100 over 65s in Southwark are estimated to be economically active (Annual Population Survey, March 2011). With the forthcoming rise in pensionable age, these numbers will increase. Many more are active in a voluntary capacity. This activity is likely to enhance well- being. User views In 2010 the council commissioned DEMOS to ascertain the views of older people and younger disabled adults. Thirty five percent of the 338 older people questioned, indicated that the lack of money was the most significant thing that they would change about their life (Following only from an improvement in their health. Similarly work undertaken with older people in Southwark in 2011 through the PECCI funded through money awarded by The Department for Communities and Local Southwark Older People s JSNA 2012 6
Government, found that lack of financial resources was a significant factor for older people to loose their independence. Fuel poverty remains a significant issue amongst the older population of the borough. What still needs to be done The World Health Organisation (WHO) Age-Friendly Environments programme promotes an age-friendly environment, and encourages active ageing by optimising opportunities for health, participation and security so as to enrich quality of life, though improving outdoor spaces and buildings transportation housing social participation respect and social inclusion civic participation and employment communication and information community support and health services. WHO Global Age-friendly Cities: A Guide 3 Town planners will be important to progress this as the neighbourhood environment will need to be one that is hospitable to older people in terms of the above criteria. 3 http://www.who.int/ageing/publications/global_age_friendly_cities_guide_english.pd Southwark Older People s JSNA 2012 7
Appendix Table 1: Benefit claimants of the state pension and average weekly payment in May 2011 Age group Number Payment aged 65-69 5,710 109.30 aged 70-74 5,170 110.45 aged 75-79 4,130 117.77 aged 80-84 3,090 122.85 aged 85-89 1,860 120.30 aged 90 and over 920 113.26 unknown age 10 90.64 Total 20,890 114.41 Source: DWP data on NOMIS Table 2: Beneficiaries of pension credit in May 2011 Age Guarantee credit only Savings credit only Both guarantee and savings credit Total 65-69 1,690 300 730 2,730 70-74 1,530 350 700 2,590 75-79 1,040 300 610 1,950 80-84 560 320 590 1,480 85-89 290 210 490 990 90 and over 130 70 350 540 unknown 10 ~ ~ 10 age Total 5,250 1,560 3,480 10,290 Source: DWP data on NOMIS Southwark Older People s JSNA 2012 8
Table 3: Attendance Allowance Claims in May 2011 Ward Name Total 65-74 75-84 85 and over Male Female Lower Rate Higher Rate Brunswick Park 200 55 90 55 75 125 65 135 Camberwell Green 250 55 125 70 80 170 90 160 Cathedrals 245 50 125 70 95 150 100 145 Chaucer 160 35 75 50 60 100 50 110 College 185 15 75 95 60 125 80 105 East Dulwich 190 30 90 70 70 120 75 115 East Walworth 240 55 120 65 100 140 90 150 Faraday 205 50 90 65 70 135 65 140 Grange 225 45 95 85 85 140 80 145 Livesey 290 60 145 85 110 180 130 160 Newington 310 65 140 105 125 185 105 205 Nunhead 315 65 140 110 105 210 125 190 Peckham 195 50 95 50 70 125 70 125 Peckham Rye 195 35 90 70 70 125 75 120 Riverside 210 40 100 70 70 140 85 125 Rotherhithe 240 20 125 95 85 155 90 150 South Bermondsey 210 45 95 70 80 130 70 140 South Camberwell 165 30 70 65 50 115 50 115 Surrey Docks 165 35 75 55 65 100 55 110 The Lane 305 65 130 110 105 200 100 205 Village 165 20 65 80 35 130 55 110 Totals 4665 920 2155 1590 1665 3000 1705 2960 Southwark Older People s JSNA 2012 9