Ageing through Austerity: Critical Perspectives from Ireland 9781447316251

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AGEING THROUGH AUSTERITY Critical perspectives from Ireland

Edited by Kieran Walsh Gemma M. Carney and Áine Ní Léime

AGEING THROUGH AUSTERITY Critical perspectives from Ireland Edited by Kieran Walsh, Gemma M. Carney and Áine Ní Léime

First published in Great Britain in 2015 by Policy Press North America office: University of Bristol Policy Press 1-9 Old Park Hill c/o The University of Chicago Press Bristol 1427 East 60th Street BS2 8BB Chicago, IL 60637, USA UK t: +1 773 702 7700 t: +44 (0)117 954 5940 f: +1 773-702-9756 [email protected] [email protected] www.policypress.co.uk www.press.uchicago.edu © Policy Press 2015 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book has been requested ISBN 978 1 44731 623 7 hardcover The right of Kieran Walsh, Gemma M. Carney and Áine Ní Léime to be identified as editors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved: no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission of Policy Press. The statements and opinions contained within this publication are solely those of the editors and contributors and not of the University of Bristol or Policy Press. The University of Bristol and Policy Press disclaim responsibility for any injury to persons or property resulting from any material published in this publication. Policy Press works to counter discrimination on grounds of gender, race, disability, age and sexuality. Cover design by Policy Press Front cover image kindly supplied by Gemma Hodge Printed and bound in Great Britain by CPI Group (UK) Ltd, Croydon, CR0 4YY Policy Press uses environmentally responsible print partners

Contents List of tables and figures iv Acknowledgements v Notes on contributors vi Foreword by Alan Walker viii one Introduction social policy and ageing through 1 austerity Kieran Walsh, Gemma M. Carney and Áine Ní Léime two Contextualising ageing in Ireland 17 Sheelah Connolly three Citizenship in an age of austerity: towards a constructive 31 politics of ageing Gemma M. Carney four Active ageing: social participation and volunteering in 47 later life Áine Ní Léime and Sheelah Connolly five Pension provision, gender, ageing and work in Ireland 63 Áine Ní Léime, Nata Duvvury and Aoife Callan six Interrogating the ‘age-friendly community’ in austerity: 79 myths, realities and the influence of place context Kieran Walsh seven Reframing policy for dementia 97 Eamon O’Shea, Suzanne Cahill and Maria Pierce eight Between inclusion and exclusion in later life 113 Thomas Scharf nine Conclusion – beyond austerity: critical issues for future 131 policy Gemma M. Carney, Kieran Walsh and Áine Ní Léime Afterword: Austerity policies and new forms of solidarity Chris Phillipson

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References 155 Index 189

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List of tables and figures Tables 2.1 2.2 2.3 2.4 2.5 2.6 7.1 8.1

Population aged 65 and over as a percentage of the total population – 2010, 2030 and 2050 Marital status (%) by sex for those aged 65 and older, Ireland – 2011 Educational attainment (%) by age group, Ireland – 2011 ‘At risk of poverty’ rate (%) by age group, 2004, 2009 and 2011 Life expectancy at 65 for females and males, 2011 (or nearest year available) Total public social expenditure and old age social spending as a percentage of gross domestic product Estimates of the number of people with dementia in Ireland, 2011 11-item basic deprivation index

19 20 21 22 23 25 100 121

Figure 2.1

Number of people aged 65 and older in Ireland, 1951–2011 18

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Acknowledgements We would like to thank all the contributors to this text for their insightful analyses and their perseverance with this process. We would especially like to express our appreciation to Alan Walker and Chris Phillipson for their contributions to the Foreword and Afterword of this book, respectively, in addition to providing feedback on the overall volume. We would like to thank Isobel Bainton and her colleagues at Policy Press for all their very kind and helpful guidance in publishing this text. For their administrative support and constant assistance throughout this process, we would like to thank Sandra Hallinan and Christine De Largy of the Irish Centre for Social Gerontology. For their mentorship and invaluable comments on early versions of this text, we would like to thank Thomas Scharf, Director, and Eamon O’Shea, Founding Director, of the Irish Centre for Social Gerontology. We would also like to thank the community of older people associated with the Irish Centre for Social Gerontology, who have inspired and supported our work since the centre was founded in 2006. Finally, we would like to express sincere thanks to our respective families for their continuous support and encouragement.

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Notes on contributors Suzanne Cahill is Director of The Dementia Services Information and Development Centre’s research programme at Trinity College Dublin and Research Associate Professor of Social Work and Social Policy, Trinity College Dublin. Aoife Callan is a post-doctoral researcher with the Discipline of Economics, National University of Ireland Galway, and a former post-doctoral researcher with the Irish Centre for Social Gerontology, National University of Ireland Galway. Gemma M. Carney is Lecturer in Social Policy and Ageing at the School of Sociology, Social Policy and Social Work, Queen’s University, Belfast, Northern Ireland. From 2008 to 2013, she was Research Fellow at the Irish Centre for Social Gerontology, National University of Ireland Galway. Sheelah Connolly is a research officer at the Economic and Social Research Institute, Dublin and a former Research Fellow with the Irish Centre for Social Gerontology, National University of Ireland Galway. Nata Duvvury is Lecturer in Global Women’s Studies at the School of Political Science and Sociology at the National University of Ireland Galway. Áine Ní Léime is a Marie-Curie Fellow and Research Fellow at Project Lifecourse and the Irish Centre for Social Gerontology, National University of Ireland Galway. Eamon O’Shea is a Personal Professor in the School of Business and Economics at the National University of Ireland Galway, and Founding Director of the Irish Centre for Social Gerontology at the National University of Ireland Galway. Chris Phillipson is Professor of Sociology and Social Gerontology, at the Manchester Institute for Collaborative Research on Ageing, at the University of Manchester. Maria Pierce is a postdoctoral researcher in the School of Nursing and Human Sciences in Dublin City University.

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Notes on contributors

Thomas Scharf is Director of the Irish Centre for Social Gerontology and Academic Director of Project Lifecourse at the National University of Ireland Galway. Alan Walker CBE, FBA is Professor of Social Policy and Social Gerontology and Director of the New Dynamics of Ageing Programme at the University of Sheffield. Kieran Walsh is Senior Research Fellow at Project Lifecourse and Deputy Director of the Irish Centre for Social Gerontology at the National University of Ireland Galway.

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Foreword Alan Walker I am delighted to provide the foreword to this book. The book’s main contribution is the bringing together of varied discourses concerning the social policy impact of ageing within the context of fiscal austerity. As the editors rightly state, the economic recession has sharpened the focus of governments on the implication of demographic ageing. It is vital, therefore, as the editors again argue, that the social policy implications of societal ageing are studied and understood within a wider political economy of austerity. Of course, the fiscal crisis of the 1970s and the ensuing first wave of neoliberalism in the AngloSaxon countries in the 1980s gave us a foretaste of the various ways in which the public burden thesis has been applied with great force to the older population. This recession is different, certainly in Ireland, but a combination of neoliberal ideology and neoclassical economics is enforcing severe budgetary constraint on a range of countries (within and outside of the Eurozone) in the name of funding deficits. Policymakers appear to be disinterested in both the origins of the 2008 financial crisis and the distributional consequences of their austerity policies. In the absence of official concern, social science research has a key role to play. We should not lament the absence thus far of critical perspectives on ageing and austerity because events are still unfolding before us. In fact, it is helpful to remind ourselves that poverty and inequality in later life did not originate with post-2008 austerity policies. What the latter have done is to exacerbate existing inequalities, particularly between rich and poor, and added new ones. Located as it is within a critical-gerontology perspective, it is not surprising that this volume is sensitive to the importance of unequal ageing. This is exemplified in discussions of the extending working life agenda and social inclusion and exclusion. A further significant contribution of the book, in my view, is to bring Ireland in from the cold in social-gerontology literature by providing us with a specific case study of austerity and ageing. In social policy terms, Ireland is often seen as an appendage of the UK, being similarly classified as a ‘liberal’ welfare regime, which is wrong in many ways – size, culture, rural–urban split and membership of the Eurozone,

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to name only four. It is helpful and refreshing to see an account of contemporary ageing in Ireland in its own right. There is much that is special about Ireland in gerontological and social policy terms. For example, it is a relatively young country, with only 12% aged 65 and over. In policy terms, the constitutional role of the Catholic Church is unusual. As the editors note, the economic boom years saw Ireland develop a dual political economy of US-style free-market liberalism with elements of European-style social policy. The crash left the country in dire straits, with no effective democratic control over the policies agreed as part of the 2010 European Union (EU) bailout. Given such particularity, does a study of age and austerity in Ireland contain any broader lessons? There are at least two. First, the programme of severe cuts to social spending mirror those inflicted on the welfare state in the UK (and hark back to the first wave neoliberalism of the 1980s). Remarkably for a European welfare state the UK is projected to be devoting a lower proportion of gross domestic product (GDP) to social spending in 2020 than will the US. It is essential that the distributional impact of these cuts is catalogued nationally and their consequences examined, both for the purposes of domestic policymaking and in the interests of comparative research. Second, it is important to track the effects of austerity politics on older people (and other groups) and on relations between the generations. As older people are the largest users of welfare states in most European countries, it is inevitable that sharp cuts in social spending, without mitigation, will affect them disproportionately. As in the UK, however, the picture in Ireland appears to be one in which older people have fared better than some other groups, such as young people with minimum qualifications. The danger, in both countries, is that this outcome will be used to stoke the flames of intergenerational conflict, as happened in the UK and the US in the 1980s, for example. Crude generational politics, appealing to an often ignorant and invariably credulous media, targets vital risk protections in the form of social policy measures that were hard-fought for and won by previous generations. In the hands of politicians who oppose public provision as a matter of principle, these welfare state institutions could be undermined. So, those who oppose such crude characterisations of whole generations need research evidence to support their arguments. In fact, on close inspection, what one finds is that some groups of older people have fared well, especially the affluent among the young-old, but so, too, have some groups of young people. This emphasises the significance of an unequal ageing perspective.

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It is for these reasons that I warmly welcome and endorse this book. It represents a carefully crafted case study of the relationship between ageing and austerity, and one that has considerable relevance, beyond Irish shores, for both ageing and social policy research and the framing of alternatives to market-obsessed neoliberalism. Alan Walker Professor of Social Policy and Social Gerontology, and Director of the New Dynamics of Ageing Programme University of Sheffield October 2014

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ONE

Introduction – social policy and ageing through austerity Kieran Walsh, Gemma M. Carney and Áine Ní Léime

Introduction Demographic ageing is identified as a global challenge with significant social policy implications across local, national and international contexts. The 2008 economic crisis and related austerity policies further compounds and complicates this challenge, whether we are considering a single national setting, the European Union (EU) or a broader international environment. However, the degree to which austerity impacts on social policy issues for older people, and frames approaches to the development of related policy, at these different scalar levels has been under-researched. As in many other advanced industrial nations, Ireland’s population is ageing. The proportion of the Irish population over the age of 65 years is projected to more than double over the next 30 years (Central Statistics Office, 2013a). As is the case in many other nations, these ageing population structures have raised concerns in Ireland about the ability of its social policy and its various social systems to cope with such a demographic shift. In the wider European context, and in the face of accelerated ageing patterns, questions around the readiness of societies, the capacity of pension and social transfer schemes, the adequacy of health and social care systems, and the sustainability of communities are certainly pervasive within spheres of policy and governance (eg European Commission, 2010). Such questions existed before the global economic recession of 2008 and the subsequent introduction of austerity-driven policy; they also reflect globalised processes of economic and social change, and shifting patterns in markets, families, labour mobility, communities and individualisation in social security infrastructure. While the legitimacy of some of these concerns may be more questionable than others, a distinct and enveloping burden discourse, where an increasing older population represents a

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Ageing through austerity

financially and socially crippling challenge, appears to have taken hold of much of the political rhetoric on ageing. This is true for a range of different country settings that possess different welfare regimes and different political ideologies (Estes et al, 2003; Powell, 2010; Coole, 2012; Phillipson, 2013). This is also to the neglect of the diversity of individuals, local political-economy contexts (Phillipson, 2007) and the value-based forces that shape social policy within those contexts. In many ways, the economic recession has served to sharpen the focus of policymakers and governments on the implications of demographic ageing for under-resourced and struggling public fiscal systems. It is necessary, therefore, that the social policy pressures characterising ageing societies are understood within the current economic recession and, perhaps more importantly, the ever-evolving circumstances of austerity. As evidenced by Ireland, and other countries implicated in the European economic crisis, austerity appears to be the dominant policy pursued by many EU member states (Clark and Newman, 2012; Levitas, 2012; Blyth, 2013; Busch et al, 2013), regardless of their traditional ideologies. Austerity is also the approach that has been largely endorsed by the EU, and ‘stipulated’ by the ‘Troika’ – the tri-partite of funders for ‘bailout nations’ (ie the EU, the European Central Bank [ECB] and the International Monetary Fund [IMF]) (Matsaganis, 2012; Busch et al, 2013). There have been suggestions that these developments will shape not only the lives of today’s older population, in such areas as work and retirement, care, generational solidarity, and social integration (Hillyard et al, 2010; Walker, 2012; Caïs and Folguera, 2013; Phillipson, 2013; Warburton et al, 2013; Milbourne, forthcoming), but also the lives of future generations of older adults. With a significant rise in unemployment figures, mounting personal and state debt, and increases in inequality and economic stagnation (Rajan, 2010; Crotty, 2012; Nolan et al, 2014), it is not difficult to see why this might be the case. However, a critical understanding of how the economic recession and austerity policies affect older people has yet to be developed in a meaningful way. Despite some notable critiques of the austerity approach (eg Blyth, 2013; Mirowski, 2013; Schui, 2014) and its impact on people’s lives (eg O’Hara, 2014), the extent to which the global economic crisis intensifies problems experienced in later life has been largely neglected as a research and policy topic. Instead, the focus has typically been on how ageing demographics contribute to the challenge of the crisis, making its resolution less certain (Liedtke and Schanz, 2012; Phillipson, 2013) – echoing the observations of Estes (1986) during a previous period of recession. Even when

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Introduction

such overt arguments are not made, ageing is often a part of the politically weighted contextual preamble that is used to justify harsh policy measures (Walker, 2012). Narratives of older people being disproportionally protected from the worst of austerity have also been evident in some European jurisdictions. Walker (2012) has suggested that the apparent acceptance by policymakers and the media of these interwoven ageing and austerity discourses has enhanced the pervasiveness of their influence and given rise to what is termed a ‘new ageism’. Interestingly, much of the existing research on austerity and ageing comes from, or is based on, the austerity period of the 1980s and early 1990s in Europe and the US (eg Estes et al, 1982; Davies, 1987; Norris-Baker and Scheidt, 1991; Rauch, 2006). This points to a substantial gap in contemporary gerontological and social policy knowledge, and a need to develop an analytical perspective on older people, the economic recession and austerity. In this book, and to address this deficit, we use Ireland as a site for unpacking social policy issues in ageing through austerity – where Ireland refers to the 26 county-region of the island of Ireland that gained independence from Britain in 1922, and which is sometimes referred to as the Republic of Ireland. This book examines the transition of Ireland from a nation that experienced unprecedented economic growth, to a country that suffered severe economic recession, to a nation that is perhaps once again on the road to economic recovery. In doing so, we interrogate whether or not the economic recession and austerity has, in fact, altered ageing experiences and the social policy landscape for older people in Ireland. While there can be a tendency to view population ageing as a set of disparate challenges, this text serves as a lens through which a selection of internationally recognised policy issues for ageing societies are explored. These include the seven areas of: demography; participation and volunteering; citizenship; work, gender and pensions; age-friendly communities and place; dementia care; and poverty and exclusion. As reflected in the thematic priorities of the Madrid International Plan of Action on Ageing and the Global Social Initiative on Ageing, these topics are key social policy issues not just for Ireland, but for many other international contexts. We aim to develop a critical and an applied analysis to contextualise and elaborate on current international debates around these issues within the Irish austerity setting, and, in turn, to identify future directions for research and policy on ageing that are relevant beyond Ireland. This in itself, we hope, will mark a meaningful contribution to the international social gerontology and social policy literature. The

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focus on austerity means that the book comes at an opportune time to contribute to empirical and theoretical knowledge, demonstrating the significance of Ireland’s experience to other national contexts. This includes European austerity settings and other EU states affected by the European economic crisis (eg Portugal, Greece, Spain, Cyprus, the UK and Italy), but also international jurisdictions where both the economic recession and demographic ageing have intersected (eg the US and Japan). For example, the reliance on the community and voluntary sector for health and social care provision to older people, and how this sector has been shaped by austerity policies, means that Ireland has particular relevance to Southern European countries. Likewise, the concerns raised around the impact of pension reforms for women and those in precarious employment are applicable to a greater or lesser degree across all European countries. Moreover, a central role of this text will be to demonstrate linkages between the global, national and local levels that shape the experiences of ageing in a time of austerity. The focus here, however, will be as much on the capacity of the local to shape and manipulate global influence and forces as it is about the power of globalisation over national and community contexts. This book will allow for the emergence of a nuanced perspective on: how elements of austerity and elements of these seven social policy issues (such as age-friendly models or retirement policy) can be transferred to local and national contexts; how they can pre-exist in or are a function of local and national settings that are distinct from global forces; and how they can be co-produced across these different scalar levels. Unless otherwise stated, our focus is on people aged 65 years and over.

Our approach Ireland is neglected as a setting in the international ageing literature. Perhaps more importantly, existing texts that focus on a particular region often fail to translate and transfer the significance of specific regional issues to other jurisdictions – in this case, ageing through austerity. Conversely, texts that consider ageing and social policy in a general way fail to contextualise some of these issues in terms of social, cultural and political structures. These circumstances have provided the impetus for this book, and prompted an interdisciplinary team of researchers from the Irish Centre for Social Gerontology, with other colleagues, to pull together interconnected strands of ageing and social policy research. As the contributors have worked together on developing a multifaceted understanding of ageing over a

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Introduction

number of years, the book aims to provide a more coherent account of growing older in Ireland that provides insights for ageing societies in Western developed contexts. Contributors come from a range of social science disciplines, including sociology, political science, social policy, economics and social and environmental gerontology. Each has been engaged in interdisciplinary and international collaborative research in ageing since the establishment of the Irish Centre for Social Gerontology in 2006 – coinciding with the transition between economic boom and economic crisis in Ireland. Authors use this experience to tap into current international perspectives and research advances made in the study of ageing. Contributors to the book adopt a broadly critical perspective and thus locate their chapters in the tradition of critical gerontology, recognising the social construction of ageing, where social norms, societal values and vested interests can shape and influence how we view ageing and older people (Minkler and Estes, 1991). The social policy system is viewed as a primary mechanism in creating current and future experiences of ageing, in its direct and indirect response to demographic change and the economic recession – whether this is in Ireland or elsewhere. Consideration is given to how structural inequalities and divisions within society shape the resources and the sets of advantages and disadvantages accumulated over a person’s life course. How social policy, and austerity-driven policy reforms, reinforce and are reinforced by these inequalities and divisions will also be explored in the context of older people’s lives. The book seeks to engage critically both with global discourses on ageing and with the voices and experiences of older people in Ireland to inform individual chapters in this book. To help frame this perspective, the remainder of this introductory chapter will, first, describe the context of ageing and austerity in Ireland. We then set about positioning Ireland, and its economic crisis, in the global political economy. Next, we chart the historical evolution of ageing-related social policy in Ireland. This will help to contextualise the analysis that is presented in the individual chapters and generalise the issues identified in each chapter to other European settings. We end this introduction with an overview of the book’s structure.

Austerity and ageing in Ireland After experiencing severe economic circumstances for much of the 20th century, including economic recessions in the 1930s, 1950s and 1980s, Ireland became in the mid-1990s an apparent success story of the

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expansion of global capitalism via European economic cooperation and its membership of the EU (since 1973). This success was manifest in: a diversified economic base with large-scale, foreign direct investment; a significant rise in national standards of living; increased levels of welfare and social transfer provision; significant improvements in public infrastructure; a substantial decrease in emigration and the establishment of net inward migration (after 70,000 people left the country in 1989 alone; see Walter, 2008); and a significant decrease in unemployment, dropping from 14.6% in 1989 to 4.8% in 2007 (Central Statistics Office, 2013b). However, a combination of a national property bubble, a poorly regulated national banking system and a relatively weak global position meant that Ireland was severely hit by the banking crisis of 2008. The subsequent economic recession resulted in an EU, ECB and IMF (EU–ECB–IMF) Troika bailout programme in 2010. After a three-year period of intense Troika scrutiny, and having met a series of tough financial and budgetary targets, Ireland exited the programme in December 2013. While free from the structures of the Troika, Ireland is still burdened by considerable public debt and economic uncertainty. Since 2008, Ireland has experienced a threefold increase in its unemployment rate (reaching a high of 15% in 2012; see Central Statistics Office, 2013b) and a return to net outward migration, with, on average, 84,000 people leaving the country per annum (Central Statistics Office, 2012a). So, international emigration, which featured in the life course of many Irish older people, is once again a significant, and many would consider a critical, social and cultural issue in Ireland (Glynn et al, 2013). Two successive Irish governments have implemented six austerity budgets since 2008, enforcing severe cuts to social spending – with four of these budgets driven by the Troika bailout programme. This has resulted in a cumulative decline in state spending of €9.6 billion, a cumulative drop of 14% in gross national product (Barrett and Kelly, 2011) and a heightened sense of insecurity that characterises what has been termed the ‘Great Recession’ of the early 21st century (Allen, 2012; Crotty, 2012). The comprehensiveness and depth of the reduction in public expenditure has meant that not only have budget allocations in key areas been consistently eroded, but fundamental aspects of Ireland’s social policy (such as welfare provision and social care) have been undermined (Allen, 2012). Groups most vulnerable to deprivation, such as lone parents, children with special needs and people with disabilities, have all had their direct payments reduced (Carney et al, 2012). It could certainly be argued that the orthodox social policy principles of identifying societal need and providing universal or at

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Introduction

least collectivist welfare have been superseded by an austerity doctrine. Whether these principles were already destabilised by other sets of globalisation-led reforms, or, indeed, were never stabilised in the first place in the Irish context, is a matter of debate and a topic that is raised in the individual chapters of this book. However, despite the direction and degree of these austerity-related developments, public and political discourse in Ireland is somewhat conflicted about what it is like to be older in a time of austerity. Yes, there have been clearly negative implications for older people – including reduced income, cuts to social transfers and benefits, reductions in health and social care service provision, and the closure of service facilities (Hillyard et al, 2010; Walsh et al, 2012a, 2012b; Central Statistics Office, 2013c; Scharf et al, 2013) – but there is also evidence to suggest that at least some groups of older people are faring rather better during the economic recession than other groups of Ireland’s population. For instance, the gross weekly equivalised income of the older population increased by more than 48% from 2004 to 2009. The ‘at risk of poverty’ rate for older people has also gone from being one of the highest rates in the Irish population (27.1% in 2004) to being one of the lowest rates during the period of the recession (8.7% in 2010) (Central Statistics Office, 2012a). Although this pattern now appears to be in a slight reverse (having risen to 9.7% in 2011; see Central Statistics Office, 2013c), such a reduction in risk is likely to be largely related to the fact that state pension payments have not been reduced, and, indeed, in some circles, are considered to be reasonably generous, at €219 per week as a basic rate (as of 2014). With significant salarybased tax increases, high levels of negative housing equity and large numbers of people in mortgage arrears, some commentators have also framed austerity in intergenerational terms, suggesting that it has disproportionately hit younger and middle-aged generations (Minihan, 2012; Collins, 2013a, 2013b) – dividing people into deserving and undeserving groups and effectively creating different levels of social citizenship. As noted earlier, a similar discourse has been observed in other European nations (Walker, 2012; Eurostat, 2013). In many ways, the conflicting patterns of evidence point to the need to be aware of the diversity of the Irish older population when considering ageing and austerity. This includes those who may be well off, those who exist on a low income and those who are marginalised or vulnerable through other circumstances and conditions, such as those related to health and disability. There is also the need to be aware of the relative positioning of particular older adult cohort perspectives.

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Many Irish older people would, in an absolute sense, have experienced increased standards of living and enhanced quality of life over the course of their own lives. Such patterns reflect the increase in life expectancy, the general rise in national levels of affluence and, despite long-standing issues of public service fragmentation, the increased role of the state, in overall terms, in Ireland’s welfare system during their lives. Due to the higher levels of education, infrastructure and service provision in Ireland today, even the current economic conditions may not appear to be as severe to some older people as the economic recessions of the 1950s and 1980s. In addition, a number of ageing-related social policy areas, as we will see later in this book, have already been in need of fundamental reform for quite some time, and so the impact of the economic recession and austerity may not be entirely relevant when considering the experiences of older people within these areas. Looking beyond austerity, there are other considerations that must be accounted for in the local Irish context. Ageing for the current generation of older people in Ireland has been accompanied by significant economic and social change. Relevant changes encompass, for example, Ireland’s political and social history of colonisation and independence, its increasing secularisation, and, as already mentioned, its economic and welfare development and recurring patterns of recession and migration. Many of these aspects feed into the Irish political economy and are very much evident in the attitudes and lifecourse experiences of older people in Ireland. While some changes reflect broader globalisation characteristics, others emerge from and are permeated within the national context. Indeed, due to previous emigration in the 1950s and high fertility in recent decades, Ireland’s rate of demographic ageing is more gradual than that in many other Western developed jurisdictions – 12% of Ireland’s population is aged 65 years and over, compared with an EU average of 18% (Eurostat, 2014). These local factors may produce different experiences for older people in Ireland and different social policy responses to global ageing issues. Or, they may not. Therefore, what we say about demographic ageing, social policy and austerity must be informed by a nuanced understanding of: the national context and social policy system; the characteristics of the recession and austerity in a specific setting; globalisation processes; and the interrelationship between these factors in the lives of older people.

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Introduction

Ireland in the global political economy To help frame the developments in Ireland in an international context, it is useful to consider the position of the nation, and its economic crisis, from a global perspective. Ireland is a small, independent, island nation located on the western periphery of Europe, with a population of just over four-and-a-half million. Ireland’s colonial heritage has acted as a definitive influence over its political, economic and social development as many of the most challenging aspects of social policy in Ireland relate to this break from British rule in 1922. In shrugging off the influence of British Protestantism, Ireland was founded as a Catholic country, giving the Catholic Church a special position in the Irish constitution and particular roles in education and health and social care provision (Power, 2009). The special status of the Church is enshrined in the norm of subsidiarity, through which government cedes responsibility for welfare to the family and communities. Even up to the late 1950s, Ireland was a relatively isolated, agrarian, nationalist state with a protectionist economic policy and a strong reliance on the family and Church to provide social welfare (Kearney, 2010). The most significant change in Ireland’s fortunes was the decision to join the European Economic Community (now the EU) in 1973. A process of modernisation and economic liberalisation followed. To all intents and purposes, Ireland moved from an agrarian society to a post-industrial knowledge economy in just a few decades. From 1994 until 2008, Ireland’s enthusiastic entry into ‘the brave new world of unsupervised global markets’ (Krugman, 2009, cited in Allen, 2012: 423) seemed to be paying off as Ireland experienced high employment, unprecedented levels of inward migration and a burgeoning property market. Having strategically placed itself between the two major drivers of Western capitalism (the US and the EU), Ireland seemed able to combine US-style free-market individualism with European standards of collectivism. Comparatively, Nolan and Smeeding (2005) assessed Ireland as uncommon: by US standards, income inequality is relatively low; while in comparison with some European partners, the distribution of resources is unequal. By 2008, this strategic position as a relaxed trade zone for global companies and a member of the liberalised Eurozone area meant that the Irish economy was exposed to the best and worst of global capitalism. The worst happened when the country spiralled into recession after the global banking crisis in 2008.

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The crisis led to the collapse of normal economic governance in the country and the acceptance of the international EU–ECB–IMF Troika bailout. Significantly, the decision to offer a bank guarantee, where government assistance was provided to recapitalise a number of Ireland’s financial institutions, led to the Irish people being effectively responsible for the country’s ‘toxic’ banks. Under the terms of the Troika bailout, the country had lost its economic sovereignty. Severe budgetary cuts were introduced and the country entered into economic recession. The improvement in Ireland’s budgetary position, allied to international economic recovery, has seen a return to positive growth rates and employment gains. Nevertheless, Ireland’s engagement in old traditions, such as mass emigration, serves to demonstrate how austerity may drive modernising societies back to old practices. The question for those who are interested in social policy is whether such practices, together with severe programmes of austerity, will ultimately undermine economic development and signify a rolling back of much of the progress made on key social policy issues during less austere times. As we enter what is hoped to be a period of economic growth, the question is also whether or not anything has been learnt from Ireland’s experience.

Evolution of age-related social policy in Ireland In a book that focuses on key social policy issues for older people in Ireland, it is necessary to consider the cultural and political context and the developmental trajectory of national ageing-related social policy, and its various drivers. In the fledgling Irish state (from the 1920s to the 1960s), there was effectively no overall vision for social policy for older people, in common with many other countries at the time. Older people were generally constructed as being in need of care. Accordingly, social policy for older people, and relevant policy documents, during this period were mainly confined to long-term care and pension policy. A non-contributory pension was first introduced in 1909; however, the pension system remained relatively restricted until the 1970s. In terms of care, families were expected to look after dependent older relatives. Where this was not possible, long-term care was provided in large state-run and Church-run publicly funded institutions (InterDepartmental Committee, 1968). What is often considered the first significant piece of policy-related work on older people in Ireland was the Care of the aged report, published in 1968 (Inter-Departmental Committee, 1968). In many ways, this document served as the basis

10

Introduction

for subsequent policy development in the years to come, recognising: that old-age is not necessarily characterised by ill-health and disability; the diversity of needs among the older Irish population; and the need for state-led services to support the community and voluntary sector in caring for older people in the community (Inter-Departmental Committee, 1968). The years ahead report, published in 1988 (Department of Health, 1988), was perhaps the first official government policy document to provide a comprehensive set of policies for older people. Due to its holistic and multidimensional consideration of ageing, it is considered by many to have been a considerable step forwards, both nationally and internationally, in ageing-related policy development and, perhaps until recently, the most significant policy document on older people in Ireland. The report addresses income maintenance, housing, health services and the organisation of services, as well as long-term care. It advocated a broader role for community care and partnership between carers, volunteers and statutory agencies. While, at this stage, policy documents articulated the view that older people should be treated with dignity, policy was still focused perhaps on providing services for rather than in consultation with older people. However, this was not unusual during this period and was certainly the case in many other nations. In the 1990s, discourses relating to ‘positive’ and ‘healthy’ ageing advocated by the United Nations, the World Health Organization and the EU were invoked in ‘The National Health Promotion Strategy for Older People’ in 1998 (Brenner and Shelley, 1998). This document directly reflected a healthy ageing approach and outlined national goals for promoting mental and physical health, increasing social interaction, and combating ageism (Brenner and Shelley, 1998). This approach implicitly regards the older person in more holistic terms and sets out a broad range of policies that are recognised as affecting the well-being of older people. The strategy recommended that the government work in partnership with non-governmental and voluntary organisations to provide programmes to encourage physical activity, social engagement and anti-ageist practices. During this period, a number of non-governmental organisations working with and for older people were established and the importance of involving older people themselves in policymaking was beginning to be recognised and consistently advocated for. More recently, there has been a sustained effort to emphasise the rights and dignity of older people. This is expressed in various strategy documents (eg the National Disability Strategy [Department of Health, 2009] and the National Carers’ Strategy [Department of Health, 2012]) published during the economic

11

Ageing through austerity

recession, often contrasting sharply with austerity policies, which tended to restrict the resources devoted to implement such strategies. The National Positive Ageing Strategy, published in 2013 (Department of Health, 2013), is the most recent comprehensive policy document in relation to ageing in Ireland. Explicitly drawing on European and global agendas, it advocates a holistic approach to ageing and emphasises that ageing requires a cross-departmental response at government level (Department of Health, 2013). The strategy encompasses an extended range of policy areas that contribute to positive ageing, including employment and retirement, education, volunteering, age-friendly communities, cultural and social participation, transport, financial security, and health and personal social services. Older people and non-governmental organisations working with and for older people were extensively consulted in drawing up the National Positive Ageing Strategy, reflecting a perceptible change in the way in which older people are regarded by policymakers. The introduction to the strategy document by the minister of state (with responsibility for older people) also explicitly calls on younger people, older people and their families to take responsibility for their own ageing, suggesting, on the one hand, that the government continues to consider the sector as a mixed model of provision. On the other hand, this also perhaps suggests that for the ageing sector, as with many other social policy areas, there is a stronger move to a more individual-based approach. This is not unique to Ireland, and is certainly reflective of broader international trends in Western developed nations (eg the UK and US), where austerity has been accompanied by a deeper and more significant shift towards the individualisation of responsibility and risk, whether this is in terms of access to care, economic security or health (Polivka and Estes, 2009; Lloyd et al, 2013; Lymbery, 2013; Estes, 2014). The development of Irish ageing-related social policy, therefore, has reflected a combination of different factors over time, including the changing economic and social conditions of the nation and the evolving role of the state in social issues. It has also reflected varying sets of global forces, ranging from Ireland’s membership of the EU to the influence of global institutions and international policy. These forces were noticeable during different periods of Irish social policy development. For instance, the social protectionist influence of EU directives was evident in the 1970s and 1980s, whereas the more neoliberal agenda supported by the Organisation for Economic Cooperation and Development (OECD), and the EU itself, has been more apparent since the advent of the global economic crisis (see, eg, Chapter Five). Moreover, and as is the case in many other countries, Ireland’s

12

Introduction

ageing-related social policy echoes the evolving social construction of ageing, and the shift from viewing older people as being financially dependent, unhealthy and disengaged from society, to being healthy, potentially productive and engaged in society. That said, as has been shown for other jurisdictions (such as the US; see Campbell, 2003), the institution of retirement, the inconsistency of pension provision, gender inequality and other as-yet-unchallenged social norms and assumptions about ageing have combined to make the development of ageing-related policy a significant task. Beyond these factors, there are particular systemic issues that must be considered when analysing Irish ageing-related social policy. For instance, irrespective of some of the positive aspects contained within the National Positive Ageing Strategy, the key challenge for its implementation remains a resource issue. Even prior to the economic recession, the resources necessary to support the recommendations of various policy documents and strategies were rarely made available. As a result, over time, policy recommendations have tended to focus on the same concerns and sometimes the same solutions, exhibiting an inheritance of unresolved and deep-seated problems within the sector. This betrays an underlying theme in social policy for older people in Ireland that, in many ways, appears to be more influential than internal economic and social factors, or external global forces. It is fair to say that the overall Irish ageing-related policy system is most accurately characterised by a lack of implementation and a long-standing ad hoc and, sometimes, haphazard approach to policy development for older people. This approach, as rolled out in practice, is often devoid of any particularly strong party-political ideology, and, as it seems from Ireland’s period of economic growth, is not always reflective of prevailing socio-economic conditions. Consequently, from a pragmatic viewpoint, in terms of ageing policy development, there is a continuity of ineffectual sameness. From a more critical perspective, it may be argued that there is a subtle but impactful indifference towards older people, which rarely generates any serious commitment and rarely recognises through actual actions the value, depth or diversity of the older population. Despite the evolving policy discourse on consultation, choice and personhood, then, it can be surmised that these principles are more likely to be absent than present in the experiences of older people that are framed by Irish social policy. It can also be surmised that, to a degree, there may be a politicisation of austerity that helps to justify a lack of resources for policy implementation. In the current circumstances, it is difficult to argue against the notion that the state cannot afford to pay for certain

13

Ageing through austerity

items, even when these are ageing-related. There is often, though, a legitimate question around the prioritisation of these items. While this indifference might result in similar outcomes to those experienced in neoliberal settings, it is perhaps necessary to consider this ad hoc or indifference approach as a political culture that can sometimes be more engrained in the overarching policy landscape for older people in Ireland, and, in many ways, supersedes any other discernible ideological agenda. How specific age-related social policy has evolved in Ireland, for each of the topics of interest, and how this has responded to economic shifts and evolving conceptions of ageing, is the focus of individual chapters in this book.

Structure of the book Each chapter opens with an assessment and review of the existing international literature on the relevant area of social policy. This is followed by an applied analysis of the Irish case, exploring each topic within the context of austerity and drawing out learning and policy relevance for other country contexts. Finally, authors conclude with key insights arising from the analysis and identify important questions for future research. By taking this consistent approach, the book aims to provide a coherent and critical account of ageing and social policy but with a contextualised focus, adding new depth to understandings of austerity in ageing societies. In Chapter Two, Sheelah Connolly contextualises ageing in Ireland in a time of austerity, describing the demographic and socio-economic situation of older people in Ireland, and providing an overview of many of the key issues related to the economic downturn addressed in later chapters. The book then turns to key social policy areas around the broad themes of participation and inclusion. In Chapter Three, Gemma Carney adopts a political perspective to explore the implications of demographic ageing, austerity and elements of globalisation for social citizenship in Ireland. In Chapter Four, Áine Ní Léime and Sheelah Connolly critically examine the participation of older people in social and volunteering activities in Ireland, engaging with the international active ageing literature and interrogating the inclusiveness of active ageing policy discourse during austerity. In Chapter Five, Áine Ní Léime, Nata Duvvury and Aoife Callan problematise and critically assess the gender and class implications of the ‘extended working life agenda’ within an austerity frame, analysing implications for future employment and pension policy.

14

Introduction

In Chapter Six, addressing a major international social policy trend concerning ageing and environments, Kieran Walsh interrogates the concept of the age-friendly community, exploring what makes a community a good place to be older in the context of the global agefriendly movement, the economic recession and forces of austerity in Ireland. In numerous international contexts, and particularly in Ireland, dementia and dementia care is becoming a significant social policy challenge. In Chapter Seven, Eamon O’Shea, Suzanne Cahill and Maria Pierce explore this challenge and set out the need for an analytical and conceptual framework for an alternative paradigm for dementia care in Ireland, regardless of economic conditions. In Chapter Eight, tying together many of the themes addressed in earlier chapters, Thomas Scharf uses the current economic crisis in Ireland to explore older people’s integration in societies experiencing fiscal austerity and to assess the impact of the economic recession, and reactive social policy, on the exclusionary experiences of an ageing population. In Chapter Nine, Gemma Carney, Kieran Walsh and Áine Ní Léime draw on the core insights offered by the contributing authors to present overarching conclusions, methodological questions, theoretical challenges and critical issues for social policy relating to ageing and austerity. The book closes with an Afterword prepared by Chris Phillipson (University of Manchester). Chris Phillipson, who, like Alan Walker, is closely associated with critical perspectives on ageing, reflects on what the Irish experience of ageing in austerity can offer for comparative, international political economies in ageing societies, and what insights the analysis presented in this book provides for scholars of globalisation and ageing.

15

TWO

Contextualising ageing in Ireland Sheelah Connolly

Introduction The global phenomenon of population ageing has resulted in a significant increase in the number of older people in many countries. Ireland has lagged behind other high-income countries in the proportion of its population aged 65 and over, but this is projected to change in the coming years, when there will be a significant increase in the number and proportion of older people in the population. The potential impact of population ageing, in particular, on the pension fund and, to a somewhat lesser extent, the health and social care system, has been debated and discussed. However, these discussions have been somewhat overshadowed by the global economic downturn starting in 2008. This chapter attempts to set the scene for the remainder of the book by contextualising ageing in Ireland in a time of austerity and, where appropriate, examining Ireland’s position relative to other high-income countries. The first part will describe the demographic and socio-economic situation of older people in Ireland and the second part will assess the impact of the economic downturn on the lives of older people.

Older people in Ireland The demographic profile of older people in Ireland: past, present and future According to the most recent Census of population, there were over half-a-million people aged 65 and older in Ireland in 2011. This number has been increasing over time, with 70% more people aged 65 and older in 2011 compared to 1951 (see Figure 2.1). Such increases, in Ireland and elsewhere, are due to a combination of factors, including high fertility rates after the Second World War and, more recently, a reduction in death rates at older ages.

17

Ageing through austerity Figure 2.1: Number of people aged 65 and older in Ireland, 1951–2011

Population aged 65 and older

600,000

500,000

400,000

300,000

200,000

100,000

0 1951

1961

1971

1981

1991

2002

2011

Year

In addition, declining birth rates has meant that the proportion of the total population aged 65 and older is also increasing. Currently, 12% of the population are aged 65 and over. This is projected to increase to 17% by 2026 and to 25% by 2046 (Central Statistics Office, 2013a), while the proportion of the population aged 85 and over is projected to more than double from 1.3% in 2011 to almost 4% by 2046 (Central Statistics Office, 2013a). However, while Ireland’s population is ageing, it remains young relative to other high-income countries. Table 2.1 shows the (estimated) percentage of the population aged 65 and older in a number of high-income countries in 2010, 2030 and 2050. Of the 19 countries included, Ireland has the lowest proportion of its population aged 65 and over in 2010 and 2030; however, a catch-up is projected by 2050, when the proportion in Ireland will surpass that of other countries. A brief statistical portrait of older people in Ireland The experience of ageing is a personal one influenced by a variety of social factors, including gender, socio-economic situation and health status. Many of these factors are, in turn, shaped by circumstances during the life course. People do not reach old age in a vacuum, but, rather, with a culmination of lifetime exposures to social risk. This section describes the social characteristics of older people in Ireland today and attempts to examine how circumstances throughout the life course can influence the experience of ageing.

18

Contextualising ageing in Ireland Table 2.1: Population aged 65 and over as a percentage of the total population – 2010, 2030 and 2050 2010

2030

2050

Australia

13.5

19.7

22.2

Austria

17.6

24.0

28.3

Belgium

17.2

22.3

24.5

Canada

14.1

23.1

26.3

Denmark

16.6

22.6

23.8

Finland

17.3

26.1

27.6

France

16.9

23.6

26.2

Germany

20.6

28.8

33.1

Greece

19.1

24.8

32.5

Ireland

11.5

18.5

26.3

Italy

20.3

27.3

33.6

Luxembourg

13.9

20.0

22.1

The Netherlands

15.4

24.3

26.9

New Zealand

13.0

21.9

26.2

Norway

15.0

20.6

23.2

Spain

17.0

25.1

35.7

Sweden

18.3

22.7

23.8

UK

16.0

21.9

24.1

US

13.1

19.3

20.2

Source: OECD (2011a).

Demographic profile Of those aged 65 and older in Ireland today, approximately 55% are female (largely reflecting the increased longevity of women), 57% are aged between 65 and 74, and 11% are aged 85 or older. Two thirds of older men are married, compared to 44% of older women (see Table 2.2). Compared to other Western European countries, a significant proportion of older people in Ireland never married (16% of males and 13% of females) or married late in life, largely due to social norms of the past that only permitted the heir to marry and remain in the home (Fitzpatrick, 1985). Widowhood is especially high among older females, with 40% widowed compared to 13% of older males. Approximately 28% (136,295) of people aged 65 and over who were living in private households lived alone. Unsurprisingly, the proportion increased with age, with 37% of people aged 75 and over and 44% of people aged 85

19

Ageing through austerity

and over living in single-person households (Central Statistics Office, 2012b). Comparatively, the proportion of older people living alone in Ireland is similar to the European Union (EU) average and falls between the relatively high levels of single occupancy in Nordic countries and relatively low levels in Southern European countries (Walker, 2005). Table 2.2: Marital status (%) by sex for those aged 65 and older, Ireland – 2011 Male

Female

Single

16

13

Married

66

44

Separated

3

2

Divorced

2

1

Widowed

13

40

Source: Central Statistics Office (2012b).

Traditionally, Ireland was an ethnically homogeneous society. However, economic prosperity from the mid-1990s up to 2008 resulted in an unprecedented period of inward migration, peaking with 104,800 people in 2007 (Central Statistics Office, 2012a). Although the majority of these migrants were of working age, Ireland’s older population is becoming increasingly diverse. The number of people over the age of 65 years classified as foreign nationals rose from 11,336 in 2002 to 18,763 in 2011. While these figures are small relative to older immigrant groups in other Western nations, they represent a distinct subgroup of the older Irish population who will have diverse needs and requirements depending on where they have come from and how long they have been resident in Ireland. Socio-economic situation Socio-economic status is a powerful predictor of health and mortality in old age (Connolly et al, 2010) and is heavily influenced by the social and economic circumstances experienced at different stages of people’s lives. Identifying an indicator that accurately reflects an older person’s socio-economic situation is difficult. One commonly used indicator is education, which has the advantage of being relatively easy to measure and reliable, as well as acting as a marker of early life circumstances. Table 2.3 shows the educational attainment of those aged 65 and older in Ireland in 2011. The younger-old (aged 65 to 74) tend to have higher

20

Contextualising ageing in Ireland

educational attainment than the older-old (aged 75 and over), likely reflecting the introduction of free secondary schooling into Ireland in 1968. Educational attainment is important for a number of reasons, not the least of which is its impact on occupation and income throughout the life course, with those with higher educational attainment more likely to have higher occupational status and an associated pension, reducing the likelihood of poverty in older ages. Table 2.3: Educational attainment (%) by age group, Ireland – 2011 65–74

75+

No formal education

3

4

Primary

39

48

Secondary

34

31

Higher/Third

24

17

Source: Central Statistics Office (2012b).

Given the move from employment to retirement around the age of 65 and the subsequent reduction in income, there is a significant risk of poverty among older people in general. A commitment by the government to reduce poverty among older people in Ireland at the start of the millennium resulted in an increase in the basic state pension rate from approximately €99 per week in 1997 to the current basic rate of €219, the result of which was to increase the average incomes of older people and to reduce their poverty rate relative to other age groups (Central Statistics Office, 2013c). Recent research for Ireland found that the average household disposable income of people aged 50 and above was €767 per week. However, this figure masks significant variation across older people, for example, 13% had an income of more than €1,000 a week, while 11% had an income of less than €200 per week (Barrett et al, 2011). Table 2.4 shows the ‘at risk of poverty’ rate – defined as the percentage of persons with an equivalised income below 60% of the national median income – by age group in 2004, 2009 and 2011. While older people had the highest risk of poverty in 2004, at 27%, this had decreased to 9.7% in 2011, with the result that, as a group, those aged 65 and over had the lowest risk of poverty in 2011. The poverty rate for older people in Ireland in 2011 was substantially below the EU151 average rate of 16.2%. However, while there has been a significant improvement overall in the financial position of older people in Ireland in the last number of

21

Ageing through austerity Table 2.4: ‘At risk of poverty’ rate (%) by age group, 2004, 2009 and 2011 2004

2009

2011

0–17

22.7

18.6

18.8

18–64

16.6

13.0

15.9

65+

27.1

9.6

9.7

Age group

Source: Central Statistics Office (2013c).

years, there is evidence of significant poverty and deprivation among some older people (Patsios et al, 2012; Walsh et al, 2012a), including those living alone and with poor health – a theme that will be returned to in Chapter Eight. Health status Health status is one of the most important determinants of quality of life in older age (Blane et al, 2004) and is strongly influenced by the cumulative impact of lifetime exposures to risk. In Ireland, as elsewhere, population health has improved over time, with increases in life expectancy and a decrease in death rates (O’Shea and Connolly, 2012). However, life expectancy at 65 in Ireland continues to lag behind that of other high-income countries (see Table 2.5). One potential explanation for the relatively low life expectancy in Ireland is a relatively high rate of cardiovascular disease, partly explained by genetic and lifestyle factors, including a high fat intake (O’Neill, 2003). Within Ireland, there is also evidence of considerable heterogeneity in the health of older people. Kearney et al (2011), for example, noted strong socio-economic gradients in health, with those with greater asset wealth and more completed education being in substantially better health, regardless of the health measure used. For example, data from The Irish Longitudinal Study on Ageing (TILDA) showed that only 30% of respondents with primary education rated their health as excellent or very good compared to 57% with third-level education; similarly, 9.3% of those in the lowest wealth quartile reported diabetes compared to 4.6% of those in the highest wealth quartile (Cronin et al, 2011). While socio-economic health inequalities exist across all age groups and are due to experiences and exposures across the life course, disadvantage at older ages can further exacerbate such inequalities and contribute to increased morbidity and premature mortality.

22

Contextualising ageing in Ireland Table 2.5: Life expectancy at 65 for females and males, 2011 (or nearest year available) Life expectancy at 65, females

Life expectancy at 65, males

Australia

22.0

19.1

Austria

21.7

18.1

Belgium

21.5

17.8

Canada

21.6

18.5

Denmark

19.7

17.3

Finland

21.7

17.7

France

23.8

19.3

Germany

21.2

18.2

Greece

20.6

18.5

Ireland

20.7

17.9

Italy

22.6

18.8

Luxembourg

21.6

17.8

The Netherlands

21.2

18.1

New Zealand

21.3

19.0

Norway

21.4

18.2

Spain

22.8

18.7

Sweden

21.3

18.5

UK

21.2

18.6

US

20.4

17.8

Source: OECD (2013a).

Impact of the economic downturn on older people in Ireland Between 1994 and 2008, Ireland experienced rapid economic growth, and with it came significant increases in government expenditure. During this period, a number of measures benefiting older people (as well as other groups) were introduced, including an increase in the state pension rate, free medical care for the over 70s and an increase in expenditure on social care services. Since the onset of the economic crisis, the Irish government has pursued a series of austerity measures. This section will provide an overview of how the economic downturn and subsequent austerity measures have impacted older people in Ireland.

23

Ageing through austerity

Austerity measures and older people: the Irish welfare state In a comparative context, Ireland has a somewhat unusual welfare state and does not neatly align with that of any other country. In terms of Esping-Anderson’s (1990) influential classification, Ireland is usually located in the liberal regime (rather than the conservative or social-democratic regimes) on the basis of its relatively low level of social entitlement; however, in reality, Ireland’s welfare state includes elements of all three regimes. Perhaps one of the defining features of Ireland’s welfare state is the mix of public and private, with the state providing a basic level of provision and more extensive coverage secured through private means. Comparatively, public social expenditure in Ireland is low (see Table 2.6), with Ireland ranked 13th out of 19 selected Organisation for Economic Co-operation and Development (OECD) countries. This may, in part, be explained by Ireland’s relatively young population, as old-age spending as a percentage of gross domestic product (GDP) in Ireland, at 4.5%, ranks 18th out of the included countries (see Table 2.6). The following sections will examine the impact of the economic downturn on those parts of the welfare state of most relevance to older people – the pension, health and social care systems. The pension system The pension system in Ireland is a mix of public and private sector provision, with the state providing a basic level of entitlement and more generous provision available through private purchase (traditionally encouraged through the provision of tax breaks). A detailed description of the Irish pensions system will be provided in Chapter Five. In short, the system consists of three main components: a means-tested non-contributory pension and state-provided social insurance-based pension; occupational pension schemes; and private (voluntary) pensions. The state (non-contributory) pension may be paid from age 66 to people who do not qualify for a state (contributory) pension, and its aim is to provide a minimum standard of living for those who have no other means (Duvvury et al, 2012), rather than to smooth income between working life and retirement. For those with enough social insurance contributions, the state (contributory) pension is paid. The state pension is the most important source of income among older people in Ireland and makes up approximately two thirds of gross income for those aged 65 and older (Barrett et al, 2011). It is essential in keeping older people out of poverty, with research showing that 84%

24

Contextualising ageing in Ireland Table 2.6: Total public social expenditure and old age social spending as a percentage of gross domestic product Total public social expenditure as a % of GDP (2012)

Old-age social spending as a % of GDP (2009)

Australia

18.7

4.9

Austria

28.3

12.0

Belgium

30.0

8.1

Canada

18.2

4.1

Denmark

30.5

8.2

Finland

29.0

10.2

France

32.1

12.3

Germany

26.3

9.1

Greece

23.1

10.9

Ireland

23.1

4.5

Italy

28.1

13.0

Luxembourg

23.3

5.8

The Netherlands

24.3

5.8

New Zealand

22.0

4.5

Norway

22.1

7.1

Spain

26.3

7.7

Sweden

28.2

10.2

UK

23.9

6.7

US

19.4

6.1

Source: OECD (2012a).

of those aged 65 to 74 and 89% of those aged 75 and over are at risk of poverty before receiving social transfers, including the state pension (Boyle and Larragy, 2010), making recipients particularly vulnerable to any change in the pension rate. However, despite significant cuts across a variety of welfare payments since the introduction of austerity measures in Ireland, the state pension rate has remained unchanged at 2008 levels. While the maintenance of the basic state pension rate since 2008 has been important in protecting older people from poverty, in some ways, it distracts attention away from a number of cuts that have been made to ancillary benefits for older people: the payment of a fuel allowance, for example, has been reduced from a period of 32 weeks to 26 weeks despite an increase in fuel prices since the onset of the downturn; the Christmas bonus, paid to those in receipt of social welfare payments, including the state pension,

25

Ageing through austerity

has not been paid since 2008; and in the 2014 budget, the telephone allowance for older people was abolished. While such measures may seem relatively small in isolation, the cumulative impact at a time of increasing financial pressures (including the recent introduction of a property tax and water charges) can have significant consequences, especially on the most vulnerable older people. Receiving somewhat less attention is the impact of the economic downturn on occupational and private pensions, perhaps because such pensions are generally the preserve of the better off. Plummeting stock markets associated with the downturn in 2008 flattened the value of many pensions, having significant financial consequences for those drawing on such pensions in recent years. While, in many countries, pension fund assets have now climbed back above their pre-crash level, this is not the case in Ireland, where pension fund assets in 2011 only represented 83% of the 2007 level (OECD, 2013b). Perhaps more worrying is the impact of the current economic downturn on the ability and willingness of current workers to contribute to an occupational or private pension. While the National Pensions Policy Initiative set a target of an occupational and private pension coverage rate of 75% of workers aged 30 to 65, the coverage rate only stood at 58% in 2009, with evidence of a decrease since then. The ability of the pension system to cope with the increasing number of older people in the coming decades is dependent on a number of factors, including the level of the state pension, how fast the economic recovery will take hold, how well current workers are covered by private pensions and how long older people will remain in the labour market (OECD, 2013b). The health system The Irish health system is complex, with a mix of public and private provision (Smith, 2010). Over one third of the population are eligible for a medical card, which entitles them to a range of services without significant charge, with eligibility determined through means testing. The remainder of the population pay the full cost associated with GP care (on average, about €55 per visit) but are entitled to heavily subsidised public hospital care (O’Shea and Connolly, 2012). Approximately 45% of the population purchase private health insurance, which allows easier and faster access to private hospital-based care. Older people are treated somewhat differently to other groups in terms of their entitlement to a medical card. Between 2001 and 2008, all people aged 70 and over were automatically granted a medical card, regardless of their means. However, in light of austerity measures, means testing was reinstated

26

Contextualising ageing in Ireland

for the over 70s in 2009. Initially, the means test was to be introduced as it applied to the over-66 age group. However, the proposal was modified following an unprecedented protest and campaign by older people and their organisations (Boyle and Larragy, 2010; for further detail, see also Chapter Three). Instead, a threshold was introduced so that those with a gross income over €700 per week for an individual or €1,400 per week for a couple would lose eligibility. In the 2014 budget, the threshold was reduced to €500 per week for an individual and €900 per week for a couple, with the result that an expected 35,000 people over the age of 70 would lose their entitlement. Additionally, while those in receipt of a medical card were traditionally entitled to free prescriptions, austerity measures have resulted in the introduction of nominal charges – initially set at €0.50 per prescription item but more recently increased to €2.50. While the charge is relatively small, such payments will have the greatest impact on those with the poorest health and in the greatest need for health care. In addition, it sets the precedence for the co-payment for health services for those whose lower means traditionally entitled them to free medical care. Despite the majority of older people retaining access to a medical card, a significant proportion choose to purchase private health insurance, with 38% of those aged 70 to 79 having both a medical card and private health insurance (Barrett et al, 2011). While a medical card provides entitlement to free GP and hospital-based care, the purchase of private medical insurance is likely a reflection of the perception that insurance allows easier and faster access to hospital consultants, specialist cover and admission to private beds (O’Shea and Connolly, 2012). Fear among older people about excessively long waiting times for public health care means that many are continuing to purchase expensive health insurance. While this is not a new phenomenon in Ireland, the continuing ability of older people to purchase private health insurance looks questionable in light of ever-increasing premiums, as well as rising household costs, forcing more people towards an already overstretched public health system. Ongoing criticism of the Irish health system around unequal access to acute care services and excessively long waits for public health care have led to a commitment by the current government to introduce a universal health insurance system, largely based on the Dutch model, with a system of mandatory universal coverage and competing private health insurers. However, given concerns about the cost implications of such a system, it remains to be seen if and when such a system will be introduced. More recently, there has been a political commitment to the introduction of free GP and primary care. However, it is not

27

Ageing through austerity

yet clear how this will be funded given current cuts in the health budget. Since 2009, over €2 billion has been cut from public health spending, and with it came a significant reduction in staff and hospital beds. While the health system has performed relatively well to date in adapting to these cuts through efficiency gains, continued austerity will likely mean cuts in entitlements and services (Thomas et al, 2013). The social care system Older people in Ireland, as elsewhere, generally prefer to remain within their own home for as long as possible and this has been recognised in official government documents (Department of Health and Children, 2001). Despite this, social care in Ireland, particularly that relating to care in the community, tends to be patchy and fragmented – a situation that has existed through times of economic boom and bust. While there was a significant increase in both the number of older people in receipt of formal home-care services (from 16,000 in 2000 to almost 63,000 in 2009) and public expenditure on home-care services (from €102.3 million in 2001 to €331 million in 2008) during the first decade of the millennium in Ireland (Timonen et al, 2012), policymakers failed to develop policies to govern the extended provision. One impact of this policy is that people do not have a statutory entitlement to community care services. This is in contrast to long-term residential care, where the system of access to and eligibility for publicly funded or subsidised residential care was given a statutory basis in 2009 with the introduction of the Nursing Home Support Scheme (NHSS). The scheme, marketed by the government as the ‘Fair Deal’, requires a co-payment from the resident (of approximately 80% of assessable income and up to 7.5% of the value of any assets per annum) with the remainder of the cost of care provided by the state. However, the scheme also fell victim to the economic downturn when it was temporarily suspended in 2011 due to a shortfall in funding. While the scheme was reinstated a month later, there is much concern about its continuation in light of increasing demand and growing financial pressures. A recent review of the Fair Deal scheme noted that the statutory provision of the scheme, compared to the ‘discretionary’ basis of home-care supports, has inadvertently prioritised long-term residential care over home and community care for older people (Citizen Information Board, 2012). They note that because:

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the provision of community care supports are at the discretion of the health service, many families have no choice but to place a loved one in residential care prematurely, when home help, day care or respite services are withdrawn, reduced or not provided at all. (Citizen Information Board, 2012: 5) This situation has been further compounded since the onset of austerity measures, which have resulted in cuts in home-help hours, respite care grants and the carer’s allowance, despite recent government commitments to support older people to remain within their own home. Indirect effects of the economic downturn While it is not possible to address all of the potential impacts of the economic downturn on older people in this chapter, one area that deserves some attention is the discourse around the intergenerational impacts of the austerity measures being implemented. Some international commentators suggest that older people have not only been spared the worst of austerity measures, but are also living on credit for which younger generations will have to pay (Howker and Malik, 2010; Willets, 2010). While there is some evidence to suggest that aspects of the downturn, including unemployment, emigration and negative equity, have been mostly keenly experienced by younger generations (Gerlach, 2013; National Economic and Social Council, 2013), such factors can also have significant consequences for older people who share their lives, households and communities with those of other generations. High levels of unemployment, for example, have resulted in a significant increase in emigration from Ireland in recent years. While the majority of emigrants are younger people, the loss of such a number of people can have significant consequences for the people left behind, especially ageing parents, including loneliness, isolation and the loss of instrumental and economic support (Adhikari et al, 2011). Such losses at the individual level may be further compounded in rural areas, where depopulation and budgetary cuts have contributed to the curtailment of public and social services (Walsh et al, 2012a), thereby increasing the isolation experienced by many older people. For those remaining in Ireland, there is increasing evidence that older parents are providing financial aid to adult children and other family members affected by the current economic downturn through financial

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and other means (Boyle and Larragy, 2010; Patsios et al, 2012; Timonen et al, 2013). Patsios et al (2012), for example, found that some children have moved back home to live with their older parents, with a potential negative consequence that the older person may lose benefits or have them reduced. In other cases, they identified older adults who have remortgaged their homes to help their children who are struggling with their own mortgage or to provide financial help to their children who are unemployed or struggling financially. While many of these features existed before the recession, the evidence suggests that these aspects of family life have been exacerbated by the recession, especially for older people (Hillyard et al, 2010).

Conclusions The aim of this chapter was to examine the circumstances of older people in Ireland in a time of austerity and, in doing so, provide context for the topics and themes developed in subsequent chapters. The chapter has highlighted the considerable heterogeneity among older people in Ireland; such differences among older people mean that they will have different experiences of the ageing process, as well as austerity measures. While some commentators have been quick to suggest that older people have escaped relatively unscathed from the downturn and subsequent austerity measures, this is an oversimplification of the situation and fails to recognise how seemingly small cuts (such as the introduction of prescription charges and the reduction in the fuel allowance) can have a significant impact on those who are relatively disadvantaged to begin with. There is a pressing need, therefore, to identify the implications of any current or future austerity measures on levels of inequality in order to ensure that those who are disadvantaged are not further penalised during this time of austerity. Note EU15 area countries are Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden and the United Kingdom.

1

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THREE

Citizenship in an age of austerity: towards a constructive politics of ageing Gemma M. Carney

Introduction Every human being comes into the world alone, and ultimately leaves it with equal singularity. Were it not for collective notions such as citizenship, we would experience life only as individuals, living in a Hobbesian ‘State of Nature’, in ‘continual fear, and danger of violent death; and the life of man, solitary, poor, nasty, brutish, and short’ (Hobbes, 1994 [1640]). Early political organisation was based on the realisation that rampant individualism is an ineffective means of survival for the human species (Bates, 2003). The implication of this admission is that some degree of individual sovereignty must be surrendered if humans are to achieve enough peace and security to pursue a social life, an agreement identified as the ‘social contract’ (Hobbes, 1994 [1640]). By the end of the 20th century, in the global North, peace and security were based on a shared welfare state, where each individual contributes some of his or her own personal resources to be guaranteed health, security and freedom (Powell, 2009). The social contract eventually evolved into the establishment of state-funded welfare states that provide income support and health and social care, which are provided on the basis of social citizenship. The welfare state was, at least in part, responsible for advances in public health that have extended life expectancy by a decade over the last 50 years in the 28 states of the European Union (EU) (Eurostat, 2011). Paradoxically, it is the success of the welfare state in providing enough social security to contribute to longevity that now places pressure on the social contract which underpins that same system. In this chapter, I examine some of the implications of demographic ageing for social citizenship. There are inevitable policy implications of human evolution away from the ‘nasty, brutish and short’ life of

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early humans. What are the implications of demographic change for the model of collective provision of welfare? Will having more older people mean that resources must be redistributed between age groups? Will the existing social contract have to be renegotiated? If we accept that the existing social contract is based on a set of taken-for-granted life-course transitions – from childhood to work, and from work to retirement – then renegotiating this contract will be complex and require strong, positive intergenerational relations. Added to this is the fact that intergenerational relations are filtered through a set of culturally ascribed norms relating to gender, class and age, making the peaceable transition towards a new demographic age profile look all the more challenging. While much work has been done to examine how life can be prolonged, how fertility can be controlled and how public health can be promoted, more research is needed if we are to work out a coordinated response to the combined effect of these changes at the societal level. Prolonged life expectancy changes the timing and sequencing of life-course events: childhood is extended, retirement can last for upwards of 30 years, and the number of people in work looks set to be overtaken by numbers outside the labour market within the next generational cycle. If we are to maintain the level of agreement necessary to facilitate these changes, we must become more knowledgeable on the potential implications of demographic ageing for citizenship now and in the future. What is needed is a dynamic, temporal understanding of the impact of ageing on citizenship across the life course. It is through theorising this flow of time, from one generation to the next, that Mannheim established ageing as a biological phenomenon that must be understood within its social context: Were it not for the existence of social interaction between human beings – were there no definable social structure, no history based on a particular sort of continuity, the generation would not exist as a social phenomenon: there would be merely birth, ageing and death. (Mannheim, 1997 [1952]: 28) The challenge now is to devise social responses to the biological evolution of extended life expectancy. Population ageing requires the major social institutions, such as families and communities, to accept a new generation of older citizens who may require appropriate social supports. Those aged over 65 are likely to continue to contribute after retirement – as taxpayers, unpaid carers and voters and community activists in a diverse range of contexts. It is this question (How will

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social, economic and political institutions adapt in order to keep pace with the rate of population change?) that has challenged gerontologists over the past four decades (Bengtson et al, 2000; Bernard and Phillips, 1998). Politically speaking, ageing societies must use the institutions of democracy to renegotiate the social contract between generations (Binstock, 2010). In policy terms, the challenge is to ensure that the social and economic needs of older people do not grow to the extent where larger numbers of older people feel obliged to use their political rights (ie their votes) to lobby for greater spending on health and social care for their birth cohort. To avoid such a divisive politics of ageing, solidarity between generations must be maintained. For the purposes of this chapter, we are interested in applying the politics of ageing (decisions about the redistribution of resources) to the sociology of citizenship, defined by Turner (2009: 66) as ‘the bundle of rights and obligations that define the identity of members of a political community, thereby regulating access to the benefits and privileges of membership’. From this perspective, once citizens have reached whatever local social norms and/or legislation ascribe as ‘retirement age’, they become united by the fact that their social citizenship permits them access to one particular benefit, an old-age pension. This has the effect of drawing together a diverse and heterogeneous segment of the population to form one ascribed identity as ‘pensioners’. Pensioners can then use some benefits and entitlements to exercise their civil or formal citizenship (eg by using a free bus pass to travel to a polling booth on election day or a political protest on budget day). Knowledge of entitlements and access to resources is the other side of the coin of citizenship, as without resources, citizens experience a diminished, marginal version of citizenship (Craig, 2004). In this chapter, the experience of undertaking research on ageing during the course of Ireland’s austerity programme is used to examine some of the implications of demographic ageing for social citizenship. The chapter begins by contextualising 21st-century citizenship in the context of globalisation, drawing out particular insights offered from the global economic crisis. It continues with an exploration of citizenship, making particular reference to how ageing impacts on the capacity of citizens to voice their needs. Next, I introduce the Irish case, establishing Ireland’s colonial history as the main driver for the ‘client-ship’ that has resulted in a form of civic Republicanism that has struggled to emulate the collectivist welfare states of European partners. In reflecting on the implications of austerity for citizenship in ageing societies, the chapter concludes by calling for a life-course approach to understanding civic involvement (Hirshorn and Settersten, 2013),

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particularly in the context of austerity. The contingency of all forms of citizenship in Ireland is most notably observed in the country’s recent economic history, which has revealed basic inadequacies in Ireland’s system of governance. The core outcome is a set of unequal power relations where decisions made by elites left Irish citizens with no control over the country’s economic sovereignty from 2010 to 2013 (Allen, 2012).

The impact of globalisation on ageing and citizenship The ageing of the world’s population occurs in tandem with two other significant and rapid changes: economic globalisation (Judt, 2010) and the expansion of democracy as the dominant form of political organisation (Posner, 2010). Globalisation and democratisation infinitely complicate how human societies can plan for (and respond to) demographic change in distinct but related ways. Demographic ageing is a major societal change, occurring at the same time as other significant transformations of societies around the world that have major implications for governance and welfare states. Chhotray and Stoker (2009: 2) identify globalisation and democratisation as ‘twin forces that mark this era of change’ for governance. Globalisation refers to the growing interdependence of nation-states through the flow of capital, both financial and human, across borders. This tendency towards sameness, the rise of multinational companies and the ubiquitous influence of information technology in communicating across borders has reduced the capacity of nationbased governments to maintain control over borders. The passage of people across borders also makes it more difficult for governments to control who has access to public services funded by national systems of taxation. For countries like Ireland, globalisation is something of a double-edged sword. While globalisation offers freedom from colonial control, through membership of the EU, the Eurozone and latterly global markets, it also presents risks as downward swings in the market are likely to have deep impacts on small, open economies like Ireland. Phillipson (2013) makes clear the potential impact of globalisation on older people as economic and social life are speeded up to the point where it becomes difficult to convincingly attribute a value to the safety and security of the labour market models of the 20th century. However, social gerontologists have been less articulate on how globalisation combines with democratisation to produce a particularly challenging set of conditions for older people and ageing societies in general. Democratisation of much of the Western world means that

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citizens have a higher expectation that they will be able ‘to influence the decisions that affect them’ (Chhotray and Stoker, 2009: 2). As populations age to the point where more than 25% of the electorate are over 60, the fear is that older people will vote in blocs to influence the flow of resources in their favour. Later in the chapter, I will discuss how strategic self-interested voting among the over 60s is not likely (Campbell, 2003; Goerres, 2008). Nevertheless, the time has come to investigate how these ‘twin forces’ of globalisation and democratisation might combine to exacerbate or alleviate the perceived pressure that population ageing is expected to place on welfare states. It is this political interpretation of the implications of ageing for existing welfare states that is increasingly recognised as an area of research that is ripe for development. In his study of the political participation of pensioners in 20 European countries, Goerres (2008: 1) questions predictions that Europe is becoming a ‘pensioners’ democracy’. Goerres (2008) and Vanhuysse and Goerres (2011) set out to frame a ‘comparative political science approach to generational politics and policies’ (Vanhuysse and Goerres (2011). To achieve this, Goerres (2008) used quantitative data to show that despite rising numbers of older voters as a proportion of the population, there is little evidence of a gerontocracy in Europe as ‘pure material self-interest seems not to be the only concern for older voters’ (Goerres, 2008: 69). Rather, he argues the ‘greying democracies’ should be viewed as neither better nor worse than youthful democracies. There are two opposing views. Participatory democrats argue that mass participation of citizens is the lifeblood of democracy as it ‘keeps political elites on their toes, socialises individuals into their role as citizens’ (Goerres, 2008: 174). A more cautious, representative interpretation of democracy differentiates between activists and non-activists. It is this view that fears the impact of demographic ageing, arguing that ‘older people will skew outcomes in their favour, permanently excluding the interests of younger people, especially children’ (Goerres, 2008: 174). These two competing perspectives are not so easy to separate in the case of older people. Carney (2010) theorises that when designed to target individuals in receipt of certain benefits (such as the oldage pension), policies can lead to unintended consequences, such as the formation of interest groups (Campbell, 2003). In other words, the country context is significant as the experience of ageing in one democracy might be a complete contrast to occupying the same birth cohort in another country context. By comparing and contrasting the experiences of citizenship for ‘pensioners’ in Ireland and ‘senior citizens’ in the US, Carney (2010) demonstrated how social citizenship,

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expressed through access to benefits such as the pension, produces divergent forms of political expression among older people. In Ireland, Carney (2010) argues, the experience of ‘structured dependency’ of many older people was assumed to be related to relatively inactive citizenship (Townsend, 1981). The opposite is the case among ‘seniors’ in the US. Under the US liberal democracy, state-related benefits are modest. One exception is the established norm of linking entitlements to age through the provision of social security to people over the age of 65. Such is the significance of these state-funded payments to senior citizens that US social security is said to have created a class of ‘retirees’ who run one of the most influential lobby groups (American Association of Retired Persons – AARP) in the US (Campbell, 2003; Grim, Huffington Post, August 2011). This is in complete contrast to Ireland, where pension, health and social care policies for older people are fragmented and piecemeal. The lack of a coherent, unifying programme for seniors in Ireland, has left the older people’s lobby fragmented and issue-specific (Schneider and Ingram, 1993; Carney, 2010). This, in turn, appears to allow governments to continually offer contingent and piecemeal social service provision to older people in the knowledge that marginal lobbies such as older people’s are unlikely to represent any real electoral threat to ruling elites. The perceived relative powerlessness of older people as a group combined with the social construction of them as needy or greedy makes it difficult for them to stage a legitimate protest to the systematic, habitual allocation of resources in favour of other, more powerful or positively constructed groups (Schneider and Ingram, 1993). It is the social construction of some groups and identities as strong and others as weak that explains how some groups, such as scientists and professionals, ‘can come to dominate and receive considerable benefits from some policy without appearing to have a great deal of political power’ (Schneider and Ingram, 1997: 199).

The social impact of ageing on citizenship at the individual level For some people, the experience of ageing can lead to a loss of confidence as retirement, ill-health, bereavement and loss of mobility combine to erode a person’s self-efficacy. This can range from feeling as though they ‘have been thrown on the scrapheap’ after retirement (De Largy, 2013) to older people with dementia being treated as if they are ‘socially dead’ (Spicker, 2000; Branelly, 2011). Socio-economic status and gender affect the experience of retirement significantly.

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For older people who have accumulated disadvantage over the life course, charities and advocacy groups tend to speak for older people, constructing them as a homogeneous subsection of the deserving poor.1 Critical gerontologists have argued that the ‘speaking for’ approach to advocacy is damaging as it leaves little space for older people to speak for themselves (Evers and Wolf, 1999). The effect of speaking for older people on a number of disparate issues can lead to older people viewing their situation as a series of fragmented health, income or mobility issues, effectively ‘depoliticising’ their position. Scholars have linked this set of circumstances to processes that lead to general passivity among the over 60s (Vincent et al, 2001: 45). Social constructions that use age to limit the expectations of older people serve to compound that depoliticisation through the fragmentation of ageing into ‘older people’s issues’. Moreover, having a reputation as an ineffective lobby group is damning because, as Estes and colleagues (2003: 129) argue, powerful groups grow more powerful over time as a reputation for power can lead to actual power: ‘if people believe that something is so (e.g. that the elderly have political power), it becomes so through a form of self-fulfilling prophecy’. Campbell (2003) observes a similar role for reputation in the collective voting habits of US seniors, who are often referred to as the ‘gray vote’ when there is no evidence of any strategic voting on their part. Campbell (2003: 8) finds that this reputation is overstated: ‘Journalistic accounts … correctly note that senior citizens vote at high rates, but writers often make unsubstantiated claims about older people’s policy preferences and cohesiveness’. The perception that older people vote strategically makes politicians more sensitive to their demands as a politically mobilised minority (Wilson, 2000). The US case suggests that political participation (and, more specifically, reputation for political participation) may be a significant variable in understanding societal responses to age-based resource allocation. If governments expect older people to accept cuts to benefits and entitlements, such as increasing the age at which one is eligible for the pension, for instance, then governments may find it easier to allocate resources away from older people in the future. Of course, the opposite is equally possible – resources could potentially be diverted towards older people because they are politically mobilised. Such a trend is bad for both democracy (Schneider and Ingram, 2005) and policy design as it allocates resources according to the level of political influence of a particular ‘bloc’ (Rae, 1981) rather than according to human need (Titmuss, 2001 [1955]).

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Wilson (2000: 46) argues that older leaders do influence politics, citing examples like Reagan and Churchill. More recently, we see global movements for change such as ‘The Elders’,2 who describe themselves as ‘independent global leaders working together for peace and human rights’. Chaired by Kofi Annan The Elders offer leadership and wisdom as values and attributes that they have accumulated over the life course. The Elders are the ultimate ‘good citizens’ – seeking to improve human life around the globe. However, these leaders are the exception that proves the rule, as many older people subsist on low, fixed incomes and experience old age as a period of life during which one survives rather than flourishes (Vincent et al, 2001: 107). Reduced or inadequate basic income is identified as a major barrier to older people enjoying full citizenship. Empirical research from the UK has demonstrated how lack of income curtails older people’s lives as having an adequate income is necessary if older people are to have ‘independence and mobility, dignity, choice and control, and the ability to participate as fully as possible in society on terms of their choosing’ (Craig, 2004: 112). In other words, access to an income generally in line with that of the working population is necessary if older people are to have the means to participate as full citizens (see Chapter Eight). In most countries implementing austerity policies, older people’s already inadequate payments have been further reduced (Levitas, 2012). This is not the case in Ireland, where declining incomes for those at work, through unemployment for many and the imposition of government levies on public sector workers, has improved the relative income position of older people. Austerity in Ireland has shifted pensioners from being a bloc with one of the lowest incomes in society to one with relatively high incomes when compared with falling averages (see Chapter Two; for a more detailed analysis of this pattern, see also Chapter Eight). Does this mean that austerity has been good for pensioners, or just bad for younger people? Perhaps austerity is more subtle in how it impacts on the lives of older people? In the next section, I focus more closely on the experience of ageing through Ireland’s austerity programme in order to address this question.

Ireland: post-colonial heritage and political culture The experience of citizenship in Ireland is best understood in the context of a history of colonialism (Powell, 1992). While, ostensibly, the country has been a functioning member of the EU since 1973, it has struggled to shake off the clientelism and clerical-nationalism of the early post-colonial period (Bolleyer and Weeks, 2009). In

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political terms, a two-and-a-half-party system of two conservative parties and a weak labour movement can be traced back to Ireland’s colonial heritage. The constitutional issue of partition, which divided the country into an overwhelmingly Catholic Republic in the South and a predominantly Protestant and unionist North, which remains part of the UK, still influences national political culture. Despite all of the changes brought about by economic globalisation, the impact of colonialism on Irish political culture runs deep, continuing to shape what is essentially a conservative and religious form of politics. While there have been some minor, Dublin-based labour protests since the foundation of the state, it is the absence of an industrial revolution or an organised labour movement to speak of that characterises Ireland’s process of modernisation. Essentially, the country made the transition from agrarian nationalism to a post-industrial society in just a few generations. Since its establishment in 1949, the Industrial Development Authority, a government agency charged with developing industry and employment in the Irish Republic, pursued a policy of foreign direct investment (Barry and Daly, 2011). Until the 1990s, mass emigration masked long-term economic stagnation. As we approach the centenary of the foundation of the Irish Republic in 1922, liberal democracy in Ireland is still struggling to emerge from a stunted form of Republicanism, based not on civic engagement, but on an oppressive form of clerical-nationalism. Political power bases structured around family and local community have evolved into a form of ‘clientelism’, where democratically elected representatives act as advocates for individuals on every conceivable issue. This system continues to shape Irish society and politics (O’Toole, 2011), more recently, being evidenced by a number of high-profile tribunals of enquiry into the bribing of politicians by property developers (O’Toole, 2010). The dominance of the Catholic Church has, however, been diminished by a number of high-profile crises exposing institutionallevel cover-ups of child sex abuse in recent decades (Moran, 2010). Despite secularisation, education, health and social care provision are still dominated by Church and private sector providers. This history suggests that Ireland demonstrates many of the attributes of a post-colony, as ‘new identities’, such as member state of the EU, must emerge from ‘old power relations’ (Robins et al, 2008). It is under the shadow of this complex post-colonial heritage that Ireland, having experienced the highs of an economic boom (1994–2007), descended into the worst recession in the history of the state in 2008. The following section focuses on the political response of older people to one particular austerity measure to illustrate the complex

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relationship between age, social citizenship and political agency under highly restricted economic conditions.

Applied analysis from Ireland: the political implications of austerity measures Following a sharp downturn in the global economy and consequently in Ireland’s economic fortunes, the 2009 national budget was the most austere for many years. Among other cutbacks, and as outlined in Chapter Two, the government introduced a means test for the free basic medical care that had been provided to all citizens aged over 70 from 2001 onwards. There was a strong public outcry objecting to this policy change. Organisations representing older people such as the Irish Senior Citizens Parliament (ISCP) and Age Action Ireland appeared on the national evening news saying that they had received a high volume of calls from angry members of the public. The media later revealed that elected officials were reporting a large number of calls from General Practitioners (family doctors), who receive substantial capitation payments from the government for clients whose medical card was awarded on the basis of age. The ISCP (which is largely run by a group of retired trade unionists) and the charity Age Action Ireland, organised two separate protest marches within days of the budget announcement. Older people from all over Ireland were urged by Age Action Ireland and the ISCP to use the travel passes that allow pensioners free use of public transport to attend a mass rally outside Dáil Éireann, the Irish Houses of Parliament in Dublin. The main evening news on 22 October 2008 broadcast images of older people holding placards with slogans like ‘No Country for Old Men’ and ‘A Budget to Die For!’, pensioners barracked politicians and vowed never again to vote for the party in government. Backbench and independent members of Dáil Éireann (TDs) began to revolt against the government’s proposals. Within a week of the announcement to abolish access to free primary medical care for the over 70s, the government made an almost complete U-turn, vowing to ensure that 95% of pensioners would qualify for the medical card under the new means-testing rules. The media presented older people as an articulate, mobilised and coherent bloc, willing to use their ‘grey power’ to protect their rights. In the final analysis, the universalism of access to free medical care for the over 70s was lost as government agreed to more generous means testing rather than a complete reversal of the proposal. While their victory was not complete, threats to never again vote for the political party in government may have been enough

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to shift older people’s orientation from ‘passive’ to ‘vigilant’ in the perception of elected officials (Schneider and Ingram, 1993). This was a significant threat as it broke the power of traditional party loyalties that had remained stable since the foundation of the Republic. In hindsight, this display of political activism is viewed as a crucial turning point for older people in Ireland, who are now imbued with a reputation for political activism (Estes, 2001). In media, policy and academic circles, the mobilisation of older people in response to this first raft of austerity cuts has been credited with dissuading successive governments from applying any reduction to the state pension. Interviewed not long after the protest in October 2008, the leader of one age-sector charity described the sea change that this one stand represented for the public’s and government’s perception of older people in Ireland: “A hint of the future would be the famous church protest meeting last October [2008]. People were stunned by that and the ageist reaction is, ‘Good God, these old people are speaking for themselves.’ The surprise was ageist in itself, but older people felt they had more power because they were doing it with 1,600 other people … it shocked the government.” (Author interview, 2009) By 2013, pensioners were described in the national media as ‘one of the most powerful lobby groups in the country’ (Collins, 2013a). In organising a follow-up protest in October 2013, the ISCP succeeded in mobilising a smaller, but equally vocal, group of political protestors to another public rally outside Dáil Éireann. This time the protest slogan was ‘Protest Rally Against Attacks on Senior Citizens’. The ISCP referred to the success of the first austerity protest by calling for protestors to assemble on the ‘fifth anniversary of the 2008 protest’ (Irish Senior Citizens Parliament, 2013) to highlight how a range of stealthy reductions in indirect benefits paid to pensioners had diminished their purchasing power since 2008. Cuts included a further reduction on the Over 70 Medical Card Limit, an increase to €2.50 on the prescription charge, the withdrawal of free line rental on telephone landlines and the abolition of a small bereavement grant paid on the loss of a spouse. It is likely that their reputation for political activism, demonstrated by the language and activities of the ISCP, has certainly played a part in the relative stability of the rate of the state pension in comparison with other payments, such as child benefit and jobseekers’ allowance, which have been reduced. This complies with the government strategy

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to justify each cut under a general claim that ‘everyone must pay’, ably supported by the national media. As more extensive and deeper cuts were made to every vulnerable group in Irish society, attention gradually turned to pensioners. As is evident in media reports: ‘Detailed figures released by the Central Statistics Office … confirmed once again that younger people have borne the brunt of the recession and that the elderly have been largely protected’ (Collins, 2013b). This interpretation of the inequality of austerity – as a division that should be conceived of as generational – has not gained ground in public debate. In the final budget under the bailout programme (the budget of 2014), the state pension was not reduced. In the following section, it is argued that the retention of the basic pension rate since 2008 is as much to do with high levels of intergenerational solidarity in Ireland as it is to do with the new reputation of pensioners as political activists. Perhaps the most accurate interpretation of this turn of events is that the programme of austerity revealed the extent to which solidarity at individual, family and societal levels is interlinked and mutually reinforcing. The next section outlines some qualitative empirical evidence supporting this claim. Austerity and solidarity: support from younger generations In 2011/12, a team of researchers on a project called Changing Generations used Charmaz’s (2006) Constructing grounded theory to interview 100 people from all walks of Irish life about solidarity between generations at societal and individual levels. The research concluded that people living in Ireland express high levels of solidarity between generations, particularly within the family and specifically in the identification of older people as a group deserving the benefit they receive (Timonen et al, 2013). Researchers found that younger people were supportive of maintaining pension rates even when their own incomes were falling (Scharf et al, 2013). The study also found evidence of older people transferring financial resources down the generations to adult children who were struggling to make mortgage payments and pay bills during the austerity programme. In some cases, retired parents reported using their disposable income to pay mortgages or loans of sons and daughters who had lost jobs (Carney et al, 2014). This finding corroborates evidence from survey-based data emerging from The Irish Longitudinal Study on Ageing (TILDA), which demonstrated significant financial transfers from pensioners to adult children (Barrett et al, 2011). Levels of family solidarity are high in Ireland, sometimes replacing public services and providing

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income support when the minimal welfare system fails (Timonen et al, 2013). In Ireland, as elsewhere, the family is a fourth pillar of social security (Kohli and Albertini, 2008), where families provide care, share resources and act as the first port of call in terms of social security. In such a system of family-based redistribution of resources, denying basic income to older people would therefore have immediate negative effects on their adult children who themselves are struggling with mortgages in negative equity, job loss, declining incomes and rising emigration (Allen, 2012).

Discussion: lessons for other countries Between 2008 and 2013, the Irish government imposed seven austerity budgets in a five-year period. Austerity has provided an opportunity to observe a sea change in popular and elite perceptions of older people from politically passive and economically dependent to political engaged and relatively well off. Despite stringent cutbacks to public services, education and welfare payments to children, people with disabilities and the unemployed, the state pension has not been reduced. The maintenance of the state pension has been attributed to a successful mass political protest by older people held in advance of the first austerity budget in 2008. The Irish experience suggests that political activism, and the reputation for political activism, plays an important role in protecting the interests of senior citizens in the context of globalisation (Estes et al, 2003). However, as older people represent only 12% of the population, a reputation for activism, while necessary, would not be sufficient to ensure protection of the pension from austerity cuts. In this, the support of younger generations of people living in Ireland, and other powerful lobby groups, such as medical doctors, proved sufficient to convince politicians and policymakers to preserve pension rates. Until the global economic crisis of 2008, scholars assumed that older people in Ireland, by virtue of their relative poverty, social isolation and economic disenfranchisement, would remain a quiescent segment of the population. It was expected that processes such as ‘individualisation of the social’ (Ferge, 1997), observed across capitalist democracies, would exacerbate the ‘depoliticisation’ of older people as the burden of paying off debt is made the responsibility of entire populations (Allen, 2012). The protection of the flat rate of the state pension has led some commentators and politicians to call for pensions to be cut in the interest of ‘intergenerational justice’ (Minihan, 2012). These calls appear to have been ignored by austerity-obsessed governments. Why

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have decision-makers implementing Ireland’s austerity programme chosen to leave the state pension uncut while make significant cuts to child benefit and disability services? I propose that high levels of family solidarity in the Irish culture, together with Ireland’s recent history of pensioner poverty, have combined with the burgeoning reputation of older people for political activism to account for the maintenance of the state pension throughout the austerity programme. Each of these issues merits further explanation. Until a number of significant increases were made to the state pension during Ireland’s Celtic Tiger boom-time economy (1994–2007), pensioners were one of the groups most at risk of poverty in Ireland. Receiving the state pension still represents the single most significant means of protecting the over 65s from poverty (see Chapters Two and Eight). Moreover, the maintenance of the state pension has the support of younger voters. The Changing Generations study found that younger people are aware of the significance of the pension to the welfare of their own elderly relatives (Timonen et al, 2013). Moreover, as family support involves the undocumented transfer of financial and other material resources between generations, most often, from older to younger, then a cut to the pension amounts to a cut in the income of younger generations too. It is my assessment, then, that the new-found reputation of older people as political activists in Ireland, while not the only reason, is a contributing factor to the maintenance of the state pension. Ruling politicians have found it easier to make cuts to groups who cannot vote (such as children) or who do not have the same societal support as older people (such as lone parents). A hierarchy of the vulnerable has been established by a divisive and unequal policy of austerity. The unrelenting focus on cutting benefits, rather than increasing taxes, to fund Ireland’s austerity programme has prompted civil society organisations to mobilise service users to take to the streets, albeit in small numbers (Carney et al, 2012). A key lesson from the austerity programme is that when governments are allocating cuts under a programme of austerity, those groups with a reputation for political activism are less likely to lose out than those whose voice is less easily heard.

Conclusion In this chapter, I have sought to build on the work of critical gerontologists, such as Walker (2006) and Townsend (2006), who have demonstrated how social policy might be better designed to

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produce services and relative equality for older people. I suggest that this literature might further explore the possibility that the unequal distribution of power, respect, influence and basic human rights is an important indicator of the quality of citizenship enjoyed in old age (Townsend, 2006). I have used the case of Ireland to demonstrate strong links between population ageing and globalisation. My exposition has drawn out the role of national political culture and, in Ireland’s case, a colonial history to demonstrate the impact of economic globalisation on small countries like Ireland who remain relatively weak on the world stage (Powell, 2002). I have explored a significant change in the political reputation of older people in Ireland, particularly in the response to the austerity programme. Findings from both quantitative and qualitative studies in Ireland suggest that while the political reputation of older people may motivate politicians to resist cutting pensions, this is tacitly endorsed by younger citizens, who support the maintenance of older people’s incomes. At the time of writing, Ireland has exited the EU–ECB–IMF bailout programme, giving domestic politicians greater control over public spending. I suspect that older people still remain one of the most protected groups in terms of the swathes of cuts to benefits and entitlements that most people living in Ireland have experienced since the onset of the austerity programme. Austerity continues to be the mainstay of government economic policy. The ‘everyone must pay’ mantra allows policymakers to present austerity as a programme of cutbacks that, by virtue of its breadth and indiscriminate application, somehow amounts to equality (Allen, 2012). This discourse continues unchecked as elites have successfully argued that austerity is the only solution to Ireland’s crisis (Carney et al, 2014). If we are to avoid the discourse morphing into a negative portrayal of older people as the ‘winners’ in an unequal society, social policy analysts must demonstrate the virtues of a perspective that has more potential to produce social cohesion between age groups. For these reasons, when advocating for a constructive politics of ageing, it is important that we begin to think of relationships between ageing and citizenship across the life course, not just the citizenship of older people. Given this life-course perspective, it is important that scholars of ageing attempt to put older people and the experience that they have gained after many years of life into a context that lends legitimacy to their voices. In Ireland, today’s generation of older people, many of whom were born just as the Republic gained freedom from British colonialism (1922), have lived through many substantial social and political changes that give complexity and weight to what they

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have to offer political decision-making, including the Second World War (1939–45), mass emigration (the 1930s, 1950s and 1980s), a long period of clerical nationalism (1922–90), and, more recently, inward migration and rising gross domestic product (GDP) (1994–2008).3 As Mannheim explained, the problem of generations is that the impact of any social change is never confined to one single cohort. Rather, a single historical event, be it a war, a recession or other defining moment, extends its reach far into the future, affecting current and future generations differently, incrementally, but certainly (Mannheim, 1997 [1952]). Finally, I propose three lines of enquiry with which to develop this analysis. First, if we are to begin to understand the possible impacts of globalisation and austerity on future generations of senior citizens, then more cross-national and comparative research on ageing, globalisation and citizenship is required. Second, I endorse Hirshorn and Settersten’s (2013) claim that scholars must expand their attention beyond civic engagement of youth and old age, and adopt a life-course perspective on studying civic involvement instead. Third, as social policy scholars, we would do well to remember that citizen participation has a role to play in the reform of social policy. Citizens can help to shape social policy, not just through the payment of taxes and as recipients of benefits, but also in using their civil and political rights to challenge anti-democratic economic policymaking. Such an active form of citizenship is ever-more necessary in the many democratic states living under severe austerity and loss of economic sovereignty in the Great Recession of the early 21st century. Notes See, for example, ‘Age Action tells IMF: austerity measures are hurting the most vulnerable of older people’, 13 November 2012. Available at: http://www.ageaction. ie/age-action-tells-imf-austerity-measures-are-hurting-most-vulnerable-older-people 1

2

See: www.theelders.org

3 For a full exposition of Irish social and political history, political culture, and economic change, see Galligan (1998), O’Hagan and Newman (2008) and Coakley and Gallagher (2010).

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FOUR

Active ageing: social participation and volunteering in later life Áine Ní Léime and Sheelah Connolly

Introduction Extended healthy life expectancy across many Western countries has contributed to the period after retirement being increasingly viewed as a time of health and activity. International organisations, including the World Health Organization (WHO) and the United Nations (UN), advocate ‘active ageing’ as a solution to the policy challenges associated with demographic ageing (Walker and Maltby, 2012), as have many national governments, including Ireland’s (Department of Health, 2013). The activities recommended by those who advocate ‘active ageing’ include participation in voluntary work, retirement-related associations and interest/hobby-related clubs, as well as continued participation in the labour market. This emphasis has continued during the economic recession, both in Ireland and in other jurisdictions. While, at first glance, the promotion of active ageing appears to be an unproblematically positive development, there are aspects of it that need to be critically interrogated. For example, whose responsibility is it to encourage, promote and resource active ageing, especially in a time of austerity? Are there groups of people who are currently excluded from active ageing, and, if so, what should be done about it? It has been suggested that governments may use the rhetoric of ‘active ageing’ to avail of the labour of older people themselves (many of whom may already be overburdened) to carry out unpaid work that should be the responsibility of the state (Minkler and Holstein, 2008). If ‘active ageing’ is beneficial, should governments be allocating resources to ensure that suitable programmes are provided and that all groups of older people have the resources to participate in these activities (Boudiny, 2013)? Finally, while continued participation in the labour market may be indicative of active ageing, it may also be a necessity for some older people, both in Ireland and in other countries, given

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the significant decrease in the value of pensions during the current economic downturn (Minkler and Holstein, 2008; Duvvury et al, 2012), an issue that will be returned to in Chapter Five. In addition to a relatively established body of international research on the ways in which social participation and volunteering among older people impact on the lives of older adults and the wider community, there has been a small but expanding body of recent work in Ireland (Morrow-Howell et al, 2009; O’Dwyer and Timonen, 2009; MorrowHowell, 2010; Barrett et al, 2011). Nevertheless, the majority of national and international research studies do not explicitly address social participation and volunteering in the context of recessionary conditions and austerity policies. The aim of this chapter, therefore, is to critically examine the participation of older people in social and volunteering activities in Ireland in a time of austerity. For the purposes of this chapter, we define volunteering as the commitment of time and energy for the benefit of society, local communities, individuals outside the immediate family, the environment or other causes. Social participation includes engaging in social activities (meeting with peers and going on social and/ or sport outings and short trips), cultural activities and/or creative activities with other older people. While many of the motivations, impacts and barriers are often common across participating in social and volunteering activities, differences clearly exist. Explicit reference will be made to these differences where appropriate. The chapter begins by defining active ageing and then reviews some of the international and national literature on the correlates and benefits of participation among older people, including the potential benefits to society in a time of austerity. The chapter will then consider the issue of whether being engaged in active ageing empowers people to become more active in relation to issues affecting older people, including the introduction of austerity policies. Next, and crucially, the chapter will identify and analyse barriers to engagement, internationally and nationally, and thus shed light on whether and which particular categories of older people are not well-represented. Finally, the chapter will explicitly consider the ways in which austerity measures have impacted on the opportunity for participation among older people in Ireland. The chapter draws on the qualitative findings of three recent Irish studies that offer illustrative examples of participation in Ireland in the context of economic recession and austerity policies. The first of these studies – the Active Retirement Ireland study (Ní Léime et al, 2012) – examines the impact of belonging to Active Retirement

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Ireland – a self-run organisation providing opportunities for older people to meet socially and engage in leisure, educational, physical and creative activities. The study assessed the nature and level of involvement, the motivation for involvement, impacts on the individual and barriers to engagement, including austerity. The second study – the Bealtaine study (Ní Léime and O’Shea, 2009; O’Shea and Ní Léime, 2012) – examined the motivations, impacts of and barriers to older people engaging in the Bealtaine festival, an annual national festival that celebrates creativity in older age. The third study – the Third Age volunteering study (Connolly et al, 2011) – looked at the motivation and impact of volunteering among a group of older volunteers participating in voluntary programmes organised though the Third Age – an older people’s organisation and social enterprise.

What is active ageing? While active ageing is commonly advocated by international organisations (WHO, 2002), the concept itself is contested and there is no exact, universally accepted definition (Walker and Maltby, 2012). The concept has been critiqued on the basis that original formulations focused in a somewhat narrow way on individual older people continuing their engagement in physical, social and productive activities in society. It was initially defined as ‘activity, health and independence in older age’ and tended to have a labour market focus (Walker and Maltby, 2012). This approach, particularly as formulated by the Organisation for Economic Co-operation and Development (OECD), tended to privilege active work-like engagement, with its main policy emphasis being to recommend that older people ‘live longer, work longer’ (OECD, 2006). Critical gerontologists contend that at least part of the motivation for this ‘productive ageing’ approach is to reduce the anticipated increased pension burden for welfare states (a topic that will be dealt with in more detail in Chapter Five). In addition, it contributes to the individualisation agenda that is becoming increasingly accepted in Western countries (Phillipson, 2013). This approach tends to exclude certain categories of older people, such as those who are mentally or physically frail or the ‘oldest old’. It also tends to ignore the constraints that specific groups of older people may face in pursuing a lifestyle characterised by ‘active ageing’ due to a relative lack of material resources and transport, power differentials, or being engaged in a caring role (Walker, 2002; Boudiny, 2013). Arguably, a broader, more holistic and inclusive definition of active ageing is that set out by

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the WHO in 2002, which describes it as ‘the process of optimising opportunities for health, participation and security in order to enhance quality of life as people age’ (WHO, 2002: 12). This definition is capable of encompassing the experiences of diverse groups of older people, although the emphasis on ‘health’ may still exclude those who face various kinds of health challenges (Boudiny, 2013).

Participation among older people Correlates of participation The ability and willingness of an older person to participate depends upon a variety of personal and environmental factors (Levasseur et al, 2011). Looking at both international and Irish evidence, a number of individual-based characteristics have been shown to be consistently associated with social participation. These include age (being under 75 years) (Bukov et al, 2002; Desrosiers et al, 2009; Barrett et al, 2011; Levasseur et al, 2011), being married or living in a steady partnership, having a higher socio-economic status (Thoits and Hewitt, 2001; Bukov et al, 2002), and having a good self-rated health status (Adamson et al, 2004; Barrett et al, 2011). While international evidence suggests that women are more likely to volunteer than men, Irish studies have found little gender variation in the likelihood of volunteering (Barrett et al, 2011). Bukov et al (2002) found that the level of education and occupational status were positively related to the intensity of social participation; educational level is also associated with the likelihood of volunteering (Erlinghagen and Hank, 2006; Barrett et al, 2011). The reason for higher participation in volunteering among the more educated is unclear. It may be that the more educated have more resources that facilitate participation or that there may be social selection (Thoits and Hewitt, 2001), with the more educated more likely to be asked to participate. In addition to an older person’s personal characteristics, the social and physical environment in which they reside can be an important determinant of their participation in various activities. The norms and values that regulate the role of older people in society can influence an older person’s participation (De Jong Gierveld, 1998). Motivations and benefits of participation Motivations for volunteering and participation The motivation for participation differs depending on the activity under consideration. A large body of international and some recent Irish

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research, for example, has focused on the motivations for volunteering, and identified altruistic reasons, including ‘the desire to help others’ and ‘to give something back’, as important motivating factors for volunteering among older people (Lie and Baines, 2007; O’Dwyer and Timonen, 2009). Older people have also been found to volunteer to add purpose to their lives, to engender a sense of belonging and to feel needed, at a time when other roles such as employment and rearing a family are less important (Lie and Baines, 2007; Warburton and Stirling, 2007; O’Dwyer and Timonen, 2009). Echoing international findings (eg Morrow-Howell et al, 2009), the Third Age volunteering study (Connolly et al, 2011) found that the majority of respondents reported a desire to help others as their main reason for volunteering, while a significant proportion also reported a need to feel useful or needed. This was particularly important for those for whom previous roles, including employment, looking after a family and care-giving, were no longer as time-consuming as they had been. Similarly, in the Active Retirement Ireland study (Ní Léime et al, 2012), bereavement was mentioned as an important motivator, with many participants indicating that the active retirement association (ARA) supplied a social network that helped fill the gap brought about by the loss of their spouse, while others were motivated to participate because retirement had resulted in the loss of social networks. Perhaps somewhat particular to the Irish context or at least to countries with high levels of past emigration, emigrants returning at retirement age found that they no longer knew people and needed to find a way of reconnecting to their communities (Walsh et al, 2012a). As one woman, who was a member of an ARA, expressed it in the Active Retirement Ireland study (Ní Léime et al, 2012): Well, I came back from England having been there for 43 years and came back to close to where I came from, but of course people had moved on and I had lost contact. I went [to an ARA] and it was a great way of getting back into the community and getting to know people. (Ní Léime et al, 2012: 40) Participating in social organisations and/or volunteering may therefore provide a sense of social connection for those who have lost previous roles or who need a way of integrating into the community. Arguably, the loss of many ‘natural’, traditional meeting places in communities, which has resulted from government rationalisation programmes, such as post offices and pubs (a topic that will be dealt with in more

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detail in Chapter Six), provides a motivation for older people to join in social programmes or voluntary organisations to replace these lost opportunities to meet casually. It is likely that many of these motivations for volunteering and/or social participation in social/leisure activities are present irrespective of external economic conditions; for example, this may be true in the case of bereavement or families growing up, and for people moving into a community. However, given the level of cutbacks to the community and voluntary sector, it is likely that there is a greater demand for the types of services provided by volunteers in a time of austerity and there may be greater expectations that older people will contribute their time and effort to the provision of services. Similarly, since many older people were made redundant or strongly encouraged to take early retirement during the recession in Ireland, this is likely to provide a strong motivation to these people in the sense of providing a sense of purpose, which was disrupted by redundancy or unplanned retirement. Benefits of volunteering and participation A number of studies have linked both social participation and volunteering with a catalogue of well-being indicators, including life satisfaction (Van Willigen, 2000), physical and mental health (Thoits and Hewitt, 2001; Hughes and Ganguli, 2009; Richard et al, 2009; Morrow-Howell, 2010), and survival (Holt-Lunstad et al, 2010). However, selection effects are an issue as it is unclear whether increased participation leads to better health outcomes or whether those with better health are more likely to participate. Such selection effects could lead to an overestimation of the beneficial effects of volunteering (Li and Ferraro, 2006). However, a number of longitudinal studies that allow the direction of causation to be established have now demonstrated the positive outcomes for those that have increased participation, even after controlling for selection effects (Harris and Thoresen, 2005; Lum and Lightfoot, 2005; Holt-Lunstad et al, 2010). A range of literature has shown a positive correlation between participation and mental health among older people (Hughes and Ganguli, 2009). Crooks et al (2008), for example, found that compared with those with smaller social networks, women with larger social networks were significantly less likely to develop dementia, while Holtzman et al (2004) noted that interaction in larger social networks was related to better maintenance of cognitive health. While maintaining and improving the physical and mental health of the population is a key objective of most governments, it may be especially important in current times as ageing populations

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compete for often declining health and social care budgets due to the economic downturn (Walker and Maltby, 2012). For example, reducing or removing funds allocated to programmes that support active ageing may be less controversial than cuts in the health budget; however, the longer-term implications of such cuts need to be considered, especially their potential impact on the health of older people and their subsequent need for health care. A number of mechanisms linking participation and well-being have been proposed. One potential benefit of participation is the opportunity it provides for social relations with other people. Holt-Lunstad et al (2010) identify two means by which social relationships may influence health. First, social relationships may provide resources (informational, emotional or tangible) that promote adaptive behaviour to acute or chronic stressors (illness, life events, life transitions). The benefits from social relationships thereby moderate or buffer the deleterious influence of stressors on health. Alternatively, social relationships may be associated with protective health effects through more direct means, such as cognitive, emotional, behavioural and biological influences that are not explicitly intended as help or support. For instance, social relationships may directly encourage or indirectly model healthy behaviours. The second way in which participation in volunteering and social activities may influence health status is through its impact on loneliness, as participation has been linked to lower levels of loneliness. Loneliness has been shown to be associated with chronic illness and low selfrated health, as well as poor health behaviours (Mullins et al, 1996; Lauder et al, 2006). In relation to loneliness, the Active Retirement Ireland study (Ní Léime et al, 2012) noted lower levels of loneliness among ARA members compared with older people in the general population (Timonen et al, 2011b). The fact that ARA members are meeting other people through volunteering and participating in social and creative groups and are busy and engaged appears to make them feel less lonely. One member of an ARA notes the impact of membership: ‘For me, the quality of life it’s [being an ARA member has] given me from loneliness to not having time to bless myself now in this organisation. It’s just made me very, very active and aware’ (Ní Léime et al, 2012: 52). In addition, a host of other benefits may accrue depending on the activity undertaken. Engaging in physical activities, for example, impacts positively on both physical (Weerdesteyn et al, 2006) and mental (Blake et al, 2009) health. A large body of research has highlighted the potential benefits of participating in voluntary activities

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(as distinct from social participation), including giving the volunteer a sense of identity (Morrow-Howell et al, 2003; Greenfield and Marks, 2004; Lum and Lightfoot, 2005) as the volunteer role provides older people with a sense of identity in the (relative) absence of other work responsibilities. Other possible mechanisms linking volunteering and health include a sense of ‘mattering’ (Piliavin and Siegl, 2007) and feelings of well-being from the philanthropic nature of volunteering (Brown et al, 2008; Greenfield, 2009). While the cross-sectional nature of the three Irish studies means that it is not possible to determine if participation itself leads to better health, there is, at least, evidence to suggest the positive impact of participation on quality of life. Qualitative evidence from the Active Retirement Ireland study (Ní Léime et al, 2012) indicates that a higher quality of life results from participants’ absorption into the activities and from their enjoyment of the social interaction. A related benefit of participation concerns increased confidence among participants. As demonstrated by the Bealtaine study (Ní Léime and O’Shea, 2009; O’Shea and Ní Léime, 2012), people appeared to value their enhanced ability to express themselves, as well as their enhanced personal development, facilitating them to master new skills and to develop a new perspective. As one participant of the Bealtaine festival noted: ‘I have to say I have found my voice since joining this group’ (Ní Léime and O’Shea, 2009: 108). This resonates with international findings, including findings from Cohen’s (2009) study, which suggested that participation in cultural programmes among older people may lead to an increased sense of mastery or control over a skill or activity. In addition to the benefits accruing to older persons themselves, there are a range of potential benefits to the wider community and society arising from social participation, including intergenerational solidarity (Walsh and O’Shea, 2008), an economic value arising from the productive contribution of older people and potential savings to health services (Walsh and O’Shea, 2008; O’Shea and Connolly, 2012; Ní Léime, 2013). For example, research from the UK estimated the value of unpaid work provided by older people to be in the region of £10 billion (SQW, 2011). Another potential benefit includes older people becoming more aware of and acting upon older people’s issues nationally. This is particularly relevant at a time when the government is imposing cutbacks, with some ARA members indicating that becoming a member of an ARA had made them more aware of issues for older people in society during austerity and more inclined to take action to effect change. For example, and as dealt with in Chapter Three,

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many older people participated in a large demonstration in Dublin against a plan by the government to introduce a means test for medical cards for older people in Ireland (Carney, 2010). Older people’s organisations (including Active Retirement Ireland) were instrumental in spreading the word through its country-wide network of local ARAs to encourage a large number of older people from around Ireland to participate. This politicisation of older people appears to be at least partly a by-product of being involved in the local ARA, as indicated by the following quote: ‘If pensions are threatened or something like that. If there’s some kind of campaign to make an impact on Ministers.… Before, I mightn’t have bothered. Since I got involved in this [ARA], I do’ (Ní Léime et al, 2012: 56). Others had gained the confidence to transfer their new skills to other older people in their local areas, enhancing their local community in the process. For example, one woman set up a creative writing group in her local community as a result of being involved in Bealtaine (see Ní Léime and O’Shea, 2009; O’Shea and Ní Léime, 2012). Being involved in creative and intergenerational programmes had a number of other positive impacts, for example, breaking down barriers between older people who were resident in hospitals and residents in the local community. It provided them with opportunities to mix through the arranging of events, such as art exhibitions and dramas, that would allow members of the community to visit the hospital. It also created an appetite in participants to attend similar events in the community, thus stimulating greater engagement between them. Finally, intergenerational programmes provided some older people with opportunities to engage with young people in their communities for the first time (O’Shea and Ní Léime, 2012; Ní Léime, 2013).

Barriers to participation among older people in Ireland The role of public transport at a time when private transportation may become more limited is crucial in allowing older people to reach places of social gathering. Both international and Irish research indicates that the reduction or removal of funding for public transport, especially in rural areas, is likely to have a detrimental impact on older people’s ability to access places of participation (Newbold et al, 2005; Ni Leime et al, 2012; Walsh et al, 2012a). There have been cutbacks in rural transport in Ireland as part of wider austerity policies. Walsh et al (2012a) identified those without access to a car (either because they cannot afford one, because they are unable to drive or because a medical condition prohibits driving) as being vulnerable to exclusion.

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In addition, the oldest old and those with mobility issues were also identified as being potentially excluded, since many venues for social participation are not accessible to those with certain mobility difficulties (Ni Leime et al, 2012). The availability of opportunities for participation within walking distance of the home is likely to increase participation rates. Austerity cutbacks to local and national community and voluntary organisations mean that the provision of such programmes has been curtailed (Richard et al, 2008). Perceptions of safety and security in the locality are also likely to influence participation, with one study finding that an older person’s perception of an area as being less neighbourly was independently associated with a greater likelihood of decreased participation in social activities (Bowling and Stafford, 2007). It is likely that other austerity measures may also have implications for the participation of older people. Falling incomes and wealth may affect participation as fewer resources may be available to fund some of the inevitable expenses that arise from participation. Previous Irish research shows lower participation rates in cultural activities among those with fewer socio-economic resources (Lunn and Kelly, 2008), perhaps because many creative and cultural activities were perceived to be the preserve of the elite in society. While belonging to ARAs is relatively inexpensive, it is likely that the cumulative effects of the various austerity measures affecting older people may impact on the disposable income of people who are on very low fixed incomes and make it difficult for those on the very lowest incomes to join. Conversely, it may provide an opportunity to belong to a social organisation for those older people who are no longer able to afford to belong to private leisure clubs. A reduction in formal social care may mean that some older people have less time to engage in active ageing activities as they are required to provide increasing amounts of informal care for incapacitated family and friends (Ginn, 2013). Although active ageing is advocated by government policy, it is clear from looking at the profile of people involved in the Irish studies that certain groups of older people are relatively under-represented. In particular, men, the ‘older old’, people with mobility difficulties and those who do not have access to transport (as discussed earlier) are less likely to participate in social or creative activities (Timonen et al, 2011b; Ní Léime et al, 2012). In-keeping with international findings (eg Australian Bureau of Statistics, 2010), the three Irish studies found lower participation rates among men in these particular social and creative programmes and organisations (Ní Léime and O’Shea, 2009; Connolly et al, 2011; Ní Léime et al, 2012; O’Shea and Ní Léime,

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2012). This is different from The Irish Longitudinal Study on Ageing (TILDA) findings, which measured either volunteering specifically or a broader composite measure of social engagement, and which found little gender difference in participation in volunteering and social engagement between men and women (Timonen et al, 2011b). While for some relatively privileged men, not belonging was due to the fact that they were already engaged in many leisure activities, others did not participate because they perceived the clubs to have activities that suited women only; however, others did not join due to a lack of confidence. In addition, masculine norms of self-reliance, particularly in rural areas, are thought to be partially responsible for lack of social participation by men (Cleary et al, 2012). Another potential barrier to participating in social clubs for older people is the reluctance to be regarded as ‘old’ or to associate with other older people. Interviews with current ARA members and nonmembers reveal that some older people have internalised negative stereotyped views of ageing and activities in ARAs, as typified by the following reply given by a non-member who was asked why he had chosen not to join an ARA: ‘When you say an active retirement group, I think of a lot of elderly people, sort of doddery people staying around the place trying to organise themselves to do something.… I’m not drooling yet, you know’ (Ní Léime et al, 2012: 60). If older people are to be encouraged to join such organisations, the groups need to combat such stereotypes and communicate the nature of their activities to potential members.

Active ageing: who is responsible in times of austerity? One of the questions raised by critical gerontologists in relation to volunteering, and one that is particularly relevant in the context of austerity, is whether the work of older volunteers (as opposed to those who just participate in social participation) is being used to provide services that should be provided, paid for or supplemented by the state (Morrow-Howell, 2010). The amount of time spent volunteering can be quite substantial, with one in five people aged 65–74 in Ireland doing voluntary work at least once a week (Timonen et al, 2011b). In the Active Retirement Ireland study (Ní Léime et al, 2012), chairpersons of the ARA organisation, for example, provided on average of 5.54 hours of work per month on chairperson duties alone. While many chairpersons saw the organisation as something beneficial for themselves, there was also evidence that some members felt overstretched in carrying out the organisational roles and could

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benefit from financial and other forms of support. However, in Ireland at least, there has been relatively little financial support for implementing active ageing policies in relation to older people, despite a recognition in policy documents since 1988 that ‘active ageing’ and ‘healthy ageing’ should be promoted (see, eg, The years ahead report; Department of Health, 1988). Policy and practice for active ageing in Ireland in a time of austerity There has been relatively slow policy development, and even slower implementation of such policy, in relation to social and cultural participation for older people in Ireland in the past number of years. In 1998, a health promotion strategy for older people recommended that a holistic approach to healthy ageing for older people be adopted. It suggested that attention be paid to physical, psychological and social well-being and set out goals for physical health, mental health and social interaction (Brenner and Shelley, 1998). However, with the exception of physical health, there has been very little progress towards the implementation of the recommendations by the government. In terms of current policy, active ageing is addressed under the National Positive Ageing Strategy (NPAS; see Department of Health, 2013b). In fact, the WHO definition of active ageing is described as providing the theoretical underpinning for the strategy. One of the national goals set out in the NPAS, which specifically addresses active ageing, is to ‘remove barriers to participation and provide more opportunities for the continued involvement of people as they age in all aspects of cultural, economic and social life in their communities according to their needs, preferences and capacities’ (Department of Health, 2013: 19). The strategy identifies specific objectives to achieve these goals, including promoting access to education and learning, promoting the concept of active citizenship and the value of volunteering, and encouraging older people to contribute to their own communities. Another objective is to ‘Promote the development of opportunities for engagement and participation of all people of all ages in a range of arts, cultural, spiritual, leisure, learning and physical activities in their local communities’ (Department of Health, 2013: 20). However, despite this positive and progressive policy rhetoric, the main thrust of current service provision for older people remains a narrow focus on hospital care, long-stay care, medication and curative approaches, with relatively few resources being devoted to health promotion. There is an increasing focus on care in the community, with the introduction of Primary and Community Care teams. However,

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even within this arena, the concentration is on care, which, for the most part, is provided by a range of medical professionals, rather than on the development of social and cultural programmes that have been shown to have beneficial mental and physical health effects. In order to address this gap in provision, a number of nongovernmental organisations (NGOs) focus on the well-being of older adults, including Active Retirement Ireland, the Third Age Foundation and Age & Opportunity, who provide a range of services and social, physical, creative and educational programmes, as well as encouraging advocacy for older people. However, a relatively low level of resources has historically been directed towards these organisations, even during the period of the economic boom. For example, in its 2008 Annual Report, Active Retirement Ireland reported that its core government funding had not increased over the previous four years (during the high point of the ‘Celtic Tiger’ economy). With the advent of austerity policies, government grants for Active Retirement Ireland activities have been reduced, for example, a reduction of 20% is reported in 2010 over the previous year (Active Retirement Ireland, 2011). It is clear that these cutbacks are having an adverse impact on local ARAs, as illustrated by the following quote: ‘I think the funding is the biggest issue for running things. I really do because the money is just not there anymore and we have to make do with small money’ (Ní Léime et al, 2012: 65). Given the associated mental and physical well-being accompanying the activities that these organisations promote, and its own stated policy goals in the NPAS, it appears that if the government wishes to promote positive and healthy ageing, more resources need to be directed to providing such programmes. International and Irish evidence suggests that a partnership approach between the government, local authorities and NGOs in the age sector to delivering participatory social programmes is extremely effective, and, indeed, the government itself recommends such an approach (Department of Health, 2013; United Nations, 2002; Moody and Phinney, 2012; Ní Léime, 2013). Therefore, resources invested in developing and maintaining these partnerships are likely to yield long-term individual and societal benefits. The Age-Friendly Cities and Counties Programme (which is discussed in detail in Chapter Six) may provide a mechanism for ensuring that organisations working with older people receive support from local government and community development partnerships to overcome barriers to participation caused by the lack of transport and appropriate spaces for older people to meet – although, in itself, it is currently a resource-neutral programme. Innovative policies using information

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and communication technologies (ICTs) may help to ensure that the oldest old, or those confined to their homes or long-stay care facilities, may participate in cultural, physical and educational activities. Similarly, given the increasing international evidence that older people who are physically and/or mentally frail can benefit from such engagement (Noice and Noice, 2006; Noice and Noice, 2011; Yuen et al, 2011), resources devoted to programmes that encourage such participatory activity in long-stay care facilities may yield significant health and social benefits.

Conclusions The aim of this chapter was to critically discuss the motivations and participation of older people in social and volunteering activities in a time of austerity, with reference to the international literature and a number of specific Irish studies. Discussion of the link with austerity is largely exploratory since research exploring the explicit link between active ageing and austerity is underdeveloped. Motivations for volunteering include the desire to ‘give something back’ to society and to have a continuing role and identity in the absence of paid employment. It is likely that this extends to additional cohorts of older people in a recession, including those who have become unexpectedly unemployed or have been pushed out of the labour market to take early retirement. Motivations for participation in social, leisure and creative activities are similar to those in the international literature and include having a sense of purpose, social interaction, integrating into the community and providing people with a social outlet in the event of bereavement or when family members have moved away in search of employment. The high levels of emigration in Ireland since the economic recession will doubtless mean that this latter motivation has been more prevalent in Ireland in recent years. The chapter has highlighted the many mental and physical health and social benefits arising from the active participation of older people. These benefits apply both to volunteering and to participation in social activities, and include reduced loneliness, enhanced self-esteem and better self-rated health. While many of these benefits are obtained irrespective of whether or not there is an economic recession, given that being a member of an ARA or participating in a cultural festival is relatively inexpensive, such organisations can be an effective and affordable means of encouraging active ageing and enhancing life in older age. Volunteering and social participation also appear to have helped make older people more politically aware and engaged citizens.

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This is a welcome development given that older people in Ireland had previously been perceived as somewhat disengaged in terms of activism (Carney, 2010). Given all that, these benefits, organisations and programmes that give older people opportunities to volunteer and/ or participate should be supported by governments. This would help to ensure that such participation is choice-based and that volunteers are not overburdened to the extent that their health suffers (Smith, 2004). Cutbacks to resources in social care in austerity, including cuts to home-help hours and respite care, may mean that some older carers are not free to participate in these life-enhancing activities (Ginn, 2013). In particular, in Ireland at least, while the importance of active ageing has been acknowledged in key government reports and strategies, this has not been backed up by adequate financial or other supports. While there has been relatively low funding of community and voluntary organisations in the ageing sector, even prior to the recession, arguably, during the period of economic growth, the need for such support is increasing – in part, because of the increasing number of older people and, in part, because of the impacts of the economic downturn and subsequent austerity measures (Ní Léime and O’Shea, 2009; Ní Léime et al, 2012). It appears that there are particular groups of people who encounter barriers to participation in social and cultural programmes, including the oldest old, people with disabilities, those living in nursing homes and older men. Again, these barriers and their associated low participation have been present prior to the introduction of austerity policies. However, an adequately resourced and implemented active ageing policy may be particularly important to address the needs of vulnerable groups of older people in times of economic hardship. There is a need for governments to provide funding to ensure that all groups of people, including those with disabilities or chronic conditions, have access to existing programmes given the health benefits they provide at a relatively low cost. There is also a need to provide such active ageing programmes in long-stay care facilities for those who cannot travel to attend them at other venues. In addition, the economic crisis has led to a new wave of emigration of young and middle-aged people from rural areas, causing the further depletion of both private and public services and meeting places. The relative lack of priority given to programmes that support active ageing pre-dates the current period of austerity. The acknowledgement in the NPAS of the need to support active ageing is a welcome and far-sighted development at a time of recession. Directing additional resources towards active ageing at this time will help ensure that older

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people live active, connected lives that enhance their health and the lives of their communities and that should be cost-saving in the long run. If these resources are not provided, however, and this commitment is not given, then it is likely that specific groups of older people will continue to be excluded from the physical and psychological benefits that accompany active ageing.

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FIVE

Pension provision, gender, ageing and work in Ireland Áine Ní Léime, Nata Duvvury and Aoife Callan

Introduction International policy bodies (such as the Organisation for Economic Co-operation and Development [OECD]), the European Union (EU) and national governments in many Western countries have become increasingly concerned about how to provide pensions for the growing proportion of older people (European Commission, 2009; OECD, 2012c). Demographic ageing is often referred to in policy discourse as a ‘crisis’ or a burden, and one of the main suggested solutions is to shift responsibility for pension provision from the state to individuals and to encourage the privatisation of pensions (Haan and Prowse, 2011). Several countries, such as Germany, Ireland, Italy, Sweden and the UK, have introduced policies designed to extend working life and to reform state pension provision. Such measures include increasing the state pension age, removing the mandatory retirement age and generally encouraging citizens to take on responsibility for providing for their own pensions (Lain et al, 2013). Under austerity, pressure to reform pension policies has intensified and implementation has accelerated, with insufficient appreciation of the implications for different groups of workers (Earles, 2013). In particular, older women’s current access to pensions is influenced both by gender norms and by austerity policies as both shape women’s work trajectories. This chapter focuses on the gendered consequences of European policy reforms on pensions in Ireland. In particular, we consider the impacts of austerity on women and their ability to provide for their pensions. The discussion focuses on the case of older women workers in Ireland. The chapter adopts a dual approach to analysis. First, it draws upon a feminist political economy of ageing approach to analyse older workers and pensions from a gender perspective. This approach emphasises the impact that legislation, policy and conditions

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in the economy, such as austerity, have on shaping the environment in which older women workers make work-life choices (Ginn et al, 2001a; Phillipson, 2004). One reason for adopting this approach is the recognition that different welfare regimes are, and were to a greater degree in the past, gendered (Price and Ginn, 2003; Meyer and Pfau-Effinger, 2006). Ireland, for example, through its employment, taxation and social welfare policies, favoured a male breadwinner model of family life (Daly, 2001), where the policy environment encouraged one (usually male) breadwinner rather than encouraging other models, such as dual-earner families (Drew et al, 1998). This included discriminatory employment policies such as the ‘marriage bar’, which compelled women who worked in the public sector to leave work as soon as they married, a policy that persisted until Ireland joined the EU in 1973 (Mahon, 1998). The second theoretical approach is a life-course approach, which helps to understand how individual men and women make work and pension-related choices (Giele and Elder, 1998). The advantage of using a life-course approach is that it is capable of identifying how macroeconomic policies and socio-economic conditions impact on and are acted upon by individual women workers over time. It can also help identify the nature of the challenges women face in relation to adequate pension provision in a time of austerity and identify where policy interventions may usefully be made. We begin by setting out more fully the theoretical approaches on which we draw to help understand the interaction between gender and pensions in a period of austerity. We then turn to a discussion of the developments of European and Irish employment policy. Here, women’s labour force participation, both its level and variation over the life course, is specifically highlighted, as the work trajectory of the individual is a key factor shaping pension provision. Next, we focus on pension policies across Europe and Ireland, with close attention to the pension structure and reforms in Ireland in the context of austerity. We then examine the gender gap in pensions in Ireland and the likely implications of austerity for women’s pension provision. We draw upon findings from a 2012 study of older women workers and pensions in Ireland (Duvvury et al, 2012) to provide insight into the gender pension gap. This study was part of a larger cross-border study of women and pensions on the island of Ireland; only the data from Ireland is used for this chapter. The study used a mixed-methods approach and analysed national statistics to explore patterns and trends in relation to pension provision. It involved conducting six focus groups with 33 women aged 45 and over from key sectors and 30 individual interviews

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using a life-course methodology to investigate how individual women experienced and behaved in relation to employment and pensions across their working lives. A detailed description of methods and sampling is available in Duvvury et al (2012). In the final part of the chapter, we provide a discussion and conclusions.

Understanding gender and pensions Policy commentators and theorists from a feminist political-economy perspective highlight the fact that many existing pension systems are ‘gendered’ – they have been developed on the assumption that a male model of working life is the norm (Ginn et al, 2001a; Meyer and Pfau-Effinger, 2006). For example, many existing pension systems are typically based on the assumption that people work full-time in the labour market for a long period (usually up to 40 years). The extent to which this mirrors the working life of vulnerable groups and of many women is highly debatable. Life-course theorists point out that socioeconomic resources and/or previous work-life trajectories may have a profound effect on the capacity to continue working past pension age and on pension outcomes (Dannefer and Settersten, 2010). A political-economy approach recognises that legislation (work, taxation and social welfare) and economic conditions, including austerity, are deeply influential in shaping the environment in which people may make employment decisions that impact on their ability to provide for their pensions. However, a political-economy-of-ageing approach has itself been critiqued (with some justification) in the past as not sufficiently accounting for personal agency (Gilleard and Higgs, 2002). Gilleard and Higgs (2002: 370) suggest that due to a combination of demographic change, socio-economic development and the breakdown of societal structures, ‘retirement now offers the opportunity to develop a distinct and personally fulfilling lifestyle unconnected with the contingencies of working life – a new third age’. However, this ‘third age’ approach has also been problematised on the basis that it tends to universalise from the position of affluent (often male) retirees with continuous careers and adequate pensions and fails to recognise the continuing importance of structures and categories such as class, gender and the segregated labour market (Kunemund and Kolland, 2007). In order to address the identified shortcomings of both the ‘third age’ and the political-economy perspective, we adopt a life-course approach combined with a feminist political-economyof-ageing approach, which can incorporate both the structures and agency that shape pension provision over the life course.

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Employment policy and women’s participation Recent developments in employment policy in Europe and Ireland Even before the current economic crisis, both the EU and the OECD responded to the phenomenon of demographic ageing by advocating that member states introduce policies designed to extend working life. The European Commission recommended the introduction of ‘active ageing’ policies (a concept that has been dealt with in more detail in Chapter Three), which involves a policy shift away from ‘over-reliance’ on state provision towards a growing role for the individual and private/ work-related provision of pensions (European Commission, 2009). This was associated, at least in part, with the neoliberal ideology that emerged in the 1980s, a period of economic downturn, which advocated market solutions to the perceived pension crisis. The OECD has also encouraged individual responsibility for pensions by advocating for the introduction of defined contribution and private pensions, thus shifting responsibility away from the state and from employers. It has also advocated that workers spend more years at work beyond the existing pension age (OECD, 2006). Recommended policy measures include increasing the retirement age and state pension age, limiting access to early retirement schemes, and developing stronger links between pension contributions and pension benefits. It is suggested that such policies will create incentives for older people to remain active in the labour market. Critics suggest that this approach is based on a highly reductionist and economistic conceptualisation of active ageing that does not sufficiently take into account other aspects of the lives of individual workers, such as their health, their other commitments or their previous experiences inside and outside the labour market (Mouleart and Biggs, 2012). Equally, it has been pointed out that diverse groups of workers, such as those engaged in heavy physical or emotional labour, those in precarious employment, and women, may be particularly adversely affected by these policy shifts (Vickerstaff, 2010). While such policies were initially introduced to deal with demographic ageing, it is likely that the global economic crisis provided a further impetus that may have accelerated their introduction. Adopting an active ageing framework, European institutions have prioritised attention to policy initiatives to support and encourage working longer. EU legislation with a particular focus on antidiscrimination has played a key role in supporting active ageing. In 2001, in an attempt to encourage extended working life, the Stockholm

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Council set a target of a 50% employment for men and women in the 55–64 age group by 2010. In 2007, The EU adopted the Council Directive 2000/78/EC, which directs member states to make unequal treatment in employment, recruitment and training illegal. The Europe Strategy 2020, against the background of the economic crisis, suggests that the overall employment target of 75% cannot be realised without rapid activation of older men and women currently out of the labour market. To advance this strategy: the Agenda for New Skills and Jobs identified the need to address upskilling in the older workforce as a priority; the European Social Fund (2014 to 2020) prioritised investment in active and healthy ageing; and the European Innovation Partnership on Active and Healthy Ageing is supporting research on expanding and sustaining an active/healthy lifespan. Specific social policies to extend working life include raising the retirement age, activating the labour force participation of older men and women (65+), restructuring incentives for contributions to pensions schemes and pension benefits, restricting early retirement, and encouraging flexible employment options. In Ireland, legislation to combat age-related discrimination in the workplace was introduced in 1998, earlier than in other EU countries, and was modified in 2004 to cover those aged 65 and over. This is a positive development since it protects the rights of those who work beyond the traditional retirement age. This legislation was also intended, at least partly, to encourage older workers to remain in or return to the workplace to help address the shortage of workers due to a booming economy from 1996. Between 2001 and 2013, the employment rate for women aged 55–64 in Ireland increased from a very low base of 28.6% to 43.1%, which is still significantly below the 2010 Stockholm target and below the average 43.3% for the 27 member states of the EU (Central Statistics Office, 2014). Over the same time period, the employment rate for men in Ireland aged 55–64 remained comfortably above the 2010 target, increasing from 64.9% in 2001 to 68.1% in 2007, at the height of the economic boom, before decreasing to 58.7% (above the EU average of 57.5%) in 2013 as a result of the economic crisis (Central Statistics Office, 2014). Features of women’s employment The increase in the participation rate of women, and that of older women in particular, makes it more likely that some groups of women enjoy standard pensionable employment. Recent research in Ireland and in international settings that adopted a life-course approach to the

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analysis found that women are normatively regarded as the primary carers for children and that this has a strong influence on constraining their choices in relation to participation in employment (Ivosevic, 2009; Moore, 2009; Duvvury et al, 2012). They are also more likely to provide informal care for older and other dependent family members, which may also interrupt their labour market participation (Frericks et al, 2009). In addition to the direct effects of care provision, many women with caring responsibilities are absent from the labour market during the crucial career-building years and often return to the labour market at lower levels. This can have an indirect effect on their earning and pension-building capacity (Dewilde, 2012). For example, previous research in European countries has shown that women with lower socio-economic resources and with interrupted careers typically return to posts with few promotional opportunities and low incomes (Collins and Wickham, 2004; Doorewaard et al, 2004; Tomlinson et al, 2005). Across Europe and Ireland, women are more likely to work part-time in order to accommodate caring, often resulting in reduced earnings over the life course (Ginn et al, 2001a; Sandor, 2011). An important feature of the labour market across European countries is that it is segregated by gender, with women largely concentrated in occupations with poor pay and conditions (Bettio, 2002; Frericks et al, 2009). As is the case internationally, there is persistent horizontal and vertical segregation by gender in Ireland (Central Statistics Office, 2014). Vertical segregation means that women are typically concentrated at the lower end of promotional hierarchies and thus tend to be paid less than men. For example, in 2010, women constituted only 17.6% of the top grade in the Irish civil service (secretary general), while they formed 77.4% of clerical officers, the basic entry-level grade (Central Statistics Office, 2012c). Horizontal segregation means that women are typically concentrated in particular sectors of the labour market, such as cleaning and caring (Central Statistics Office, 2014). The patterns identified in the preceding are interrelated and combine together to shape the gender pay gap. Such patterns are unlikely to be reversed during periods of economic recession. Another distinctive feature of the labour market is the persistence of the gender pay gap. The gender pay gap, an indicator calculated by Eurostat, is used to monitor the inequality in pay between men and women in Europe. It is defined as the relative difference, in percentage terms, between the average gross hourly earnings of women and men (Central Statistics Office, 2012c). The average gender pay gap in Ireland was 15.7% in 2009, slightly below the gap in the EU of 17.1% (Central Statistics Office, 2012c). The gender pay gap is partly caused

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by conservative social norms in Ireland. The gender gap in income can be partly understood as resulting from the social construction of women as the primary carers for dependent family members. This is embedded in article 41.2 of Ireland’s Constitution, which states ‘that the state shall, therefore endeavour to ensure that mothers shall not be obliged by economic necessity to engage in labour to the neglect of their duties within the home’ (see O’Connor, 1998). This social norm affects their likelihood of being in employment, particularly full-time employment. For example, women with children under school age are less likely to be employed than their male counterparts, while there are comparatively high employment rates for both men and women with no children (Central Statistics Office, 2012c). Their higher likelihood of being involved in caring also means that women are more likely to be involved in part-time work. In Ireland in 2013, 72% of those working less than 30 hours per week were women, while just over 23% of those working over 40 hours per week were women (Central Statistics Office, 2014). These gender-differentiated employment patterns lead to differences in the nature and level of pension-building for men and women in Ireland. Again illustrating the features of women’s employment discussed previously, many older women have been involved in atypical work throughout their lives. Duvvury et al (2012) found that many older women workers were involved in seasonal or contract work that may be fitted in around child or elder care. Examples of the type of work that women in the study undertook included running a guest house, keeping students as lodgers, being census enumerators and teaching music lessons from home. Frequently, such work was not pensionable and earnings were typically so low that women were not able to pay sufficient contributions to build an adequate private pension.

Pension policy reforms in Europe and Ireland Pension system in Ireland The pension system in Ireland is a two-tier system with a mix of public and private provision. The first tier comprises two basic state pensions – the state contributory pension and the state non-contributory pension – these are a basic safety net, providing a low level of replacement income relative to the average income for those reaching retirement age. The state non-contributory pension is means-tested and is for people who have been unable to make sufficient contributions to be awarded the state contributory pension and who have no other means. The state contributory pension is somewhat higher and the level of it

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is based on the amount of social insurance contributions made over a person’s working life. The second tier of pensions for those who wish to have a higher level of pension above the state pension comprises of occupational and/or personal pensions. In the past 20 years, the state has increasingly been encouraging citizens to contribute to secondtier pensions by providing income tax relief on pension contributions (Department of Social and Family Affairs, 2007; Hughes, 2007). Trends in pension reforms in Europe and Ireland Despite varying pension systems in EU countries, pension reforms across the continent, in line with the global discourse of the ‘pension crisis’, have focused on individualisation of risk in retirement and extending working life through raising the retirement age (Vickerstaff and Cox, 2005; Duvvury et al, 2012). Such pension reforms have been driven by severe economic challenges and fiscal constraints due to the economic recession, coupled with concerns regarding an ageing population (Börsch-Supan, 2010; OECD, 2011b). While most EU countries introduced measures to extend working lives and delay paying state pensions, the countries most affected by austerity – Portugal, Italy, Greece, Spain and Ireland – have tended to introduce very severe measures (eg increasing the state pension age and requiring more years of contribution) at a relatively fast pace in an attempt to reduce pension costs as quickly as possible (Busch et al, 2013). A critical concern highlighted in the literature is that life expectancy post-retirement has increased to more than 20 years for men and women, potentially undermining the sustainability of pension systems (Earls, 2013). A key reform to address this concern being undertaken across Europe is to reduce the length of the average post-retirement period to 15 years by raising the retirement age (Shwarz and Arias, 2014). In Ireland, for example the state pension age increased from 65 to 66 in January 2014, and will rise to 67 in 2021 and 68 in 2028 (Department of Social and Family Affairs, 2010), thus delaying the age at which the government provides for its older citizens while lengthening the workforce pension contribution period. Equally critical is the emphasis on individual responsibility, with governments shifting focus to encourage enrolment in occupational pensions and private pensions through tax relief on contributions and, more so, through auto-enrolment (OECD, 2014). In Ireland, The Pensions Board recommended an emphasis on occupational and personal pensions, reinforcing the link between earnings, length of working life and pension provision (The Pensions Board, 2006).

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As will become evident in this chapter, reinforcing this link is likely to exacerbate gender inequality since women typically have lower earnings and interrupted employment trajectories, leading to lower levels of pension provision. This policy is being adopted in many European countries and if we consider its likely impact from a lifecourse perspective, it is evident that this will serve to disadvantage older women, reversing some of the effects of policies designed to give women credit for time spent caring (OECD, 2014). Considerable discussion has also focused on reducing the level of benefits in Ireland, though this is more risky politically.

Gender pension gaps While gender pension gaps pre-dated the recession, it is worthwhile to consider whether the recession is likely to increase or decrease the gender pension gap. Historically, there were several ways in which women in Ireland were disadvantaged in relation to pension policy, as well as employment and social welfare policy. For instance, and linked to the traditional breadwinner model, women were originally typically constructed as dependants of their husbands and were not awarded pensions in their own right (Daly, 2001). Certain measures were introduced from the 1990s onwards that addressed some of these disadvantages. For example, from 1994 onwards, credits were given to women in respect of time spent out of the labour market caring for children or dependent adults. However, this legislation was not made retrospective before 1994, so women who had to leave work due to the marriage bar remained discriminated against (Duvvury et al, 2012). Overall, to date, there are notable gender differences in terms of the nature and level of pension provision that continue. In 2009, 47% of men and 51% of women aged 20–69 had no pension provision other than the state pension. However, while this may appear to be a relatively small gap, the level of private pensions is, in fact, much lower for women (Duvvury et al, 2012). Additionally, only 13% of men and 5% of women had a private pension in 2009 (Central Statistics Office, 2012c). On average, women are much more likely to be dependent on the state for their pension provision. For example, in 2009, women accounted for only one third of those receiving the state contributory pension and two thirds of those receiving the lower noncontributory state pension (Department of Social and Family Affairs, 2010). Therefore, there is a large difference in the actual amount of pension income received by women as opposed to men. Of those receiving the state contributory pension, only one third received the

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full rate of the state pension. Furthermore, in 2009, women received less than half as much from occupational pensions as men did (€46 per week, compared with €98.50 for men), while women’s income from private pensions was only 60% that of men’s income (Central Statistics Office, 2011b). Recent research suggests that across the EU states, the pension income received by women aged 65 and over is, on average, 39% lower than that received by men. The equivalent gender pension gap in Ireland is 35% (Bettio et al, 2013). Changes to pensions in the Irish austerity programme Within Ireland’s austerity programme, several important changes have been implemented to the pension system, and we will now consider the likely gender impacts of these changes. First, recent changes to the qualifying criteria for a state contributory pension for those with less than the maximum number of contributions are likely to adversely affect women in particular. The two main changes are: a) the contributions requirement for the minimum state pensions has increased, in fact, nearly doubled, from 260 to 520 contributions; and b) new rate bands have been introduced to reflect more ‘accurately’ attachment to work (Ryan, 2014). In fact, the introduction of the new rates cut the pension rate by about 20% for the bottom bands, which is where the majority of women and others in poor, temporary or part-time employment or with an interrupted work history are likely to fall. According to data from the Department of Social Protection, women make up 60–64% of the three lowest bands (Ryan, 2014). To offset this potentially serious negative impact on women, the minister for social protection proposed to move from a system of disregards (up to 20 years), as specified in the Homemakers’ Scheme (started in 1994), to credits for years spent in caring (with a maximum of 10 years’ credit). However the proposal has thus far not been accepted (Ryan, 2014). An additional important change introduced in the 2013 budget is that the number of contributions to qualify for the widower’s pension increased from 156 contributions to 260 (Ryan, 2014). Another critical element that has been agreed in principle but not yet legislated for is adopting a total contributions approach to replace the current system of yearly averaging of the contributions; this is due to take place in 2020 (Government of Ireland, 2007). Once this change is implemented, 30 years of contributions (1,560 contributions) will be required to get the maximum pension benefit, with a person accumulating 1/30th of benefit for each year of contribution/credit (Ryan, 2014). Similar measures have been introduced in other European countries (OECD,

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2014). Since women typically are more likely to work part-time or with interruptions, they are more likely to be adversely affected by these increased contribution requirements. Despite the fact that there is an acknowledged gender difference in patterns of employment and pension provision in Ireland, there has been very little qualitative empirical research into how individual older women workers experience and negotiate their work-life trajectories and the consequences of such for their pension provision. Next, we turn to a discussion of the impacts of the austerity programme and its related changes to the pension system, drawing on illustrative examples from the study by Duvvury et al (2012) on older women workers and pensions in Ireland. Gender and pensions under austerity Duvvury et al (2012) identified a number of processes that resulted in Irish women having relatively poor pension provision even prior to the period of austerity, many of which are common to women in Western countries, but some of which are particular to the Irish situation. For instance, echoing international findings, there was evidence of a strong gendered division of labour, with women more likely to be regarded as primary carers (Frericks et al, 2007). Similar findings were highlighted by Meyer and Pfau-Effinger (2006) in a comparative study of women in Germany and the UK. Several of the women who participated in the study had three or more gaps in their employment history in order to provide care for children or dependent relatives. In fact, for many women, it was the norm rather than the exception to have gaps in their employment (Duvvury et al, 2012: 28). The interviews revealed that social welfare, tax and gender discriminatory employment legislation, as well as the lack of publicly provided childcare, all made it difficult for women to participate in the labour market. Such policies meant that, for many women, it was regarded as the husband’s responsibility to make pension provision for the family (Duvvury et al, 2012: 20). It is not surprising, therefore, that 17 of the 32 married women interviewed had no pension provision. It has been found in previous international research that relying on spouses/partners for pensions is a risky strategy (Ginn et al, 2001b) and 15 of the husbands of the women interviewed in this study did not have pensions. The interviews revealed that in the event of relationship breakdown or the husband’s illness or unemployment, this reliance can leave women in a vulnerable position. In times of recession, the exposure of women who are thus dependent to financial risk is intensified. The recent recession in Ireland meant

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that many of the husbands of the women interviewed had lost jobs in sectors such as construction. The level of pension provision varied across different cohorts of older women. For some, there was evidence of cumulative advantage across the life course. The study found that some women with higher education who had uninterrupted careers in the public sector had adequate pensions approaching retirement age (Duvvury et al, 2012). These women were relatively unaffected in terms of pension provision by the recession. Others who were unaffected were women whose husbands had well-paid posts in either the private or the public sector with good occupational pensions. The interviews illustrated vividly how horizontal occupational segregation may result in women with low levels of education being confined to poorly paid types of employment that have either no or very low pension benefits. For example, one woman whose highest level of education was primary level was only able to find work in the cleaning sector and the hotel sector. She began work in her early teens, then left to care for her children and returned to work after a gap of 20 years. Even though she had worked at two part-time jobs – one for 25 years and the other for 18 years – she calculated that her pension would be worth very little since she was earning just above the minimum wage and her employer had not paid contributions for her in earlier years. The issue of low pay that arises from both horizontal and vertical segregation means that it is very difficult for particular groups of Irish women to pay into private or occupational pensions. Murphy and McCashin’s (2008) study indicated that in the years when women were caring for children and older relatives, there was very little public provision of childcare or family-friendly policies. In addition to these structural and policy factors, the recent austerity policies in Ireland make pension contributions for women in low-paid sectors extremely challenging. The austerity programme introduced in Ireland between 2008 and 2014 involved a total adjustment of €32 billion, of which €21 billion was in spending cuts (Social Justice Ireland, 2013). In the first three austerity budgets in 2008 and 2009, there was the introduction of a 7% pension levy and a 6.5% reduction in public sector wages. In effect, the pension levy, despite the name, is an extra tax on those with secure public sector pensionable jobs rather than a levy on pensions. Moreover, since 2008, there has been a systematic reduction in social welfare benefits, particularly child benefit, disability benefit and ancillary benefits for older people, such as fuel allowance and transport, coupled with the introduction of the property tax. The

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government also introduced a number of stringent austerity measures, including a universal social charge, which affected all tax-payers. These measures reduced incomes, and even though a higher proportion was taken from higher earners, the impact on lower earners who already had very little surplus was very damaging in terms of further limiting their ability to pay for pensions. Given these strained circumstances, it is not surprising that women in low-paid sectors found it extremely challenging to afford occupational or private pension contributions, as the following quote from an interviewee working in the childcare sector indicates: ‘But between that [a recent pay cut] and the new universal levy, there’s usually not €2 to spare to go to a pension. Can’t even save’ (Duvvury et al, 2012: 35). The introduction of these austerity measures undermined the previous attempts by the government to exhort people to provide for their own private pensions or to supplement their occupational pensions. The following quote from a financial sector employee at middle-management level illustrates this: ‘I have been paying AVC’s [additional voluntary contributions] but with the universal social charge etc. and all the rest of it, I simply, can’t afford to continue with it, so I had to put it on hold’ (Duvvury et al, 2012: 36). Another impact of the global economic crisis was to reduce the value of private pensions. At an individual level, this meant that some women saw their pensions lose up to 65% of their value. Some of these women had very little money but had responded to the government’s encouragement to invest in private pensions by investing their modest life savings into a private pension fund. Awareness of such losses had a more serious general impact in that half of the women said that they were now extremely sceptical about the value of investing in private pensions. The global economic crisis had a strong impact in Ireland as its effects were exacerbated by the collapse of house prices in 2008 after a period of inflated prices (Allen, 2012). Some women who had either no pensions or very poor pensions had invested in property in the expectation that it would provide an income for them postretirement and/or that they could sell it to provide nursing home care for themselves if necessary. With a sharp decline in property prices, in many cases, reducing property values by more than half, many of these women feared that owning property would no longer provide an adequate income for themselves in retirement. I have become a bit concerned since the recession, because what I thought I had put in place … I would have been

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conscious of the pension eight years ago when I bought this house and converted part of it with the income from that. So, since the recession, I’m … a bit concerned that that might not be there. (Duvvury et al, 2012: 37) Other impacts of the recession were that some of the women in precarious employment, such as the community and voluntary sector or the services sector, had lost their jobs or had had their hours of employment reduced. Such women had ceased to make occupational pension contributions. Others in the childcare sector had had pay cuts of up to 10% imposed on them. These workers were already on low pay and indicated that these pay cuts meant that they would now not be able to pay any contributions into a private pension. In some cases, family members such as spouses had lost their jobs and this had reduced discretionary spending, again reducing the likelihood of being able to pay into private pensions or to boost existing inadequate pensions. Those whose pensions were most protected in the recession were those with defined benefit pensions in the public sector. However, even those women were affected by the universal social charge and the pension levy. Many of these had an immediate incentive to leave the workforce as public sector pensions were about to be changed in a way that would reduce the level of the pension.

Discussion and conclusion The goal of encouraging active ageing through raising the state pension age seems persuasive in view of demographic ageing, and may offer choices to particular groups of workers who wish to continue to contribute to the formal labour market. Previous research has shown that well-being in retirement is related to choice. Where people have been able to exercise choice in relation to continuing to work or to retire, this has positively affected their well-being in retirement (Calvo et al, 2009). Thus, choice in retirement may be of benefit to those women and men who had to leave the labour market earlier due to unemployment or discriminatory policies and to those who are in good health or in sedentary occupations. Social class has an important bearing on having control over when to retire, with professionals being in a much better position to demand and avail of early retirement (Gould, 2006; Loretto and White, 2006). Critically, both international agencies and national governments ought to consider the burden that such policies place on particular cohorts of workers who are already in a disadvantageous position in relation to income and pension provision.

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It is clear that both women in low-paid or precarious employment and/or engaged in heavy labour in Ireland and Europe are relatively disadvantaged in relation to pension accumulation and that the policy shift towards individualisation and privatisation puts them at increasing risk of poverty in older age (Busch et al, 2013). Although this is beyond the scope of this chapter, it is likely that older men in lowpaid and precarious employment are similarly relatively disadvantaged. Requirements to have increased contributions in order to qualify for the state pension will further disadvantage these cohorts. Where policies to extend working life are being introduced, care needs to be taken to ensure that these groups are protected. A gendered analysis of pension reforms is required, as is an analysis of the impact for men and women in different socio-economic groups. As already discussed, Ireland has moved to increase the state pension age substantially and rather quickly compared to other EU countries; while the drive towards pension reform had been there prior to the recession, the accelerated pace of change and the severity of the reforms were affected by austerity. The reforms represent a change in the social contract that was imposed with little consultation or discussion with citizens. For many people, the state pension is seen as an entitlement that people have earned through their lifelong contribution to society, whether that is through their ‘productive’ engagement in the formal labour market, through the ‘reproductive’ work of providing informal care for children and older people, or through a combination of both. The brief outline of employment patterns and statistics on pension provision included in this chapter demonstrate that women, both in EU countries and in Ireland, are relatively disadvantaged in relation to pensions (Stahlberg et al, 2006). Evidence from research using a life-course perspective shows clearly how this disadvantage evolves and accumulates over time and is experienced at an individual level, both by women and (although beyond the scope of this chapter) presumably by men in precarious employment or heavy labour (Duvvury et al, 2012). The current policy shift towards the individualisation and privatisation of pensions is likely to exacerbate this disadvantage (Tuominen and Laitinen-Kuikka, 2006). It is clear that there are many barriers to women being able to contribute to private or, indeed, occupational pensions, including low pay, precarious employment and gaps in employment for caring purposes (Etxezarreta and Festic, 2009). The findings of the research with older women workers in Ireland highlights that policy changes to pensions need to be linked to other broad policy areas, supporting similar findings in other EU countries (Earles, 2013). However, the legacy of relatively recent (compared to

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other EU countries) gender discriminatory legislation in Ireland means that there is a greater need to ensure that policies that counter the resultant disadvantage are adopted. Some of the measures proposed to address the issue of future pension provision for younger people, such as making it easier to contribute to pension schemes, for example, through auto-enrolment, would be ineffective if the underlying factors that shape women’s pension provision are not addressed. The issue of low pay for caring work, the public provision of childcare, family-friendly policies and other measures to address the gender division of labour, such as extending parental leave to support and encourage men to engage in caring labour, are all critical areas that must be integrated into any broad package of pension reform, both in Ireland and in Europe, if the goal of achieving gender equity in pensions is to be pursued. Given the legacy of discriminatory legislation in Ireland and the lack of investment in childcare and other family-friendly policies, it is likely that women will continue to have the primary responsibility for caring for children and dependent family members. Thus, they are more likely to be reliant on the lower non-contributory state pension. For reasons of equity, it is important that the level of this pension is maintained so that it provides these financially vulnerable citizens, who have contributed substantially to society, with a reasonable standard of living, even in conditions of austerity. It appears that austerity policies have intensified the difficulties that Irish women face in providing for their pensions and made it extremely challenging for them to contribute to private or occupational pensions. This is an issue with profound implications for future generations and calls for public debate to consider whether policies to extend working life as currently envisaged amount to an inequitable change in the social contract. This is an opportune moment to consider how or whether policies to extend working life can best be designed to ensure that all citizens, men and women, in both secure and precarious employment, can look forward to economic security in later life.

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SIX

Interrogating the ‘age-friendly community’ in austerity: myths, realities and the influence of place context Kieran Walsh

Introduction In all of our lives, in Ireland and in other national settings, place matters. The communities, the neighbourhoods, the districts and the streets that we live in matter to us as individual residents and as members of a collective place-based community. As we age, it can certainly be argued that place matters even more, regardless of what country we live in. Many older people have simply spent longer periods of their life course in their place of residence. Therefore, their place relationship is often more established, and has paralleled and intersected with important events and transitions in their lives. Additionally, where we live can be critical when health, mobility and social connections become more of a challenge in later life. It is unsurprising, then, that there have been various initiatives focused on enhancing the relationship between people and place. Concepts such as liveable communities (AARP, 2005), compact cities (OECD, 2012b), welcoming communities and healthy cities (WHO, 2008) are now embedded in the policy and practice rhetoric of many countries. Perhaps the most prevalent of these in recent years, particularly for targeting older adult well-being, has been the agefriendly movement. Ireland, as with many other settings, has certainly embraced this movement. Building on the World Health Organization’s (WHO’s) Age-Friendly Cities Programme, the age-friendly concept has been applied to communities, cities and larger regions as a means of enhancing older people’s environmental relationship, and as a framework for social policy. With a presence in over 21 countries, the movement has become globalised, and, in some circles, is viewed

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as a way of addressing ‘challenges’ and resource demands arising from demographic ageing (eg Tompkins, 2008). In the current economic climate, however, enhancing older people’s relationship with their place is a substantial challenge in its own right. Such efforts, whether driven by political, societal or even community agendas, are starkly juxtaposed with experiences of economic recession and programmes of austerity in Ireland and in other settings. Whether we take a narrow environmental view of place or a broader multidimensional view, reductions in public expenditure are likely to influence experiences of ageing in place. However, the impact of austerity on older people’s relationship with place has not been considered, and reflects a wider paucity of research on the influence of global (or national) macro-societal issues on local settings (Phillipson, 2011). More fundamentally, what makes a community or a neighbourhood a good place to age, and thus what makes it agefriendly (Menec et al, 2011), is still very much a matter of debate. These questions sit amid broader knowledge gaps concerning how the diversity of the older population, the diversity of place and the dynamics of community change might intersect to alter the meaning of ageing in place (Walsh et al, 2014), and, indeed, how social policy can support such complex individual and place relationships. In this chapter, I explore older people’s relationship with place in the context of policy-driven austerity and the economic recession, and the pursuit of age-friendly communities. As one of the principle sites of the age-friendly movement, and as a well-documented location of economic recession and austerity, Ireland provides a valuable case study in conducting such an exploration. Ireland holds particular relevance to international jurisdictions, where age-friendliness and austerity, or, indeed, various forms of economic disadvantage, might intersect within local communities. However, beyond this, the Irish community setting will be used to demonstrate the worth of exploring how cultural contexts might shape such intersections, and how they can impact on older residents. The chapter concentrates on current place of residence, encompassing the home and the local community. However, the analysis draws on and acknowledges the relationship of localities with macro-environmental contexts, such as the European Union (EU) (Phillipson, 2011; Buffel, 2012), and their interaction and fluidity with other local places (Andrews et al, 2013).

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Importance of place – in Ireland and elsewhere To begin, it is useful to elaborate on why place is important for older people by drawing on international evidence. This will help illustrate why initiatives such as age-friendly programmes are worthwhile, and why preserving this relationship is valuable, even in austerity. At a basic level, this relationship is about proximity. Studies in Europe and internationally have demonstrated that older people spend much of their time around their home and immediate environment (Oswald and Wahl, 2005). Therefore, their daily lives are concentrated in and intertwined with their localities, illustrating a closing of ‘lifespace’ (Rowles, 1978; Buffel, 2012). Consequently, it is important to optimise what can be described as the fit, or the congruency, between an older person and their place of residence. This is a core concern of environmental gerontology, which attempts to understand the environmental interactions of older people (Wahl and Weisman, 2003). It has long been recognised that some settings fit the capabilities and the preferences of older residents more than others. As represented in both seminal and contemporary environmental gerontological theories (eg Lawton and Nahemow, 1973; Golant, 2011; Wahl et al, 2012), age-related declines can mean that older people are more susceptible to the influence and pressures of their place of residence (Oswald et al, 2011). The physical and spatial characteristics of place can contribute to or hinder the environmental mobility and the public interactions of older people in their locality. As demonstrated by research in Germany (Oswald et al, 2011) and the US (Ryvicker et al, 2012), this can be in terms of geographic elements of place, such as type and location of community, and aspects of the built environment, such as housing, public spaces and accessibility. Through the embedded amenity and service infrastructure (eg retail outlets, health services, transportation), place can serve the needs of older residents and provide instrumental support for community living and societal engagement (Dwyer and Hardill, 2011). In Ireland, qualitative studies have illustrated how these physical, spatial and structural characteristics of place are connected to older people’s social and economic participation within local communities (Walsh et al, 2012a, 2012b). The social and cultural aspects of place are critical to many older individuals. There is growing international evidence that testifies to the multiple ways in which such dimensions are connected with health and well-being outcomes (Walsh and Gannon, 2011). For instance, in a sample of 1,157 older people in the UK, Gale et al (2011) found that

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older people’s perceptions of social aspects of their neighbourhoods may be important for positive mental health in later life. In a study of rural communities in Ireland and Northern Ireland, older people’s places of residence were found to be important sources of meaningful relationships, social participation and informal support (Walsh et al, 2012a). In many ways, these elements of place are inextricably linked to older people’s feelings of community inclusion (Burns et al, 2012). The social and cultural components of place can also influence perceived community cohesion and togetherness, and, ultimately, feelings of trust, reciprocity and safety (Buffel, 2012; Walsh et al, 2012c). Older people’s relationship with place is essentially experiential. It is derived from and performed through their roles (eg neighbour, volunteer), behaviours and interactions within their place of residence (Rowles, 1983; Oswald and Wahl, 2005). Older people are therefore not passive in the construction of their relationship with place, or, indeed, in the co-production of place with other residents. Older people need to be recognised as ‘actors in place-making’ in their own right (Buffel, 2012). Older residents’ interactions with their physical and social environment are laden with subjective and symbolic meaning (Rowles, 1983; Cloutier-Fisher and Harvey, 2009). This, for example, may relate to the solace that an older person obtains from the aesthetic landscape, or the emotional connectedness stemming from community relationships. Affective, cognitive and cultural ties with place can be formed over the residential life course and through the accumulation of memories and experiences (Rowles, 1978; Peace et al, 2006). These ties can also be transmitted through generations of family and community, reinforcing notions of place-based belonging (Walsh et al, forthcoming). Additionally, and as noted by Wiles et al (2012) in a study of two New Zealand communities, ageing in place may symbolise important ideas of independence and autonomy for many older residents. In these symbolic, experiential and subjective ways, older people’s identity can often be intertwined with and bolstered by their place of residence (Rowles, 1983; Wiles et al, 2012). Place has a particular cultural and symbolic significance for older people in Ireland. Ireland possesses a place classification that is immersed in historical and cultural symbolism, and closely linked to notions of place-based cultural identity (Inglis, 2009), even in today’s global context (Inglis and Donnelly, 2011). This descending classification includes provinces, counties, baronies, parishes and townlands, with the latter being unique to Ireland and derived from Gaelic, religious and native land divisions (Dallat, 1991). Narratives of regional and local belonging are populated with references to different levels of

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this classification, betraying attachment and allegiances to place and community. This elevates the role of place-based community in Ireland, such that much of Ireland’s meso-socio-cultural structure remains rooted in these settings, whether this is in terms of traditional religious parishes or parish- and community-centred sporting clubs (eg the Gaelic Athletic Association-run Gaelic hurling and football clubs). Previous research has demonstrated that for some Irish older people, the specificity of place-based connectedness can contribute, on the one hand, to feelings of life satisfaction and belonging if the person is living in their place of choice, and, on the other, to feelings of displacement if they are not (Walsh, forthcoming). As we age, particularly for those of us who are lifelong residents of an area, home and the immediate community can represent life-course continuity (Peace et al, 2006). Yet, it is important to recognise that our relationship with our place of residence is constantly evolving. As we enter later life, this relationship is not only influenced by changes in our personal functionality, but also by the shifts that can occur in the experiential and symbolic meaning that we associate with place, and the demographic, economic, social and cultural changes that can redefine place itself. Such shifts have been shown to occur in both rural and urban settings and in a range of international jurisdictions, including Canada (Burns et al, 2012), the UK (Ziegler, 2012) and Ireland and Northern Ireland (Walsh et al, 2012c). For instance, a person’s perception of their home environment may alter with the onset of a debilitating disability, or, alternatively, residential turnover may mean a weakening in an older person’s sense of connection to place. Of course, how older people relate to their place of residence and what benefits they garner from that relationship also come down to who they are as individuals, what socio-economic and cultural background they come from, and how they prioritise the different dimensions of place. A question that will be looked at later in the chapter is to what degree the economic recession and austerity impacts on these different aspects of the older person–place relationship.

Age-friendly communities: origins, evolution and evidence With such a deep attachment to place embedded in Irish narratives of ageing, it is perhaps understandable why the age-friendly concept has been so popular in Ireland. First introduced into Ireland in 2005/06, age-friendly programmes have grown in depth and scale during the economic recession and the most significant programme of austerity

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in the history of the state. This, in itself, is an intriguing development. It is helpful, however, to first consider the origins of the age-friendly concept and how it has evolved globally. Origins and evolution In response to increasing rates of demographic ageing and urbanisation, the WHO established a global collaborative project in 2005 to identify the features of an age-friendly city. Described as being grounded in environmental and ecological perspectives, and drawing on such concepts as ageing in place, urban design and liveable communities, the project aimed to promote active ageing – thereby ‘optimising opportunities for health, participation and security in order to enhance quality of life as people age’ (Plouffe and Kalache, 2010: 735). Working with a panel of experts, the project identified eight dimensions of age-friendliness: outdoor spaces and public buildings; transportation; housing; social participation; respect and social inclusion; civic participation and employment; communication and information; and community and health services (WHO, 2007a). Focus groups with 1,485 older people, 250 carers and 515 service providers were then held in 33 cities across 22 different countries (including Dundalk in Ireland) to confirm and refine the eight dimensions. The findings of this consultation were also used to develop the WHO’s (2007a) Global age-friendly cities: a guide and the 84-item Checklist of essential features of age-friendly cities (WHO, 2007b). The age-friendly construct is multidimensional and, in broad terms, emphasises many of the important elements of place reviewed in the previous section. It also parallels social policy agendas, in Ireland and many other nations, that aim to support older people in their communities (Lui et al, 2009; Buffel et al, 2012; Scharlach, 2012; Department of Health, 2013). The Global Age Friendly Cities initiative has resulted in the establishment of a global network, 10 affiliated state and national programmes (including in Ireland), and the development of age-friendly communities, towns and broader territories around the world (Keating et al, 2013; Menec et al, 2013; Plouffe and Kalache, 2013). The programme has been embraced as a means of engaging local governments, service providers and older people in the development of practical interventions to enhance ageing in place (Plouffe and Kalache, 2011). The criteria for joining the Age-Friendly Cities Global Network are reasonably simple and primarily based on a commitment from municipality officials to a process of continual improvement (WHO, 2007a). This presents a relatively straightforward opportunity to not

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only improve these settings, but also perhaps transform public opinion of what, in some cases, may be particularly disadvantaged settings. Age-friendly Ireland In Ireland, the age-friendly programme has grown from a singlesite implementation, in Dundalk, to being a government endorsed countrywide goal and a core objective of Ireland’s National Positive Ageing Strategy, published in 2013 (Walsh and Harvey, 2012; Department of Health, 2013b). The original WHO city programme has been adapted and rolled out at a wider county level, leading to the establishment of the WHO-affiliated Ireland’s Age-Friendly Cities and Counties Programme (Ageing-Well Network, 2012), and the implementation of age-friendly strategies in 20 of Ireland’s 26 counties. Now managed by Age Friendly Ireland and benefiting from philanthropic funding, the programme serves as a national coordination and support (non-financial) body for age-friendly initiatives. The county-level approach is particularly relevant in Ireland given that many older people live outside of cities, with 42% living in rural settings (Central Statistics Office, 2011a). Ireland now represents one of the most prolific age-friendly sites in the world, hosting the first International Conference on Age-Friendly Cities in 2011 and playing a key role in the development and signing of the Dublin Declaration on Age-Friendly Cities and Communities in 2011 (Walsh and Harvey, 2012). In many ways, the age-friendly movement is a natural fit with the sociocultural and structural focus on local communities in Ireland that was mentioned earlier, and augments traditional cultural ideas around close-knit supportive communities. To some degree, the popularity of age-friendly programmes in Irish sites likely reflects this congruency. Ireland’s age-friendly programme involves a four stage approach in each county. These stages include: the formation of an age-friendly alliance with county-level stakeholders; extensive consultations with older people and their organisations; and an agreed strategy and implementation process. The programme is based on securing the commitment of local authority management to lead the strategy, along with securing support from senior managers in critical agencies (eg the health service) and elected political representatives. An Older People’s Council, a service provider forum and a business forum are also established for each county (Age Friendly Ireland, 2014). There are a number of common features across all current initiatives, including: being embedded within existing resources and structures;

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adopting a collaborative person-centred approach; finding ways to secure sustainability; and – perhaps explaining the growth of the programme even during the economic recession – reconfiguring the use of existing resources so that strategies are cost-neutral (AgeingWell Network, 2012). International evidence In contrast to the growth of the movement, there has been relatively little international research on age-friendliness and an almost complete absence of work in Ireland, in terms of either evaluating the effectiveness, sustainability and individual outcomes of programmes or exploring deeper questions around the meaning of ‘age-friendly’ in different place contexts, for different groups of older people and at different points of the life course – not to mention in different economic conditions (Lui et al, 2009; Menec et al, 2011; Phillipson, 2011; Buffel et al, 2012; Garvin et al, 2012; Scharlach, 2012; Golant, 2014; Walsh et al, 2014). The majority of the literature that is available is still primarily descriptive in nature (eg Clark and Glicksman, 2012; Hu et al, 2012). While this work outlines the details of specific programmes and their broad contributions, which are largely positive, there is typically a failure to evaluate initiatives in appropriate depth and to develop an analytical or a critical perspective (Liddle et al, 2013; Menec et al, 2013). More broadly, there is still a tendency to focus on objective environmental dimensions (eg buildings, services), reflecting perhaps the stronger emphasis of age-friendly initiatives, and wider social policy, on service and accessibility dimensions, rather than elements of respect and inclusion. At a fundamental level, there is ambiguity around what an agefriendly community actually entails (Mahmood and Keating, 2012). While this is primarily with respect to non-city settings (Menec et al, 2011, 2013; Keating et al, 2013; Liddle et al, 2013), the relatively limited evidence behind the original WHO guide also leads to questions about the universal transferability of age-friendly ideas to different city and urban contexts. Buffel et al (2012: 598) suggest that the value of the global age-friendly city perspective ‘has yet to be properly assessed in the context of the complexities and contradictions that beset modern cities’ and the myriad of conflicting interests that mould a social, physical and economic cityscape. The diversity of place has therefore been somewhat neglected in the age-friendly movement. Differences in meaning and need across diverse city contexts (eg mega-, hyper-, slum- and winter-cities), complex and sprawling conurbations,

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deprived settings, and different types of rural communities (eg remote, dispersed, near-urban) have not been accounted for in the age-friendly approach (Phillipson, 2011; Buffel et al, 2012; Keating et al, 2013; Liddle et al, 2013; Spina and Menec, 2013; Walsh et al, 2014). It is difficult, then, to justify the application of what are essentially variations of the same framework to such diverse and multilayered contexts. To some degree, Ireland’s national programme has attempted to take this into account by focusing on both cities and counties. Nevertheless, outside of an overall review (Walsh and Harvey, 2012), at the time of writing, there had not been a formal evaluation of age-friendly initiatives in any of the sites or across the different residential settings. In a similar vein, the degree to which age-friendly programmes accommodate the heterogeneity of the older population is debatable. Socio-economic status, gender, health, sociocultural and ethnic background, and length of residential tenure are all factors that have been found to alter the dynamic of the relationship between older people and their place of residence (Lui et al, 2009; Buffel et al, 2012; Walsh et al, 2012c, 2014; Keating et al, 2013). Other than what seem to be superficial references, these factors are largely absent from age-friendly implementation strategies. A diversity of life-course experiences and the influence of different events and transitions in older people’s lives have also been shown to be important for older people’s feelings of inclusion while living in Irish communities (Walsh et al, 2012a). This lack of focus on diversity is compounded by the top-down approach of some initiatives, where attention is given to strategiclevel stakeholders rather than the views of older adults (Buffel et al, 2012). Despite consultations with older people in the initial stages of development, and the inclusion of older people’s forums, this is also a feature of Ireland’s age-friendly programme, with its focus on establishing county-level stakeholder alliances. Research on age-friendly communities emphasises the need to account for the diversity of the older population and for more involved and consistent consultation with older people, recognising their role as important community agents (Menec et al, 2011; Buffel et al, 2012; Keating et al, 2013; Liddle et al, 2013; Walsh et al, 2014). The focus on active ageing within agefriendly programmes is also unlikely to assist in accommodating the diversity of needs and perspectives. While a more detailed critique of active ageing is presented in Chapter Four of this book, related policy is considered to be individualistic in nature, implicitly privileging those who are affluent, healthy and mobile (Boudiny, 2013).

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Austerity and age-friendliness in Ireland Some of the issues surrounding the age-friendly movement described in the previous section certainly come into focus when considering the intersection of processes and policies of austerity, ageing and place in Ireland. However, this intersection also raises a possibly more crucial issue about how the age-friendly process can account for or is thwarted by economic and social change, such as the economic recession, and macro-level policy, such as programmes of austerity. At a general level, whether or not existing age-friendly programmes can capture the dynamic and shifting nature of place, and its impact on older people’s relationship with their place of residence, is one of the most critical questions concerning their relevance to real-life complex communities (Phillipson, 2011; Buffel et al, 2012; Keating et al, 2013; Liddle et al, 2013). International and Irish research has demonstrated how community change, in both urban and rural settings, can contribute to the social exclusion of older residents and impact on their well-being and sense of identity (Scharf et al, 2005a; Walsh et al, 2012c, Burholt et al, 2013; Keating et al, 2013). In many cases, these changes in the local are linked to broader macro and globalised patterns (Phillipson, 2011; Walsh et al, 2014), including urbanisation and planetary urbanism, the transformation and decline of industrial and agricultural production, private market economic forces, neoliberaldriven service restructuring, and migration and population churn. In an analysis of 10 rural communities in Ireland and Northern Ireland, Walsh et al (2014) showed how some of these changes served as transformative processes in rural settings and influenced the capacity of communities to address old-age social exclusion and to be age-friendly places. Phillipson (2011) questions the suitability of the age-friendly concept, in its current form, to cope with accelerated urbanisation in some places and deindustrialisation in others. Similarly, researchers have noted that age-friendly community initiatives must not be treated in isolation from national and international policy environments, but, in fact, they often are (Menec et al, 2011; Novek and Menec, 2014). For example, due to individualised federal US policies (with similar policies becoming more evident in European jurisdictions), Scharlach (2012) notes that people and communities who lack resources will still be at risk of unmet need despite the intervention of the private market in the propagation of age-friendly communities. Without considering the influence of community change, macropolicy and globalised forces, there is a question of how age-friendly

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strategies and initiatives can assure the sustainability and effectiveness of local interventions. Criticism around the lack of consideration given to such factors inevitably leads to concerns about how the age-friendly framework at the strategic level, and programmatic interventions at the practice level, will cope with the economic recession and austerity. As a contextual factor that has the potential to alter the lives of older people and the age-friendliness of environments, austerity is likely to be a significant complicating force. This is recognised implicitly, if not explicitly, in the calls to account for macroeconomic and social change, global contexts, and the wider policy environment in age-friendly strategy development (Phillipson, 2011; Buffel et al, 2012; Keating et al, 2013; Liddle et al, 2013). Outside of such calls, however, work on exploring the impact of the economic recession and austerity on the effectiveness of age-friendly programmes and on the capacity of communities to be age-friendly is almost completely absent. These knowledge gaps exist within broader deficits in the literature concerning ageing in place and recession-induced austerity – and, as highlighted in Chapter One, concerning the general impact of the economic recession and austerity on older people (Phillipson, 2013). In the absence of research on age-friendliness and austerity, it is helpful to draw on the community experiences of older people in Ireland, as documented in a series of qualitative studies (O’Shea et al, 2012; Walsh et al, 2012a, 2012b, 2014) completed at the Irish Centre for Social Gerontology. This body of work, supported by other international literature, highlights a number of areas that need to be considered when thinking about age-friendly communities during difficult economic conditions. It is important to recognise from the outset that the size, composition and location of communities, and the diversity of the older population (in terms of age, level of affluence and health status), mean that the economic recession and austerity are experienced in very different ways, and to varying extents, by different groups of older people in different settings. The function of drawing on these studies here, however, is to provide illustrative examples of broad trends in the implications of these processes for older people’s relationship with their place of residence. At a very general level, the economic recession and austerity intensifies processes of community and neighbourhood change. For instance, the economic stability of some older people’s communities, whether these are urban or rural sites, has been weakened or weakened further by rising unemployment impeding local development. This is due to either amplified declines in local economic production (eg

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agriculture) or the general downturn in key sectors (eg construction). The demographic composition of some areas has also been influenced directly by recession-induced, and, in some cases, austerity-driven, unemployment. Emigration has traditionally been a cyclical feature of the Irish socio-economic and cultural landscape (Walter, 2008) and, as described by this older man, has once again become a feature of community life because of the recession: Oh God. One thing was if we could see this recession lift a bit is one of the things.… It’s impacting on the [local sports] club. It’s impacting on the population because people now with the qualifications are having to leave. (Walsh et al, 2012a: 74) Outward migration is often a long-standing characteristic of many rural areas in Ireland. Nevertheless, with an estimated 84,000 people (almost 2% of the Irish population) leaving the country per annum (Central Statistics Office, 2012a), international emigration can undermine the stability of older people’s place-based support networks, their sense of social and familial connectedness, and the fabric of communities in rural and urban Ireland (O’Shea et al, 2012; Walsh et al, 2012a, 2012b). Interestingly, in a study of counter-migrants in Athens, Gkartzios (2013) highlights a ‘crisis counterurbanisation’ of recently unemployed individuals returning, in many cases, to live with or to be close to their older parents. While such flows may help strengthen localised familial support for older people on the one hand, these flows have also resulted in extra pressure on the financial resources and support-giving of older people. As documented in Chapters Two, Three and Eight, similar patterns of a downward transfer of resources have been found in Ireland and can increase the risk of deprivation for some older parents (Patsios et al, 2012; Walsh et al, 2012b; Scharf et al, 2013). Evidence from Ireland and other austerity settings suggests that austerity has also increased older people’s reliance on the informal sector of their communities for care and support. In Spain, for example, cuts in state provision have led to increased pressure on families and concerns over system sustainability (Caïs and Folguera, 2013). In Ireland, additional responsibility has been levied upon already-strained families and communities during the economic recession. Evidence suggests that public infrastructure for the health and social care of older people is increasingly being decoupled from many Irish communities and neighbourhoods (Walsh et al, 2014), particularly hitting alreadyfragmented community care structures (Wall, 2012). As noted elsewhere

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in Chapters Two and Seven, this includes reductions in public funding for community projects and organisations, restrictions on community nurse services, decreases in home-help and home-care allocations, and, as noted by this rural dwelling older woman, the closure of community hospitals: ‘They closed [the hospital] – it affected [us] before it affected anyone else, because they isolated us completely. And the whole joke is if you have a heart attack, then don’t worry you’ll be dead before the ambulance comes’ (Walsh et al, 2012a: 47). This local community stakeholder describes how it is the informal sector within communities and neighbourhoods that is filling the inevitable gaps in health and social care provision: If one was dependent on the state services … to look after every single person in the community, there would be a lot of problems in the community … the voluntary groups are coming in and doing a huge amount of work that I suppose … should be done by a state agency. (O’Shea et al, 2012: 22) Reductions in public expenditure have also resulted in significant deficits in other forms of local infrastructure in Ireland. For instance, the closure of 95 community Garda (police) stations (approximately 14% of the total number) has been raised as a major concern for older people (Age Action, 2013). Along with perceived increases in crime during the economic recession, this is likely to amplify the insecurity felt by older people in some urban and rural communities (Walsh et al, 2012a, 2012b). Reinforcing pre-existing patterns of service restructuring in many settings, the economic recession and austerity has contributed to restrictions in community transport schemes and the closure of key local services, such as retail and grocery outlets, pubs, and post offices, particularly in rural areas. While this has influenced the viability of service access for older residents, the loss of these services can also impact on the social participation and inclusion of older people. This is supported by international research on community services (Dwyer and Hardill, 2011), and is highlighted by this older woman, describing the closure of the local post office: We used to have a lovely post office down here, but they closed it.… It was an awful shame because it was a great place to meet … every time you’d go down to the post office there was two or three people you knew, you know. (Walsh et al 2012a: 42)

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There is a strong sense of anxiety and frustration among some Irish older people because of the reduction and loss of key state provisions that enable them to live independently. Here, this older woman, who has a disability and lives in an urban area, expresses her despair at the successive cuts to the services and household benefits that she relied on to be able to remain in her home: You’re getting a raw deal no matter what way you’re looking at it. We’re being cut with everything. When the lady rang me up now the other day about the home help and she said to me ‘I have to come out and have a word with you. We’re cutting the home help as you know.’ – ‘No …’ I said, ‘… I don’t know.’ ‘God …’ I said, ‘… what next are you going to cut?’ ‘But then …’ I said ‘… you don’t have anything else to cut, do you?’ … ‘We’re after being cut in the fuel allowance and we’re being cut in the ESB [national electricity unit allowance] and now …’, I said ‘… you’re cutting me with the home help.’ I said ‘There’s nothing left!’ (Walsh et al, 2012b: 47) Certainly, in the Irish case, there is an intersection between the impact of the recession and austerity policies on communities and older people, and the different characteristics, advantages and vulnerabilities of individuals and community sites. Some people and communities are better equipped to deal with such issues than others – some may not even be affected in any major way by the recession or austerity. Having ill-health and disability, living alone, having a lower income, and being a new resident with poor social networks are just a number of the life-course risk factors for older people affected by the Irish recession and austerity (O’Shea et al, 2012; Walsh et al, 2012b, 2012c). These are also likely to be risk factors for being excluded from age-friendly initiatives and benefits, emphasising again the need to account for the diversity of the older population (Golant, 2014). Similarly, pre-existing levels of service infrastructure, deprivation and local social and human capital are some of the community-level factors that influence the degree to which the economic recession and austerity might impact on different settings (O’Shea et al, 2012; Walsh et al, 2012a, 2012b). For many places in Ireland, the economic recession and austerity simply intensified long-standing inequalities. Despite this, even some of the most resource-strained communities have demonstrated the capacity to support and engage older people. For instance, Walsh et al (2014) found that in some rural communities, it was the informal practices

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between public, private, voluntary and family/friend actors that were important for understanding how such settings could be age-friendly. As this public health professional describes in the context of austerity, these practices can emerge from being a part of a community and from a sense of obligation to fellow community members: ‘Collectively, we’re being told: “You’re not going to be paid for your mileage. This is what we’re cutting back on.” I suppose to a point we’re ignoring it. You can’t do your job otherwise’ (Walsh et al, 2014: 45). As also noted elsewhere (Buffel et al, 2012; Golant, 2014), Walsh et al (2014) suggest that using generic dimension-focused approaches and technocratic definitions of an age-friendly community – such as that in the WHO age-friendly guide and checklist – may make the task of capturing such practices more challenging. It may also effectively underestimate what different kinds of communities can contribute to the lives of older people. It is also important to consider how austerity can function as a barrier to the sustainability of age-friendly programmes themselves. In Walsh and Harvey’s (2012) review of Ireland’s Age-Friendly Cities and Counties Programme, there were a number of challenges identified as arising from austerity policies. These included limited financial resources for implementation, staff shortages in public stakeholder partner organisations (due to employment moratoriums) and, consequently, difficulties in securing commitment from stakeholder partners. Such challenges signify the realities of implementing such community-based programmes on a cost-neutral basis in difficult economic conditions. This raises important concerns about the effectiveness and sustainability of Ireland’s age-friendly programme. It also raises concerns about how the age-friendly programme, through a combination of its cost-neutral approach and its active ageing focus, may end up unintentionally supporting policies that effectively reduce state involvement in ageing communities.

Conclusions This chapter set out to explore some of the questions around what makes a community a good place to age and a good place to be older in the context of the age-friendly movement, the economic recession and austerity in Ireland. Given the research deficits around several dimensions of these questions, especially around age-friendly initiatives themselves, this chapter can only really be viewed as exploratory. It is important to acknowledge that in Ireland and in other jurisdictions, the age-friendly programme has very usefully focused policy and public

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discourse, and the attentions of state and non-state actors, on the importance of older people’s relationship with their place of residence – whether this is a city, town or village. Arguably, it has also helped to focus public and policy debate on ageing as a whole. It is likely that age-friendly programmes have made, and will make, a difference to the lives of older people in Ireland – although evidence is currently either anecdotal or descriptive. Nationally and internationally, there is a critical need for further empirical and evaluative work on age-friendly strategies and interventions – especially around ways to meaningfully engage older people in such processes. This is particularly needed if we seriously want to consider the age-friendly approach as a means of guiding social policy for older people. Even from the brief examples given in this chapter, we can see that the economic recession and austerity policies are having a negative influence on the community lives of some older people in some settings, and increasing inequalities. Effectively, while not for all older residents, the linkages between some individuals and their communities can be weakened by these processes. For age-friendly programmes in all affected nations, the impact of austerity has to be considered in a dual sense: as a context factor that impacts on the lives of older people; and as an operational challenge to implementing and sustaining collaborative initiatives. It is unlikely, however, that we will be able to fully assess the implications of the recession and austerity for some time, nationally or internationally. For example, the consequences of home mortgage negative equity for the well-being of future generations of Irish older people are currently unknown. However, it would be wrong to suggest that a recession-hit or austerity-shaped community simply cannot be age-friendly. Communities, often led by older people themselves, are organic, evolving and dynamic contexts that can adapt to various sets of challenges, but they need to be supported in doing so. Like many others have suggested, and as reinforced by examples used in this chapter, the diversity of people and places must be a crucial consideration in all future age-friendly research and strategy development. As evidenced by research presented in this chapter, the economic recession and the austerity programme combine with macrodemographic and socio-economic patterns, and broader policy trends, to exacerbate the existing ageing in place issues in Ireland. Problems around community care and prioritisation, service entrenchment, and cycles of deprivation certainly pre-dated the current set of economic difficulties in many Irish communities. This points to an interesting intertwinement of local contexts with broader macroeconomic forces

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– whether at the national, European or global level. It is in this light that there is also a danger of the age-friendly movement becoming a vehicle to individualise responsibility for people and places. In the Irish context, however, the global age-friendly movement also appears to have been co-opted by local communities to offer a potential means of strengthening the people–place link that is socially and culturally important in Ireland. Conceptually, therefore, there is a need to consider, in a nuanced manner, these various and often reciprocal linkages between local cultural contexts and global factors as a part of a holistic and multi-level model of age-friendliness. It is only then that we can begin to appreciate the interconnections and complexities of our relationship with our communities as we age, and it is only then that we can truly set about making our communities age-friendly.

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SEVEN

Reframing policy for dementia Eamon O’Shea, Suzanne Cahill and Maria Pierce

Introduction Dementia describes the group of symptoms caused by the gradual deterioration of brain cells leading to the progressive decline of functions such as memory, orientation, understanding, judgement, calculation, learning, language and thinking (Luengo-Fernandez et al, 2010). There is no single cause of dementia, with a combination of risk factors, both known and unknown, believed to influence its onset and progression. Within this risk-factor profile, increasing age is by far the strongest contributor, with the prevalence nearly doubling every five years from the age of 65 onwards (Lobo et al, 2000). The most common form of dementia is Alzheimer’s disease, which accounts for approximately 60% of all cases (Luengo-Fernandez et al, 2010). Dementia is a particularly debilitating condition as it affects those capabilities on which everyday life depends. Given the diverse nature of the illness, people with dementia require a wide range of formal health and social care and informal care services. Such services are delivered in a variety of settings, including hospitals, residential care settings or the person’s home, and by a variety of providers, such as health and social care professionals, family members, and friends. Unfortunately, services for people with dementia in Ireland have lagged behind both need and demand and the concern is that austerity conditions will exacerbate an already-difficult situation for people with dementia and their families (Cahill et al, 2012). The impact of dementia is substantial, affecting both the individuals and their carers on personal, emotional, financial and social levels. The cost of caring for people with dementia worldwide was estimated at US$604 billion in 2010 (Wimo and Prince, 2010), which included the costs of informal care provided by unpaid family members and others, social care provided by community care professionals and in residential home settings, and health care provided in primary and secondary medical facilities. Costs are likely to increase in the future

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given the ageing profile of the global population; the number of people with dementia worldwide is expected to grow from an estimated 36 million in 2010 to 66 million by 2030 (Wimo and Prince, 2010). It is no wonder, therefore, that many countries are already preparing for the projected rise in the number of people with dementia by putting in place dedicated action plans and/or dementia strategies. Finding the resources to support such plans is always a challenge, particularly when austerity is such a dominant economic ideology in many European countries at this time. Policy formulation for people with dementia, including the development of plans and strategies, is easier than policy implementation, which usually requires an actual commitment to spend money. This is because resource allocation decision-making for people with dementia is currently taking place against the backdrop of a prolonged period of austerity in most European countries, which is particularly the case for Ireland. Even with its exit from the European Union–European Central Bank–International Monetary Fund (EU–ECB–IMF) Troika bailout programme in December 2013, budgetary restrictions are set to continue in the coming years as the government seeks to reduce unsustainable levels of public debt. Public expenditure cutbacks have trickled down to people with dementia in the form of significant reductions in community care services, health and social care staff, and health and social care infrastructure. This chapter, which is focused on the current realities of dementia care in Ireland and the potential reframing of dementia policy in the country, cannot be read without reference to the austerity conditions that will continue to impact on the ability of government to fund person-centred, capabilities-based, personalised systems of care for people with dementia in the future. While the focus is clearly on Ireland, we draw on the international literature and the experiences of other countries to help us understand the complexities and constraints associated with policymaking for people with dementia in this country.

Dementia in Ireland While there have been no comprehensive prevalence studies on dementia carried out in Ireland, the application of European Collaboration on Dementia (EuroCoDe) age/gender-specific dementia prevalence rates to the 2011 Census of Population in Ireland suggests that there are currently 47,849 people with dementia in the country. An estimated 4,066 of these people (approximately 8.5% of all people with dementia) have early-onset dementia (occurring in people under

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65 years of age) and most of these are likely to be men. The national prevalence rate for Ireland, as estimated by Alzheimer Europe (2013), is 1.08, the third-lowest in Europe. This compares to an average for the 28 member states of the EU of 1.55, reflecting mainly the relatively young age structure of the Irish population compared to other European countries. In Italy, for example, the prevalence rate for dementia is 2.09, reflecting the relatively older age structure of the population in that country. There is regional variation in estimated dementia prevalence rates across Ireland; the west of the country has the highest prevalence rates of dementia, with many areas estimated to have significantly more people with dementia than the national average (Cahill et al, 2012). Eastern counties have the lowest share of the population with dementia, with Dublin West having the very lowest share, at 0.63%. There are, therefore, clear regional differences in prevalence rates for dementia in Ireland; once again, just looking at the age structure of local and regional populations can tell us a lot about the potential prevalence of dementia in those areas and the need to structure services accordingly. A tentative extrapolation of lowermiddle-range international incidence rates to the older population in Ireland suggests that approximately 4,000 new cases of dementia currently arise in the general Irish population every year. There are an estimated 29,869 people with dementia currently living at home in the community; most of these people do not have a formal diagnosis, many are not aware that they have the disease and few are likely to be in contact with the health and social care system. There are an estimated 50,000 family carers in the community looking after someone with at least one of six specified symptoms of dementia in Ireland (O’Shea, 2003): for example, there are an estimated 25,000 carers looking after someone with marked forgetfulness on a regular or occasional basis, while 15,000 people are looking after someone who has confusion to the point that it interferes with everyday life. An estimated 17,877 people with dementia live in various public and private long-stay facilities across the country, including 610 people aged less than 65 (Cahill et al, 2012). Official statistics on the number of people with dementia in long-stay care settings suggest less than half that figure, but most commentators accept the higher estimate. The cost of dementia in Ireland has been estimated at just over €1.69 billion per annum, 48% of which is attributable to informal care provided by family and friends to those living with dementia in the community (Connolly et al, 2014). A further 43% is accounted for by residential long-stay care, while formal health and social care services contribute only 9% to the total cost of dementia. Increasingly,

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however, the burden on the acute care sector is being recognised (Hickey et al, 1997; Nolan, 2006; Cowdell, 2010). People with a diagnosis of dementia tend to have a significantly longer length of stay in hospital than those without dementia, a finding that holds across a number of co-morbidities. Applying European prevalence data for dementia to patients in the acute care sector in Ireland suggests that the estimated cost of this extended length of stay associated with dementia is almost €200 million per annum in Ireland (Connolly and O’Shea, 2013). Dementia worldwide accounts for around 1% of the world’s gross domestic product (GDP), varying from 0.24% in low-income countries, to 0.35% in low- to middle-income countries, 0.50% in high- to middle-income countries, and 1.24% in high-income countries (Wimo and Prince, 2010). In Ireland, dementia accounts for about 1% of GDP, which is consistent with the international data. Table 7.1: Estimates of the number of people with dementia in Ireland, 2011 Age groups

Total population

Persons with dementia

Men

Women

Men

Women

Total

30–59 years

953,715

959,396

1,907a

959a

2,866

60–64 years

109,869

108,917

220

980

1,200

65–69 years

86,298

87,340

1,553

1,223

2,776

70–74 years

63,476

67,714

2,031

2,573

4,604

75–79 years

46,631

55,405

3,264

4,211

7,475

80–84 years

28,423

41,690

4,121

6,837

10,958

85–89 years

13,591

26,296

2,841

7,494

10,335

90–94 years

4,155

10,722

1,213

4,761

5,974

95+

740

2,912

240

1,421

1,661

Total

1,306,898

1,360,392

17,385

30,359

47,849

Note: a Persons with dementia estimated by application of EuroCoDe 2009 gender/age-specific prevalence rates. EURODEM early-onset dementia prevalence rates were used for those under 65 years old. Source: 2011 Census of Population data from Central Statistics Office (2011a).

Current realities for people with dementia living at home Austerity tends to target community care spending and public health budgets more than acute care or high-technology medicine. Personalised care is particularly vulnerable and it is no surprise, for example, to see services like home helps, day care and respite care under threat as governments seek to reduce public spending. Such services are

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far less visible than those for cancer patients or for people with heart disease. While, as highlighted in Chapters Two and Three, resistance to cutbacks in social care expenditure for older people has grown in recent years, particularly following high-profile street protests by lobby groups representing older people against changes to eligibility rules for general practitioner (GP) care, it is still difficult to mobilise popular support against cutbacks to community care services for people with dementia. The latter are often invisible, socially excluded and spatially isolated, making it difficult to make a case for developing appropriate services on their behalf. Even within services for dementia, it is easier to fund beds and buildings rather than community-based personalised supports for people scattered across very different living environments. Consequently, it is hardly surprising that the main bulk of care in the community is provided free of charge by family carers, most of whom are adult children and spouses and many of whom are frail and older themselves. There is strong international evidence that caring for a person with dementia places significant demands and strain on family members (Ory et al, 1999; Zarit et al, 1999; Pinquart and Sörensen, 2003; Bertrand et al, 2006). The family carer of a person with dementia in Ireland is likely to be providing 24-hour care, sometimes struggling to cope around the clock with distressing and challenging behaviours, leading to considerable emotional and psychological strain (O’Shea, 2007). Austerity is likely to increase the demands on carers as governments look to families to fill the caring gaps by placing more of the responsibility for care upon them and less on formalised support systems. Diagnosis There is now convincing evidence that early accurate diagnosis of dementia is critical to best practice in dementia care. Yet, across most European countries, including Ireland, dementia remains largely invisible and under-diagnosed (Leifer, 2003; Lopponen et al, 2003; Bamford et al, 2004; Carpenter and Dave, 2004; Wilkins et al, 2007) across all care settings. The benefits of early diagnosis to the individual include the fact that he/she may still be able to actively participate in short- and long-term care planning and engage in decisionmaking about important issues, including drug treatments, legal and financial affairs management, and service options. In some instances, getting a diagnosis may be psychologically beneficial since the person experiencing the symptoms may still have insight and may be anxious and under pressure from a spouse or relatives for what is perceived

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by them as forgetful, unreasonable, inappropriate or decidedly ‘odd’ behaviour. In about one third of cases, drug therapy may help to delay the progression of the disease (Overschott and Burns, 2005). Informing and educating people with dementia about the condition can enable them and their carers to adjust and adapt (Connell et al, 2004; Derksen et al, 2006). These benefits, in turn, may improve the individual’s quality of life and reduce carer stress. Furthermore, and at a societal level, timely diagnosis can reduce health-care expenditure by delaying nursing home admission (Leifer, 2003). Despite GPs themselves acknowledging the benefits of early diagnosis (Cahill et al, 2008), diagnostic practices in Ireland are far from optimum and the vast majority of people with dementia remain without a diagnosis (Cahill et al, 2012; Moore and Cahill, 2012). The problem of diagnosis is not confined to Ireland. The World Alzheimer report 2011 (Prince et al, 2011) reports that as many as 28 million of the world’s 36 million people with dementia have yet to receive a diagnosis, and therefore do not have access to treatment, information and care. A diagnosis is but a first step on the pathway to care for dementia. Several people with dementia and their families who participated in the National Dementia Summit in Ireland in 2011 (ASI, 2011: 6) described how even after getting a diagnosis, they felt that they were ‘in an abyss’. It is clear that there is a need for more adequate and timely post-diagnostic support services for people with dementia and their families. While there is no consensus about what constitutes a good model for early support services for those newly diagnosed with dementia and their carers, information services and counselling and emotional supports are key elements in the early stages (Cahill et al, 2012). However, there are few proven and internationally accepted evidence-based psychosocial interventions for people with early-stage dementia living in the community (Moniz-Cook and Manthrope, 2009). Community-based nursing Internationally, community-based nurses play a key role in educating people about the risk factors for dementia and about lifestyle choices that can be adopted to minimise the risk of developing a dementia in later life. The risk of dementia may be reduced if one’s general health is protected by not smoking, having a healthy diet, exercising regularly, drinking only moderate amounts of alcohol and generally protecting the head from serious injury (Ott et al, 1998, 1999; Peila et al, 2002; Ruitenberg et al, 2002; Kivipelto et al, 2005; Farrow, 2010). Public

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health nurses may also have a key role to play in helping to recognise and detect dementia in high-risk patient groups, including those with diabetes, alcohol dependency, coronary heart disease and high blood pressure. Although records are currently not being kept on the number of Irish people with dementia who avail of public health nursing services, about 13% of people over 65 years of age in Ireland are in contact with public health nursing services (McGee et al, 2005). There is a positive correlation between age and use of public health nursing services, with almost a quarter of people over the age of 80 availing of this service (Normand et al, 2011). Since age and dementia are also correlated, it is safe to assume that public health nurses in Ireland are in contact with a significant number of older people with dementia. Apart from having a role in dementia screening and assessment, in many instances, public health nurses are the gatekeepers to other community care services, such as home help, meals on wheels, day care and other respite care. They also liaise with family doctors (GPs), practice nurses, hospitals, hospices, occupational therapists and other health service providers, as well as organising and coordinating voluntary services that are vital to maintaining older people at home in the community. Unfortunately, in Ireland today, there are no public health nurses with a dementia-specific remit and their workload remains extremely diverse, thereby likely ‘crowding out’ care to people with dementia. The public health nurse in Ireland is expected to provide a myriad of different professional services (eg post-operative care, medication management, dressings changing) for a variety of different clients across the lifecycle (Nic Philibin et al, 2010). It is likely that only a fraction of people with dementia in Ireland are known to public health nurses and that the service as it currently operates is not sufficiently flexible to meet the complex, chronic and fluctuating needs of people with a moderate to advanced dementia. This is all occurring within the broader context of austerity-driven constraints on the public health nurse service. For example, cuts to mileage allowances in community settings have been reported as hindering the effectiveness of the service in some settings (Walsh et al, 2012a). Like other health and social care staff in contact with people living at home with dementia, practice nurses, public health nurses and community mental health nurses need training in dementia care. Irish research has shown that the vast majority (83%) of nurses for whom dementia comprises a significant part of their workload lack specialist knowledge and have not received training in dementia care, with no significant difference between nursing managers and clinical nursing

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staff (Farrell et al, 2007; De Siún and Manning, 2010). In particular, public health nurses and practice nurses (as compared with community mental health nurses and nurses based in nursing homes) were less likely to have received specialist training. Community-based services In Ireland, the Home Help Service and Home Care Support Schemes, otherwise known as Home Care Packages (HCPs), are two important home-care services developed to assist older people, including those with dementia, to remain in their own homes for as long as possible. These services are delivered either directly through the Health Service Executive (HSE), through community and voluntary organisations, or through private providers, a rapidly growing unregulated industry currently burgeoning in Ireland and one carving out a niche in the provision of more flexible and round-the-clock services (Timonen et al, 2011a). Dementia-specific HCPs are also delivered through voluntary organisations such as Alzheimer Society Ireland (ASI), whereby a trained dementia care worker is assigned to a person with dementia in the community for a designated number of hours per week. However, one of the resounding weaknesses of Irish statutory homecare services compared with those developed and delivered in other countries (such as the UK, Norway, Sweden, Denmark, France and Australia) is that these services are not underpinned by legislation and are not provided on a statutory basis. Accordingly, there is no onus on the health and social care system to provide services to people in need. When resources are tight, it is much easier to reduce services to people with dementia living at home, or not provide services at all, than it is to cut back on hospital-based services that are much more visible and politically sensitive. On the demand side, lack of knowledge and confusion about entitlements to services combine to exacerbate supplyside inadequacies, leading to significant gaps in home-care service provision to people in need. There are also gross inequities across the country in relation to service delivery, with considerable variation in the type and amount of home-care services available (PA Consulting, 2009). In some areas, people with dementia receive very few in-home formal support services and existing schemes that have the potential to reduce carer burden and prolong home-living, for example, HCPs lack the flexibility and specificity to address the fluctuating needs of many people with a moderate and severe dementia (Cahill et al, 2012). Day care and respite care also remain underdeveloped in Ireland, with their potential unrealised as part of the holistic care of people living

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at home with dementia. Even where day services exist, they may not always be used by people with dementia. Lack of knowledge about the availability of day-care services, geographical distance from day-care services and transport problems, including high transport costs, are all factors contributing to the low levels of utilisation of day-care services by people with dementia. There is no doubt that day care, like respite care, is underprovided in Ireland given the potential benefits associated with its use (Cahill et al, 2012). The recent period of austerity has not been responsible for the relatively low level of government support for community-based resources for dementia in Ireland. Even when resources were plentiful, investment in dementia care was weak, particularly in relation to community-based care. A major document governing the health and social care of people diagnosed with Alzheimer’s disease and the related dementias in Ireland – An action plan on dementia (O’Shea and O’Reilly, 1999). It emerged in 1999 following extensive consultation with key stakeholders working in the area, including family members directly affected by dementia. It was underpinned by a personcentred philosophy of care and contained 33 recommendations detailing how Irish dementia services should be developed, the costs of service provision and the time frame over which action should be taken. The plan recommended that an Implementation Committee should be established that would commit to delivering on the service recommendations, with a particular emphasis on community-based provision. However, no such committee was set up during the boom period of the first five years of the new century (2000–05), nor did official implementation of the plan ever occur. Accordingly, dementia has remained a hugely neglected, underfunded and underprioritised health issue in the Irish health and social care system. There is currently no protected dementia-specific budget available to support the development and delivery of statutory community-based dementia services. Moreover, within the health budget dementia spending is generally squeezed out by medical and hospital services. There is some optimism that the new National Dementia Strategy will improve matters, helped by the promise of additional funding from the Government and Atlantic Philanthropies.

Long-stay care and dementia in Ireland In Ireland, few alternatives to the nursing-home model of care exist for older people with dementia who are unable to remain in their own homes. In this regard, the Irish case contrasts strongly with that in the

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US, UK, Australia and other European countries, where a range of alternate models to nursing-home care exist, including: (i) housing with care; (ii) sheltered housing; (iii) hostels; and (iv) specialist care units. In Ireland, however, only a very small number of housing with care schemes exist, providing accommodation specifically to address the complex needs of people with dementia, and none of these are run by a statutory body. Accordingly, when older people with dementia need to move from their own home into long-term care in Ireland, there are very few alternatives outside of residential care settings available to them. Moreover, the funding system supports the residential care option ahead of all other choices (Cahill et al, 2012). In Ireland, long-stay residential care comprises a mix of public, voluntary and private providers. For Irish family carers, accessing long-term care for a relative with dementia is not easy. In the absence of community-based social workers, case managers or aged care assessment teams, many people have no idea who to turn to for advice about finding an appropriate dementia-friendly nursing home, nor are they, by and large, aware of practical issues, including wait-listing protocols for nursing homes, assessment procedures and the cost of nursing-home care. A recent Irish study has highlighted that access to residential care services specifically for people with dementia tends to be resource-led rather than needs-led (Bobersky and Cahill, 2011) and may involve multiple relocations. The depletion of the public residential care stock in the past decade in response to concerns about demands on the exchequer has changed the public–private mix in long-stay care in Ireland towards a predominantly private system of care. Investment in new public facilities has all but ground to a halt as successive governments have sought to control public expenditure on long-term care, supporting tax breaks for private nursing homes instead of building new public facilities. Not surprisingly, there are also more controls now on who accesses public and private long-stay facilities as austerity forces difficult choices to be made on who gets what, where and when. There is a widespread belief that some nursing homes often cherry-pick their clients and some long-stay care facilities are not willing to admit people with dementia, particularly younger people with dementia. This view was expressed by participants at the ASI National Dementia Summit in 2011, who believed that people with dementia are having ‘the door closed in their face’ when the diagnosis of dementia is brought up in conversation with certain long-term service providers (ASI, 2011). Good dementia care is costly to provide and the public subvention system available to cover it is not always seen as adequate by nursing-home proprietors.

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Of course, not getting access to a public bed or a publicly subvented private bed would not be too bad if community care services were available to meet expressed demands. However, we have already seen that community care is fragmented and patchy at best, or, at worst, not available at all, at least in a form that supports high-quality, homebased care for people with dementia. The vast majority of people with dementia in Ireland living in residential care are cared for within generic care facilities for older people, most of which are not purpose-built for dementia and many of which are not designed to cater for the complex, challenging and unique needs of residents with Alzheimer’s disease and related dementias. This makes the task of providing care to these people by professional care staff often very difficult. As is the case in many other countries, concern has been repeatedly expressed about the quality of care for people with different levels of cognitive impairment living in these generic nursing homes (Murphy et al, 2006) and about the very heavy and stressful workload borne by paid staff employed in these types of facilities. Research in several countries and in all types of nursing homes confirms that the quality of life for people with dementia is poor in many residential care settings (Moïse et al, 2004; Hancock et al, 2006). People with dementia are particularly sensitive to their psychosocial environment, and good environmental design is now widely regarded as critical to the care of people with dementia. Indeed, some people have argued that design is as vital to resident care as nursing care or the approach to the organisation of care within the facility (Calkins, 1987; Flemming and Purandare, 2010). In recognition of the special needs of people with dementia in residential care settings, the trend in many countries nowadays is towards providing specialist care in creatively designed small-scale units (Moïse et al, 2004; Cahill et al, 2012). Despite the absence of unequivocal evidence pointing to the value of specialist care units (SCUs), the latter are becoming an increasing feature of the residential long-term care landscape internationally. The French national plan for Alzheimer’s and related diseases (2008–12) provided for both the development of existing SCUs for people with dementia and the creation of 12,000 new SCU places. While some dedicated dementia-specific beds are available in public long-stay facilities in Ireland, these are still the exception rather than the rule. Very few people with dementia gain access to SCUs, and even when they do, the size of these units (an average of 18 to 19 residents) does not always conform with best practice models (Cahill et al, 2012). Moreover, there is no standard definition of what constitutes an SCU

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in Ireland, nor is there an agreed meaning or definition of the term ‘dementia-specific bed’ within a generic facility. Consequently, we do not have good information on where and how people with dementia are being looked after in residential care settings. The availability of reliable and valid data on the location and quality of SCUs is all the more urgent given the significant concerns about the lack of goodquality specific long-term care facilities for people with dementia expressed by participants at the National Dementia Summit in 2011 (ASI, 2011). The care process within long-stay facilities is also important in allowing residents to live well with dementia. There is no doubt that the medical and functional needs of residents dominate the care landscape within residential care settings (Murphy et al, 2006). While, to some extent, this is understandable, psychosocial approaches are also needed to complement medical and neurological models of service delivery; however, with some notable exceptions, they are largely absent in residential care settings in Ireland (O’Shea et al, 2011). In particular, psychosocial interventions can assist in developing meaningful communication with patients, using all of the senses, through reminiscence, music and various therapeutic and time-intensive activities. Given the importance of connectivity for personhood within dementia, new ways of reaching into and out of long-stay settings should be encouraged through various forms of social interventions. Very few facilities have connectivity programmes that link residents within residential care facilities to the communities that surround them, both within and outside the residential care setting.

Policy developments in other countries Many countries have now developed action plans and strategies to support investment in infrastructure, administrative systems, staffing and services for people with dementia. The various plans that are now available are relatively consistent and increasingly convergent with respect to what needs to be done, with a common emphasis on: primary prevention; changing private and public attitudes to the disease; early diagnosis; improving quality of life and quality of care; training and education for staff in primary care; enhanced day care and customised residential care; developing timely and appropriate care pathways; and research and policy implementation (Cahill et al, 2012). Most countries with action plans on dementia have prioritised core areas (Alzheimer Europe, 2013). For example, Australia and Canada have incorporated a focus on primary prevention, on risk reduction

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and on delaying dementia. The Norwegian plan – Making the most of the good days (Engedal, 2010) – is focused on day care, on adapting nursing homes and on increasing public and professional knowledge about dementia. The French approach targets public awareness of dementia, diagnosis and specialised provision. Scotland emphasises key service delivery systems, including improved services after diagnosis, better information systems and improved care in general hospital settings. There is also a uniform emphasis on the importance of involving the person with dementia in decision-making, and the role that families and communities play in facilitating people with dementia to live well with the disease. Personhood is the dominant philosophy underpinning all of the plans, allied to a strong rights orientation and the primacy of citizenship. Almost all of the strategies have succeeded in generating additional resources for dementia, most noticeably, in France, where there has been a significant increase in public investment in dementia care. Dementia, however, continues to lag behind other chronic diseases in terms of budget allocation in most countries and in the share of resources devoted to research on the topic, particularly relative to disease burden. Some of the reasons for this are: ageism; stigma; lack of knowledge; and, until recently, an absence of awareness that dementia is likely to become much more prevalent as a result of population ageing in many different countries.

Dementia framework There is some expectation that the new national strategy for dementia in Ireland will deliver a major overhaul of the care of people with dementia. However, even if additional resources were to become available, or, as is the case with the new strategy, funds can be leveraged from outside of the public system, the current approach to care would probably not change very much in terms of values or orientation. We would likely get more of the same in terms of service provision, and while this would be welcome, it would not be transformative to the lives of people with dementia or their families. Care would continue to be provider-focused rather than person-centred, with not enough emphasis on personhood or the capabilities of people with dementia. For real change to happen, the current policy frame will have to be jettisoned in favour of a new paradigm that recognises the narrowness of the current approach and the opportunity that now exists to develop more appropriate counter-policy frames. The current policy frame in Ireland, and in many other countries, conceptualises dementia in individual and biological terms. People get the disease and face it, by

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and large, on their own within their families and, if they are fortunate, with the support of appropriate medical teams and the ASI. Many people, however, receive no services at all and muddle through with whatever support they can muster outside of the conventional system of care. Policymakers tend to associate dementia with loss and risk, resulting in a funding bias towards institutional care where it is believed that people with the disease can be cared for in a controlled and secure environment, where costs can be set and monitored. The consequences, whether intended or not, are that people with dementia are excluded from mainstream society, if not from their families. There is an alternative policy frame that replaces: individual with collective; biological with social; risk with capabilities; institution with home; deficit with asset; and exclusion with inclusion. Reconfiguring the paradigm for dementia in Ireland would allow for the potential of the new strategy to be fully realised, thereby becoming genuinely liberating for people with the disease and their families. An alternative policy frame would not necessarily cost any more money to develop and implement, which is important in the age of austerity, but it would establish the primacy of the person with dementia in the decisionmaking process. What would this counter-policy frame look like? Replacing the current individual orientation with a collective focus would lead to the disease becoming more public, more mainstream, more visible and more explicit. Moving from biological to social would allow greater discussion of the meaning of attachment, place, identity and relationships, thereby challenging families and communities to develop and maintain a communal approach to care that prioritises connectivity and mutual support systems. It would reinforce the need for, and benefit of, dementia-friendly communities. Replacing risk with capabilities would allow the potential of people with dementia to be realised during all stages of the disease, particularly in the early stages of the illness. People with dementia have physical, emotional and spiritual needs that require nurturing, very often through psychosocial interventions, if the various dimensions of personhood are to be realised. Sometimes, this means taking chances with care structures and care processes that allow people with dementia to live as normally as possible in flexible, accessible and familiar environments that allow capabilities to be maximised. For the most part, people with dementia should live in their own homes, where images of self and identity are easier to preserve in the face of ongoing cognitive decline. Even when people with the disease have to enter residential care, the emphasis should be on homely, small-scale provision, where biography and

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personality are central to the care process and autonomy is preserved as much as possible. Viewing people with dementia as assets to be cherished can be of enormous transformative value to the society within which they live. People with dementia are citizens with inalienable human and civil rights that must be protected. They continue to have roles and relationships within families and communities that serve to enhance overall well-being and preserve the integrity of the human spirit – their own and others. People with dementia are better off when treated with respect and dignity, but so, too, is society. Furthermore, the power of now should never be underestimated in the care of people with dementia. Making people with dementia happy by seeking to penetrate usable memory and latent connections should be central to the care process. Through a focus on inclusion, people with dementia will become more visible in society, leading to greater awareness of the disease and an acceptance of the need for a public response in the form of improved services and community-based support systems. All of this can be achieved without adding to the overall cost of care. Even more fundamentally, adopting the counter-policy frame for dementia just outlined can lead to a seismic change in how people think individually and collectively about the disease. This includes more enlightened personal attitudes and expectations about dementia, a new awareness and understanding of prevention and of the various stages of the illness, and a recognition that dementia is one of the most important ageing questions that society will face in the coming decades. Accepting the personhood of people with dementia means giving people with the disease a more formal role in decision-making at both the micro-care level and the macro-policy level. However, for personhood to have real meaning, it must be extended into citizenship, whereby people with dementia are treated as full citizens with the consequent rights and responsibilities. Living well with dementia requires an acceptance by society of the right of people with dementia to live at home for as long as possible and practicable, remaining visible and active in their own communities.

Conclusion The implementation of the new national strategy for dementia will take place under the most testing of financial circumstances in Ireland. As in most countries, dementia is competing for ever-scarcer public resources at a time of increasing need. The allocation of resources to dementia is ultimately a political decision that can be influenced by stakeholders

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and public opinion. We have seen, for example, how political leadership in France and the UK has succeeded in raising the profile of dementia in the priority-setting process in both of these countries. Moreover, an increasing number of countries now have national plans for dementia, even if public spending on dementia has been slow to catch up with that on other major diseases. However, even within such binding budget constraints as now exist across Europe, much can be achieved in the coming years provided that resource allocation is based on an alternative policy frame for dementia that emphasises: holistic health production; home-based care; the capabilities of people with dementia; and social inclusion. For the person with dementia, the goal must be to provide them with an individualised person-centred pathway of care, from prevention, through early diagnosis, to end-of-life care. At the macro-level, the objective should be to make dementia a communityoriented public health priority, thereby placing people with dementia at the heart of local communities, comfortable and secure in their own place and time.

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EIGHT

Between inclusion and exclusion in later life Thomas Scharf

Introduction Since the late 1990s, reflecting a growing interest in the nature of inequalities affecting ageing populations, researchers have increasingly drawn on the concept of social exclusion to characterise not only the multiple ways in which people experience disadvantage in later life, but also the different life trajectories that are commonly associated with such disadvantage. As an idea, social exclusion has a much longer lineage, reaching back at least to the 1960s. However, it emerged most forcefully during the last major economic recession that affected much of Western Europe in the 1980s. At that time, the language of exclusion provided research and policy communities with a useful alternative means of discussing concerns about the social and economic consequences of rising poverty rates. Above all, since the 1990s, social policymaking in European Union (EU) countries has sought to deliver ‘social inclusion’ and counteract potential risks of exclusion by prioritising the participation of (future) workingage people in education, training and/or labour market activities. Alternative approaches to conceiving of and acting to reduce risks of exclusion have increasingly come to occupy a secondary position in the thinking of national and European-level policymakers (Levitas, 1998, 2006; Madanipour, 2011). If anything, the recent economic crisis has strengthened national social policy trends that focus on active labour market measures, aimed primarily at young people and those of working age (Scharf, 2010). The inevitable focus on the social and economic impacts on children, youth and people of working age of a widening and deepening recession, and related austerity measures, have meant that potential risks of exclusion in later life typically receive little policy attention. In Ireland, this is compounded by the relatively underdeveloped nature

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and unfulfilled implementation of ageing policies. Indeed, one of the distinguishing features of the Irish context has been the emergence of a policy discourse which suggests that older people have weathered the recession relatively unscathed by the various tax increases and deep cuts in public expenditure that followed the country’s bailout by the EU–European Central Bank (ECB)–International Monetary Fund (IMF) Troika in November 2010. While the recession and austerity programme raise obvious questions about impacts on older people’s social integration, Ireland is not alone in terms of underplaying the risks of exclusion that exist in later life. Notwithstanding long-standing gerontological interest in what might be considered forms of exclusion, such as poverty and social isolation, social gerontologists were generally relatively slow to recognise the potential to build on the emerging academic and social policy interest in issues around social inclusion and exclusion. Only since the early 2000s has a growing body of scientific work across a range of national contexts begun to consider the varied ways in which older people might experience forms of disadvantage and the contrasting pathways that lead to exclusion in older age (Scharf et al, 2001; Barnes et al, 2006; Scharf and Keating, 2012a; Warburton et al, 2013). This has been accompanied in some European countries – albeit not yet in Ireland – by a more explicit policy focus on addressing risks of exclusion that affect people in later life. In the UK, for example, ‘excluded older people’ were identified as a key target group for policy innovation in the mid-2000s (Social Exclusion Unit, 2006). Against this background, and reflecting on issues raised elsewhere in this book, this chapter has two broad aims. First, it seeks to summarise a growing, international body of gerontological knowledge relating to the theme of social exclusion as it affects ageing adults. Second, it presents a range of evidence relating to different forms of exclusion experienced by older people in Ireland, identifying possible trends in such disadvantage over the course of the recession and austerity programme. In a concluding section, the chapter reflects on the accumulated evidence to consider the ways in which ageing policy has developed in Ireland under the influence of the economic downturn, outlining potential implications for tackling exclusion in later life. Some of these implications are as relevant to other national contexts as they are to the situation of Ireland. In this respect, the argument to be developed offers an alternative view to that which currently dominates policy and media debates on ageing in a number of countries, one that identifies older people as being a relatively homogeneous group that has emerged from the period of austerity largely unscathed.

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Social exclusion in later life: conceptual developments The growing interest since the early 2000s in exclusion in later life largely reflects the coincidence of trends in demographic ageing, the impacts of fundamental socio-economic change on European societies and, more recently, the intensity of austerity programmes in countries such as Ireland (Grenier and Guberman, 2009; Scharf and Keating, 2012a; Warburton et al, 2013). Such processes are closely associated with a burgeoning evidence base concerning the persistence and, in some nations, deepening of structural inequalities that characterise Europe’s older populations. Improved access to longitudinal and biographical data allows researchers to explore evolving experiences of inclusion and exclusion across the life course. In this respect, the potential exists to explore the degree to which people who experience forms of exclusion are able to ameliorate or even escape such disadvantage as they age (Scharf et al, 2001; Scharf et al, 2005b). Notwithstanding continuing knowledge gaps in terms of the technicalities of operationalising and measuring exclusion and the analysis of changing patterns of exclusion over time (Ward et al, 2014), social-gerontology researchers are now better placed than ever before to consider both the distinctive characteristics of exclusion in later life and its life-course antecedents. However, while older people are increasingly identified as a group that is prone to experiencing exclusion (Commins, 2004; Scharf and Keating, 2012b), research exploring the intersection between distinct forms of exclusion and exclusionary processes across the life course remains underdeveloped (Scharf et al, 2005a; Buffel et al, 2013). In part, this may be attributed to the fairly disjointed evidence base concerning disadvantage in later life. For example, research on poverty in older age is often conducted without reference to parallel studies on the characteristics of ageing adults’ social relationships or the nature of their integration within their community of residence. A further difficulty arises from the contested and ambiguous conceptual understanding of social exclusion (Silver, 1995; Levitas, 1998; Abrams et al, 2007). Exclusion still lacks a universally accepted definition, with a burgeoning literature reflecting contrasting understandings of the idea (Vleminckx and Berghman, 2001; Scharf and Keating, 2012b). The closest to an agreed definition of social exclusion arises from a comprehensive review of the relevant literature undertaken by Levitas et al (2007). Here, a working definition of social exclusion is adopted that refers not only to processes associated with the experience of exclusion, but also to key outcomes of such disadvantage:

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Social exclusion is a complex and multi-dimensional process. It involves the lack or denial of resources, rights, goods and services, and the inability to participate in the normal relationships and activities, available to the majority of people in a society, whether in economic, social, cultural or political arenas. It affects both the quality of life of individuals and the equity and cohesion of society as a whole. (Levitas et al, 2007: 9) In a pioneering contribution to emerging conceptual debates that continues to be relevant, Atkinson (1998) noted three common features associated with the plethora of approaches to defining social exclusion. These features can also usefully be viewed through a gerontological lens (Scharf and Keating, 2012b) and applied to the specific context of recessionary Ireland. First, exclusion is identified as a relative concept (Atkinson, 1998), understandable only by reference to prevailing norms, values and belief systems, the socio-cultural context – as reflected in a society’s institutions and structures – and characteristics of the ‘mainstream’ population (Silver and Miller, 2003; Abrams et al, 2007; Billette and Lavoie, 2010). As argued by Scharf and Keating (2012b), such a focus on relativity raises a variety of challenging questions concerning risks of exclusion in later life. For example, should the yardstick for judging whether older adults are excluded be a comparison with their age and generational peers or with the general population of a particular society? Also, who is to make such a judgement? In contemporary Ireland, we can pose the additional question of whether the appropriate point of comparison is with the relative position of (older) people before the onset of the recession and the ensuing austerity budgets, that is, at the height of the unsustainable economic boom, or at some other point in time before, during or after the economic downturn. In this respect, there is solid evidence which shows that current cohorts of older people, especially those on low incomes, are likely to view their current circumstances rather more favourably when making comparisons with their earlier lives or with the lives of preceding family generations (Walsh et al, 2012b). In this situation, while older adults may not regard themselves as being at risk of exclusion, a ‘professional’ judgement might suggest otherwise. A second feature of definitions of social exclusion points to the role of agency. Atkinson (1998) suggests that individuals or groups can only become excluded on the basis of an act or series of actions that result in a position of disadvantage. Such actions may be seen in direct forms of discriminatory behaviour, as reflected, for example, in societies’

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prevailing legal and institutional systems. In relation to older people, enforced retirement at the age of 65, as has been standard practice in many Western nations, might be interpreted as an act leading to marginalisation in later life. Within the context of Ireland’s austerity programme, there are numerous examples of measures that have been taken to ‘balance the books’ that potentially increase risks of exclusion in later life. These range from fiscal measures, such as the reduction of taxation thresholds for retirement lump sums (in December 2010), to the introduction and subsequent increase of various charges for medical prescriptions (after January 2009), and the withdrawal from retired people of telephone allowances (in January 2014). While social exclusion can be imposed by external forces, notably, by direct government action in Ireland during the recession, there is also acknowledgement of the potential for individuals and groups to act in ways that lead directly to the experience of exclusion. Such forms of agentic behaviour may be witnessed, it might be argued, in the actions of older people who opt to withdraw from the social mainstream by moving into age-segregated housing schemes (such as nursing homes or purpose-built retirement communities), thus seemingly cutting themselves off from the types of lives led by others who choose to ‘age in place’ in traditional community settings. People who make an active decision not to claim welfare entitlements might similarly be seen as acting in a way that brings about their own exclusion in terms of an increased risk of poverty. A third characteristic of social exclusion definitions highlighted by Atkinson (1998) concerns the dynamic nature of exclusion. Exclusion should not be regarded as a static condition affecting individuals and groups at a particular point in time. On the contrary, features of social exclusion affect social groups in contrasting ways at different points in time. At the individual level, people experience risks of exclusion in distinctive ways across the life course. While some exclusionary risks are associated with normative life-course transitions, such as the financial insecurities relating to becoming independent from parents in young adulthood or linked to becoming a parent for the first time, others arise from particular sets of individual circumstances and are less predictable. In terms of ageing adults, for example, while the loss of income that typically marks the transition into retirement is largely predictable, less certain are the impacts of changing social relationships at earlier stages of the life course on an individual’s perception of the quality of their social relationships in advanced old age. The dynamic nature of exclusion points to the potential for individuals and groups not only to become excluded, but also to escape their disadvantage. In

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this sense, it also emphasises the potential for society to act – through policy measures and appropriate practice interventions – to reduce exclusionary risks in later life. During the course of Ireland’s recession, the inevitable focus has been on how the potential exclusion of different groups, including diverse groups of older people, has been influenced by a rapidly changing socio-economic context characterised by, for example, cuts in incomes, the loss of basic services, the mass outward migration of young people and, as discussed elsewhere in this book, the downward transfer of resources to younger family generations. In addition to relativity, agency and dynamism, most contemporary definitions also emphasise the multidimensional nature of social exclusion (Walker and Walker, 1997; Béland, 2007; Levitas et al, 2007; Billette and Lavoie, 2010; Scharf and Keating, 2012b). Multidimensionality is particularly important for older people given that research has highlighted the impact of social exclusion on a range of different life domains that affect the quality of later life (Barnes et al, 2006; Grenier and Guberman, 2009; Walsh et al, 2012a). While other characteristics are also reflected in exclusion definitions, they appear less frequently. This includes, for example, socio-spatial features, which can act both as locations for and as drivers of exclusion (see, eg, 6, 1997). What is not clear, however, is the degree to which the various dimensions of exclusion are subject to change under the influence of economic change, and in the case of Ireland, the recession and its aftermath. In social gerontology, key dimensions that contribute to an understanding of social exclusion in later life include exclusion from material resources, social relations, civic activities, formal services and the residential community or neighbourhood (Scharf et al, 2005a). In the following section, available evidence from Ireland relating to these different dimensions of social exclusion is examined. A particular focus is on how risks of exclusion have evolved during the economic recession and under the influence of the austerity programme introduced following the EU–ECB–IMF Troika’s bailout in 2010 of Ireland’s rapidly faltering economy.

Social exclusion in later life: the evidence Exclusion from material resources: poverty and deprivation Exclusion from material resources is typically represented by measures of poverty and of material deprivation (Gordon et al, 2000; Scharf et al, 2005a; Walsh et al, 2012b; Zaidi, 2012). Historically, reflecting the

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limited nature of public pension provision, older people in Ireland were disproportionately prone to poverty (Layte et al, 1999; Whelan et al, 2003; Prunty, 2007). With the ‘at-risk-of-poverty’ threshold set at 60% of median household income, one quarter of people aged 65 years and over were judged to be income-poor in the mid-2000s (Fahey et al, 2007). However, official data reveal a remarkable turnabout in the years immediately preceding and following the most recent economic recession. Between 2004 and 2010, the ‘at-risk-of-poverty’ rate for people aged 65 and over fell from 27% to under 10% (Central Statistics Office, 2012d). With a government commitment to maintaining the monetary value of statutory pensions, and in comparison with other age groups, older adults came to be identified as one of the groups with the lowest poverty risk (Central Statistics Office, 2011b). As already noted in Chapter One, this has facilitated an emerging public discourse in which it is argued that when other population groups are subject to substantial cutbacks in terms of state income transfers, older people should contribute rather more towards helping to restore Ireland to economic health. Indeed, those older people who have accumulated financial resources and housing wealth over the course of their lives are doing relatively well. Furthermore, many older people’s living standards have improved noticeably over their lifetime, with the statutory pension acting as a key source of financial security. As yet, and as also argued in Chapter Three, research exploring intergenerational relations has found that there is little public appetite in Ireland for making these arguments along generational lines (Scharf et al, 2013). Moreover, and notwithstanding evidence from official poverty statistics, concerns have been expressed by age-sector organisations concerning the impact of the recession on older adults’ well-being and financial security (see, eg, Age Action, 2009; Boyle and Larragy, 2010). Indeed, in a direct challenge to official data, a growing body of evidence now suggests that the risk of exclusion from material resources, as reflected in the prevalence of poverty and deprivation, is experienced by a substantial minority of older people in Ireland (Hillyard et al, 2010; Goodman et al, 2011; Walsh et al, 2012b). This applies especially to groups within the older population who are identified in official data as being ‘hard to reach’, such as Travellers (Central Statistics Office, 2011b). Ireland was one of the first countries to adopt an approach to poverty measurement that responded to acknowledged limitations of incomebased measures. In official statistics, a measure of ‘consistent poverty’ is used to capture more fully the multidimensionality of poverty (Russell et al, 2010). In addition to an income-based approach, consistent

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poverty makes use of a statistically refined 11-item basic deprivation index (see Table 8.1) (Nolan and Whelan, 1996; Maître et al, 2006). There is some concern that such deprivation measures may well be suited to assessing the circumstances of a general population but fall short when it comes to capturing deprivation among the older population (Daly, 2010). This was most recently reflected in a study by Walsh et al (2012b), which pointed to an under-reporting in Ireland of older people’s deprivation and poverty. Using a mixed-methods approach, the study sought to assess the effectiveness of existing measures of deprivation – in particular, the 11-item basic deprivation index used in official statistics – to explore how the perceptions and experiences of older people, from different backgrounds, could be used to inform public perceptions and measurement of disadvantage for older people. The study’s quantitative element, involving secondary analysis of the 2009 Irish component of the EU Survey of Income and Living Conditions, revealed, on average, lower levels of deprivation among older households when compared to the overall population. Crucially, the authors also found that patterns of deprivation among older households were heavily influenced both by older people’s response to the individual indicators that make up the 11-item basic deprivation index and by the selection of indicators to include in the index. This suggests not only that measured deprivation depends on the particular indicators contained within the composite measure, but also that some indicators may be less relevant to older people than others. As has also been borne out in several comparable studies (eg Berthoud et al, 2006; Scharf et al, 2006; Daly, 2010), this raises questions around the appropriateness of official deprivation measures in terms of older adults’ lives. The qualitative component of the study by Walsh et al (2012b) added credence to these survey findings. Focus groups and interviews with people belonging to a diverse range of participant groups, including older people who lived alone, residents of disadvantaged urban communities and people with chronic health conditions, showed how financial circumstances in later life were largely shaped by individuals’ various roles and opportunities earlier in life. Participants with disrupted employment histories and limited opportunities for labour market participation at working age were more likely to find it difficult to get by on their material resources in old age (see also Chapter Five). People ageing with disabilities, family carers and members of the Traveller community were more likely to report income-related difficulties. As also noted in Chapter Six, risk factors associated with the experience of deprivation in later life included the economic recession, with older

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participants reporting cutbacks in the services that they were receiving, reductions in direct income payments and welfare benefits, and the pressing need to transfer financial resources to adult children so that they could survive the recession (Walsh et al, 2012b). Table 8.1: 11-item basic deprivation index Respondents were asked whether they lack any of the following because they cannot afford them: 1

Two pairs of strong shoes

2

A warm waterproof coat

3

Buy new, not second-hand clothes

4

Eat meals with meat, chicken, fish (or vegetarian equivalent) every second day

5

Have a roast joint or its equivalent once a week

6

Had to go without heating during the last year through lack of money

7

Keep the home adequately warm

8

Buy presents for family or friends at least once a year

9

Replace any worn-out furniture

10

Have family or friends for a drink or meal once a month

11

Have a morning, afternoon or evening out in the last fortnight for entertainment

Source: Maître et al (2006).

Overall, Walsh et al (2012b) argued that multiple, and significantly improved, measures were needed to assess deprivation in later life and to overcome the under-reporting in official statistics of older people’s deprivation. In this respect, they also fundamentally challenged the perspective, increasingly heard in public debates, that older people’s material conditions have been protected during the recession. While this is certainly true for a significant proportion of older people, poverty and deprivation evidently continue to affect the lives of many ageing adults in Ireland, suggesting that concerted action remains necessary to meet this population group’s material needs. In particular, supports are needed for highly marginalised groups of older people, and for those who become vulnerable to poverty and deprivation at key points of transition in their lives. Exclusion from social relations: loneliness and isolation Exclusion from social relations is typically considered in terms of the dual concepts of social isolation and loneliness. In later life, people may experience such exclusion as a result of an actual or perceived lack of

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valued social contacts. While social isolation and loneliness are closely related, and typically used interchangeably in popular discourse, it is useful to distinguish conceptually between them. Isolation represents an ‘objective’ measure of individuals’ frequency of contacts with others and loneliness a ‘subjective’ judgement of the quality and quantity of an individual’s social relations. Not all isolated people are lonely and not all lonely people are socially isolated, but both isolation and loneliness are associated with reduced quality of life in older age and with increased morbidity and mortality (Gabriel and Bowling, 2004; Hawkley and Cacioppo, 2007; Holt-Lunstad et al, 2010). In this respect, recent evidence highlights the prominent role played by concerns about loneliness among older people in Ireland (eg Walsh and Harvey, 2011). While a number of studies show that older people in Ireland generally have frequent social contact with family, friends and neighbours (eg Layte et al, 1999; Timonen et al, 2011b), loneliness remains a key concern. These concerns have been expressed more forcefully during the course of the recession under the influence of such factors as the mass emigration of younger people and the loss or reduction in many communities of a range of community services and supports. In The Irish Longitudinal Study of Ageing (TILDA), loneliness is measured using a modified version of the University of California Los Angeles (UCLA) Loneliness Scale, with a range of values from 0 (not lonely) to 10 (extremely lonely). While an overall prevalence score has not been reported, at Wave 1 (2009–11), the average rate of loneliness among people aged 50 and over in Ireland was relatively low, with a value of 2 (Timonen et al, 2011b). This finding is consistent with earlier studies that report relatively low levels of loneliness in Ireland’s older population (eg Treacy et al, 2004; see also Burholt and Scharf, 2014). Mean loneliness scores in TILDA hardly varied according to age, but women were found to be more lonely than men, and people with lower levels of education were more likely to be lonely than those with higher levels of education (Timonen et al, 2011b). Identifying the prevalence of loneliness in Ireland, and especially measuring change under the influence of the recession, is difficult given the absence of nationally representative data. However, small-scale studies suggest that rates of loneliness in Ireland are likely to be similar to those reported in other European nations, where 8–10% of older adults are typically identified as being often or always lonely (Victor et al, 2005). For example, the Dublin Healthy Ageing Study – a community study of 466 adults aged 65 and over conducted between 2003 and 2005 – found 15.7% of people to be either sometimes or often lonely (O’Luanaigh et al, 2012). This is broadly comparable with earlier studies in Ireland that

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report between 7% and 14% of older people being lonely (eg Power, 1980; Eurobarometer, 1993; Garavan et al, 2001). Loneliness is more prevalent in Ireland’s rural than urban communities (Layte et al, 1999; Drennan et al, 2008). This was also reflected in the study conducted by Walsh et al (2012a) contrasting types of rural communities distributed across Ireland and Northern Ireland, where loneliness was regarded by some older participants as a ‘normal’ feature of ageing. This was summed up by one woman who responded to a question asking whether she was satisfied with her life by saying: ‘Oh God, I am yes, I’m happy in my own way like…. Apart from being lonely.… It’s a part of life’ (Walsh et al, 2012a: 46). In rural Ireland, changing patterns of social integration are often described by older people in terms of a loss of quality when compared to earlier times. An increasing population turnover, the outward migration of young family members, the quickening pace of daily life, the loss of places where people would once socially interact on an informal basis and the gradual diminution of a range of public and commercial services are keenly felt by the current cohort of ageing adults (Walsh et al, 2012a, 2014). While such processes are commonly perceived as exacerbating risks of isolation and feelings of loneliness among older people, whether exclusion from social relations has increased in Ireland during the recession remains to be seen. Exclusion from civic activities The ability to influence decisions that affect one’s life is important at all stages of the life course. Exclusion from civic activities can be represented in a variety of ways, typically encompassing the formal political arena and a range of forms of civic engagement in individuals’ community of residence. The most recent data concerning this dimension of social exclusion arise from the TILDA study. In terms of formal political engagement, older people in Ireland have traditionally been more likely to turn out to vote in local, national and European elections. For example, more than 80% of participants in the first wave of TILDA (2009–11) reported having voted in the previous general election, held in 2007. Women aged 75 and over were less likely to vote than men and women belonging to other age groups; however, even among this group, a relatively high degree of voting was reported (Timonen et al, 2011b). In terms of active engagement in politics beyond the ballot box, there is some evidence of a willingness to mobilise along generational lines when matters of particular concern to older people arise. As already noted in Chapters Two, Three and

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Seven, this was most evident in the response of older people, as well as a makeshift coalition of representative organisations from across the age spectrum, following the budget negotiations of 2008. The threatened replacement of the recently introduced free universal primary medical care for people aged 70 and over with a means-tested alternative led to the type of mass mobilisation of opposition and street protests not commonly witnessed in Ireland, which brought about a rapid political U-turn by the then government (Carney, 2010). While such visible signs of political engagement by older people remain relatively rare in Ireland, involve a relatively small proportion of the older population and have not been witnessed again on such a scale since 2008 – indeed, protests were rather more muted when a further attempt to limit medical card access was made in 2014 – they serve as a reminder to the country’s political elites of the potential power of an actively engaged older lobby. In relation to wider forms of community engagement, there is evidence of older people’s activity in a variety of different spheres of public life. For example, in relation to volunteering, the TILDA study reports that 15% of people aged 50 and over in Ireland volunteer at least once a week; a further 11% volunteer on a monthly basis, while 16% volunteer at least once a year. The remaining 58% of older adults report never participating in voluntary work (Timonen et al, 2011b). Older people in Ireland also report relatively high rates of attendance at religious services, with three fifths of the 95% of TILDA participants who indicate belonging to one of the main religions attending at least weekly (Timonen et al, 2011b). Exclusion from formal services Access to a range of services, both in the community and within the home, becomes increasingly important as people age. With a hybrid welfare state displaying characteristics of the residual Anglo-Saxon welfare model, a focus on prioritising supports provided by family and community or voluntary organisations, and a limited range of insurance-based entitlements, the service infrastructure in Ireland has remained comparatively underdeveloped in European terms. This is especially the case in rural communities, where public transport provision is also limited (Walsh and Harvey, 2011). In terms of supports available to older people with care and support needs living in community settings, formal services are delivered by public health nurses, home helps, occupational therapists and the like. A range of other services are commissioned by the Health Services Executive,

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including, for example, meals-on-wheels provision. Typically, older people on low incomes will receive such services free of charge or in return for a modest fee. People with higher incomes can generally pay to access the same or similar services, and to avoid the often long waiting times that exist to receive services. One key outcome of Ireland’s model of service provision is that relatively few older people report using state-provided services. The TILDA study invited participants to indicate which, if any, of a range of 16 types of community service they had used in the preceding year (Normand et al, 2011). While services such as an optician or dentist were used relatively frequently, with 12% and 11% of people aged 50 and over using the services, respectively, less than 1% of respondents used social work or respite care services. People aged 80 and over, the group most likely to have support needs, are most likely to make use of services, with 60% of this group using at least one service in the past year. However, even among this age group, rates of use of individual services were low. While one quarter of people aged 80 and over reported making use of a public health or community nurse, only 7% used a day-centre service and 5% a hearing service. None made use of a social work service (Normand et al, 2011). During the austerity period, successive budgets have sought to cut back on even the limited range of community services available to older people with support needs. This has been achieved using a broad array of cost-cutting measures, including the withdrawal or reduction of funding for particular services, raising entitlement thresholds, and the introduction or increase of charges for services. The hollowing out of an already-limited service infrastructure has significantly heightened the risk that older adults are excluded from receipt of basic services and supports that would allow them to ‘age in place’. As outlined in Chapter Six, the impact of such cuts on communities, and especially on the capacity of communities to become age-friendly, is also significant. Several studies highlight older people’s and community stakeholders’ concerns with this situation (Walsh et al, 2012a, 2014). For example, work undertaken on behalf of the Society of St Vincent de Paul involved consultations with a large number of older people and described some of the challenges facing Ireland’s health system in terms of basic weaknesses: Older people regarded health services as good – once they got them. The consultations heard many reports of long waiting periods on trolleys (up to three days), long waits for outpatients and accident and emergency (4hr to a day)

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and prolonged delays to see specialists (up to three years). Experiences of poor hospital care were reported, with a decline in nursing, the lack of stimulation of long-stay patients or people with dementia. (Walsh and Harvey, 2011: 3f) Exclusion from the neighbourhood/community Exclusion from the neighbourhood or community reflects the sociospatial dimension of the multidimensional social exclusion construct, recognising the importance of the home and immediate residential environment in shaping older people’s quality of life. This dimension of exclusion is most usually assessed in terms of ageing adults’ perceptions of the community in which they live and their feelings of personal safety. In relation to the former, there is ample evidence of a strong degree of place attachment among older people in Ireland. This is reflected, for example, in relatively long average lengths of residence in the same community, high rates of owner-occupation and in qualitative research where ageing adults refer in highly favourable terms to aspects of the physical and social environment in their place of residence (eg Walsh et al, 2012a, 2014; see also Chapter Six). Evidence concerning feelings of personal safety among older people in Ireland is limited. However, the available data point to parallels with findings reported in other European countries, where older people are less likely than the general population to experience crime but more likely to be fearful of becoming a victim of crime and for this to reduce the quality of their lives (National Crime Council, 2009). For example, the 2010 Quarterly National Household Survey indicated that among people aged 65 and over, 2% of men and 3% of women had experienced a crime in the preceding year, compared with 4% of the general population of Ireland. By contrast, older people were much more likely than younger people to express concern about becoming the victim of personal or property crime. Women aged 65 and over are most likely of all age and sex groups to report feeling unsafe when alone in their home after dark or when walking alone in their neighbourhood after dark (Central Statistics Office, 2010). Evidence relating to general trends in feelings of personal safety among older people over the course of the recession has not been reported. However, with only 39% of women aged 65 and over reporting feeling very safe in their homes after dark, compared with 53% of men in the same age group, the differential risks of exclusion arising from this particular dimension of disadvantage are evident.

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Conclusions The argument developed in this chapter is that it is useful to consider the changing circumstances of older people in Ireland during the course of the recession and under the influence of a succession of austerity budgets in terms of the potential for social exclusion. The evidence from Ireland corresponds broadly with that reported in other comparable countries. Understood as a relative, dynamic and multidimensional idea, exclusion draws attention to a range of processes that underpin the growing inequalities that now characterise later life, making it particularly useful when considering the disadvantage of older people during the economic recession and austerity. While a considerable body of research and policy continues to focus on the risks of exclusion that relate to people of working age and those who will join future labour markets, there is merit in exploring such risks in terms of population ageing. Drawing on the conceptual debates outlined earlier in this chapter and reflecting the empirical evidence presented, concluding thoughts encompass three major themes. First, it is useful to review the nature of social exclusion as it affects older people in Ireland, and potentially elsewhere, especially under the influence of the recession and its aftermath. Second, there are issues that can be explored in relation to the future research agenda in social gerontology. Third, questions emerge in relation to the development of appropriate policy responses to exclusion in later life. Considering the first of these themes, there is now growing evidence to illustrate the degree to which the deep economic recession has affected different population groups. While there has been a tendency in public debates to focus on the considerable impacts of the economic downturn and austerity programme on children, families and people of working age, there is an equally strong argument for exploring risks of exclusion experienced by ageing adults. This argument exists even within the context of a highly differentiated older population marked by substantial variations in material and social resources. Contrary to views expressed in some quarters that older people have been well protected during the recession and will emerge largely unscathed from the austerity programme, there is ample evidence of profound impacts on the situation of ageing adults since 2008. As in other countries, where appropriate evidence exists, exclusion from material resources, social relations, civic activities, services and the neighbourhood/community is a reality of daily life for significant minorities of older people in Ireland. While it is not always possible to chart the changing prevalence of exclusionary risks over time, the

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tendency has been for such risks to increase rather than decrease over the course of the recession: the lives of more older people are affected by poverty and deprivation; the potential for isolation and loneliness has grown; and an already relatively weak infrastructure of formal and informal community supports has been further diminished. Where multiple forms of exclusion overlap, the potential for acute disadvantage exists. Moreover, the risks of exclusion are distributed highly unevenly across Ireland’s heterogeneous older population. For example, while the risk of exclusion from material resources tends to be greater for the oldest old and for people belonging to the Traveller community, exclusion from a hollowed-out service infrastructure is more likely to affect people who age with disabilities or chronic health conditions or who lack informal (family) support. Acknowledging the importance of exclusion in later life presents a number of challenges in terms of shaping the future research agenda in social gerontology. Above all, there is a pressing need to develop the empirical evidence base relating to social exclusion and ageing adults. As indicated in this chapter, evidence concerning some dimensions of exclusion is relatively good. This applies, in particular, to the material and social resources dimensions. However, other dimensions remain underdeveloped in empirical terms. The outcome is that it is difficult for researchers to comment with any certainty on the prevalence of particular forms of exclusion. Moreover, at present, it is not possible to report on the extent to which older people are affected simultaneously by different forms of exclusion. While there is a growing body of qualitative research that examines some of these concerns (eg Walsh et al, 2010, 2012b; O’Shea et al, 2012), were major surveys, such as TILDA, to adopt multidimensional indicators of exclusion, then there would be a sound foundation for assessing the prevalence of exclusion not only among the general population of older persons, but also among key subgroups of the older population. Turning to the realm of ageing policy, the evidence presented in this chapter highlights the need for policymakers in Ireland, and probably in other countries that have experienced similar economic shocks, to acknowledge that older adults run the risk of experiencing different forms of exclusion, and that for some individuals, later life may involve multiple and enduring exclusion. This is a key distinguishing feature of exclusion in older age. While one might be able to argue that people who experience exclusion earlier in life have the potential to escape such disadvantage, for example, by securing employment, forming new social relationships or becoming more active in community life, this is less likely to be the case in later life. Opportunities to escape poverty

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by (re)joining the labour market are more limited for people who have passed statutory retirement age. This suggests a central role for policy to address forms of disadvantage that reduce the quality of many older adults’ lives. The fact that exclusion can be especially intense for some groups of older people points to the need for concerted action. With its focus on ‘positive ageing’, Ireland’s ageing strategy – introduced during the country’s deep economic recession amid a public discourse that emphasised the need to harness better older adults’ contributions to society – runs the risk that it will not only overlook the needs of some of Ireland’s most disadvantaged older people, but also ignore the potential for forms of exclusion to affect anyone who grows old in Ireland. Responding to the risks of exclusion through appropriate interventions is clearly a major task for ageing policy. It also necessitates a coordinated approach that considers the potential to intervene at earlier stages of the life course to prevent exclusion from occurring later in life. In this respect, taking exclusion in late life seriously may also have positive outcomes for the general population, and not just for older people.

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NINE

Conclusion – beyond austerity: critical issues for future policy Gemma M. Carney, Kieran Walsh and Áine Ní Léime

Introduction By focusing on Ireland, this book has sought to offer a timely contribution to efforts to understand the impact of the economic crisis on ageing societies. Ireland has garnered considerable international attention in recent years because of the country’s rapid economic demise from the ‘Celtic Tiger’ economy (1994–2007) to a ‘bailout state’ requiring a large loan from its European partners in 2010 (Carney et al, 2014). Between 2008 and 2013, two successive governments implemented one of the most austere programmes of public spending seen in Europe since the Second World War (Nolan et al, 2014). As long-term challenges, such as demographic ageing, continue to evolve regardless of fluctuations in gross domestic product (GDP) and public spending, Ireland’s experience presents a perfect opportunity to offer some insights on the experience of ageing through austerity. As older people appear to be ‘especially vulnerable to the charge of contributing to the economic crisis’ (Phillipson, 2013: 176), Ireland offers an important case study of austerity for other ageing societies implicated in the global economic crisis. In this final chapter, we draw together the perspectives taken in the book and offer possible answers to some of the issues raised by our empirical work on Ireland. By shifting our gaze from the particular (ageing and social policy in Ireland) to the general (ageing and social policy in the 21st century), we seek to highlight what we see as critical issues for future policy in other contexts beyond Ireland. While the issues raised certainly apply to Ireland, most are not limited to the Irish context. For instance, the shifting relative position of older people in comparison with other cohorts through the austerity programme is not unique to Ireland. Neither is the tendency to make ageist assumptions that seek to place some of the burden of responsibility for indebtedness

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at the feet of older people (Carney et al, 2014). Likewise, throughout the book, the authors have recognised short-term funding retractions as minor shockwaves in what are longer-term intractable inequities and inefficiencies that have existed prior to the latest economic recession. Our critical gaze means that we see current challenges as arising from some underlying inequality, together with the use of ageist assumptions in the allocation of funding, which constructs ageing as an ideology of decline (Friedan, 1993).

Perspective taken in this book This book has adopted a critical perspective and thus locates itself in the tradition of critical gerontology. Recognising the social construction of ageing, we took the view that the intersection of social norms with the Irish social policy system is an important driver in the creation of current and future experiences of growing older in Ireland. We concur with Phillipson (2013) that by taking a social perspective, it is easier to see how the multifaceted nature of population ageing is actually a series of related life experiences of a diverse range of individuals. Most notably, when taken together, the chapters reveal how structural inequalities in terms of socio-economic status, gender, neighbourhood and community, and health operate within Irish society. These same structures shape the advantages and disadvantages accumulated over a person’s life course. In each chapter, the authors demonstrated how social policy can reinforce socio-economic inequalities and divisions in the context of older people’s lives. In some cases, these inequalities have been intensified by the economic recession and austerity; in other cases, these inequalities are engrained in the Irish social policy system, pre-dating this latest period of economic difficulty. In-keeping with the desire to highlight the linkages between the global, national and local levels, the book has engaged critically with global discourses on ageing, such as active ageing, age-friendly communities, social exclusion and mass political responses to economic retrenchment. By drawing on the primary research projects undertaken by members of the team at the Irish Centre for Social Gerontology and other colleagues since 2006, the empirical bases for these arguments are robust. While we do not claim generalisability from the Irish case, our empirical findings and theoretical work contribute to a range of globally relevant questions.

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Looking beyond austerity The book has put forward the argument that a critical perspective on ageing through austerity is needed if we are to understand the human impact of the austerity programme, separate to a range of other factors, on current and future generations of older people. Our analysis offers a more nuanced, complex, life-course view of ageing and austerity. Throughout the chapters, the authors have aimed to look beyond, on the one hand, the economically stagnant and problematised discourse of the ‘demographic burden’ and, on the other, the assumption that the economic recession and austerity carries with it catastrophic implications for older people. This approach suggests that any impact that population ageing has on societies will increasingly be shaped by other global challenges (Hermann, 2012). Future research questions in gerontology have to consider issues such as inequality, globalisation and environmental sustainability. In marshalling the evidence from Ireland, the book poses a challenge for students and scholars of critical gerontology: how can we measure the impact of ageing within nationstates in the context of the challenges that emerge from liberalised and globalised market economies? The impact of globalisation is a concern for all social scientists given its far-reaching consequences for national economic and political sovereignty, welfare states, and social protection (Stoker, 2006). In the Irish case, loss of economic sovereignty brought in its wake loss of choice and control for Irish citizens in terms of how the nation’s resources were distributed. However, for many issues, particularly those with longer-term consequences, such as the relative position of older people in terms of access to resources and services, the programme of austerity merely heightened existing, intractable policy problems, such as the perennial under-resourcing of funding for community care. The impact of these diverse challenges is intrinsically social, often forcing individuals, communities and societies to question taken-forgranted practices in social policy. We have tried to demonstrate this global–local nexus throughout the book. In every chapter, we have aimed to demonstrate the connection between local communities and national and global patterns of social and economic change. We have also tried to demonstrate where there is a potential for global trends to co-opt local contextual and cultural characteristics, and vice versa: for instance, how Irish cultural community-based society can draw on age-friendly principles and impetus to reinforce notions of place-based identity and ‘the close-knit supportive community’.

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The authors have focused on a cross-section of everyday issues – work and retirement, social participation, social citizenship, and ageing in place – seeking to reposition these issues in terms that critique the taken-for-granted assumptions of existing policy provision (see Chapter Three). In addition to these core social institutions and practices, additional chapters have concentrated on major challenges for ageing societies, such as dementia and social exclusion. As our analysis developed, we became increasingly sensitive to the fact that dementia and social exclusion intersect and touch on the lives of many of us as we age. However, in themselves, these topics also represent intractable issues for ageing societies, even if this fact is not always recognised. For example, while aged and social participation and (social) citizenship are often discussed, what these concepts mean for older people’s lives is rarely addressed. Of course, the real challenge is to foster these forms of interaction and empowerment of older people through our work.

Contributions from the book In this section, we offer a brief summary of the main arguments put forward in the book, highlighting how the applied analysis from the Irish case has provided insights for policy and research in more general terms. In Chapter Two, Connolly outlined the demographic context for ageing in Ireland. Her analysis showed Ireland to be a relatively young population by European standards. There are two key insights to draw from her analysis. First, as in other countries, within the sub-population of those aged over 65, Connolly finds significant differences in the health and socio-economic status of older people, demonstrating the heterogeneity of the Irish older population. Second, Connolly usefully highlights that this heterogeneity suggests that older people experience the economic recession and the programme of austerity differently. This is in line with trends towards rising inequality, recognised across the Western world (Rajan, 2010). While the people of Ireland have been credited with passive acceptance of a challenging set of austerity measures, older people have been the exception to this general trend (Carney, 2010). In Chapter Three, Carney investigates the social citizenship of older people living through Ireland’s austerity programme. Drawing on studies undertaken in Ireland and elsewhere, the author insightfully surmises that the austerity programme has heralded a significant sea change in the reputation of older people as a politically mobilised bloc since 2008. Given that publicly funded benefits, such as pensions and child

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benefit, depend on solidarity between working and retired generations, having high levels of intergenerational solidarity should ensure that the resource redistribution required by the transition towards an older population is smooth. As levels of intergenerational solidarity vary between countries, there is a need for more comparative and critical enquiry into the potential impact of population ageing on social citizenship. The chapter also endorses a life-course perspective on civic involvement, which promotes the inclusion of middle generations in discussions of citizenship and human agency. In Chapter Four, Ní Léime and Connolly concentrate on the potential that exists for meaningful social participation for older people. Social participation is often seen as the antidote to many of the problems arising from ageing, such as social isolation, loneliness and loss of status. In drawing together a number of different studies on volunteering and social and cultural participation in Ireland, the authors begin to unpick the relationship between ageing and social participation. In particular, they offer a useful critique of active ageing in the context of both the under-resourced activity of voluntary organisations and less privileged and less socially networked older individuals. In the context of austerity, the authors surmise that the loss of social capital, exacerbated by the emigration of younger people and the closure of publicly funded services and meeting places, such as rural post offices and pubs, is set to continue (Walsh et al, 2010, 2012a). Ní Léime and Connolly highlight that while some of the challenges around social participation and volunteering in later life have been exacerbated by the policies of austerity, many pre-date the economic recession and reflect the lack of government support for such activities, even in the ‘Celtic Tiger’ era, despite their evident physical and mental health benefits. There is a risk that in a time of austerity, the unpaid labour of older people will be used to replace government services that have been cut back. This is an important consideration when viewing ageing through the lens of austerity in Ireland and elsewhere. In Chapter Five, Ní Léime, Duvvury and Callan tease out the implications for women of policies designed to extend working lives, which have been introduced by many European Union (EU) governments, including Ireland, to address the expected increase in pensions that accompany demographic ageing. They argue that policies to extend working lives amount to a change in the social contract and have been introduced relatively quickly in Ireland without adequate debate or consultation with citizens in the context of austerity. The authors, drawing on data concerning employment and pension patterns and recent qualitative research findings, highlight the fact that women (as

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well as men in certain precarious occupations) are likely to be adversely affected by the introduction of such policies because of their typically interrupted employment trajectories and the legacy of discriminatory legislation in Ireland. Such policies serve to increase individualisation and privatisation, although, in a positive sense, they acknowledge the ability of older people to continue to contribute and be rewarded for their contribution. The authors highlight contradictions between advocated policy (encouraging workers to take responsibility for their own pension provision) and the reality of people’s lives, where they are unable to afford such contributions, which are particularly evident in the context of austerity. However, such policies should be modified to ensure that extending working life is offered as a choice for older people, not something that is arbitrarily imposed. In Chapter Six, Walsh traces the global age-friendly cities initiative to the broader question of what makes a community a good place to grow old, in the context of the economic recession and austerity in Ireland. The recession and austerity combine with macro-forces and broader policy trends to exacerbate existing ageing-in-place issues in Ireland. In such a context, there is a danger of the age-friendly movement becoming ‘a vehicle to individualise responsibility for people and places’ (Walsh, this volume: p 95). The economic recession and austerity can weaken the linkages between some older people and their communities, and serve as a challenge to implementing age-friendly initiatives. However, communities demonstrate considerable resilience in continuing to engage and support older people, despite economic travails and long-standing challenges that pre-date these issues. Deeper and more substantive investigations are called for if the age-friendly approach is to be a valuable means of guiding social policy for older people. Further, there is a need to consider the reciprocal linkages between local cultural contexts and global factors as a part of a holistic and multi-level model of age-friendliness. This is necessary if we are to begin to understand the ‘interconnections and complexities of our relationship with our communities as we age’ (Walsh, this volume: p 95). In Chapter Seven, O’Shea, Cahill and Pierce reframe policy for dementia in Ireland in the broader economic context of austerity conditions. The authors use recently available data to chart the prevalence and economic costs of dementia in Ireland. They then analyse the current realities for people living with dementia in Ireland, both in the community and in long-stay care settings, and identify the crucial gaps in current capacity to realise a person-centred and community-based philosophy of care and support for people with

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dementia. Crucially, Chapter Seven highlights where such gaps, on the one hand, have been wedged and exacerbated by austerity-driven spending cuts and, on the other, represent long-standing failures in the dementia care system and paradigm. Using this evidence and lessons from other countries, the authors set out a transformative dementia framework that is person-centred rather than provider- or resourcefocused. Calling for a shift from individual to collective, from biological to social, from risk-oriented to capability-oriented, from institution to home, from deficit to asset, and from exclusion to inclusion, O’Shea and colleagues set out the need to establish the primacy of the person with dementia in the decision-making process, and to establish a more open societal and policy discourse about dementia in our communities. In Chapter Eight, Scharf questions the idea, common in the media and in policy circles, that older people in Ireland have emerged relatively unscathed (as compared to other groups) from the economic recession and its associated austerity policies. He argues that social exclusion among older people, in Ireland and, indeed, internationally, has not yet been appropriately and adequately researched. Scharf draws on recently available data sets and the limited number of qualitative studies available to assess the impact of social exclusion across a range of domains. Offering a nuanced analysis, the chapter concludes that older people have experienced social exclusion to varying degrees, and will continue to do so, due to the recession and austerity policies, and due to the erosion of the fragile social infrastructure. Groups particularly at risk include those without family members, the oldest old and those with chronic health conditions and/or disabilities. This highlights the need for integrated policy that addresses the particular challenges likely to be encountered by older people facing multiple forms of social exclusion across and at different points of their life course – other than simply those concerned with volunteering and extended working lives. Scharf argues that by addressing social exclusion in later life, positive outcomes will be achieved not only for older people, but also for the general population.

Looking beyond Ireland Each chapter has offered something novel from the Irish case that pushes forward a number of agendas ripe for development in social gerontology. We now outline a number of these areas, specifically related to methodological questions, theoretical challenges and critical issues for future policy.

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Methodological questions Ireland’s experience of austerity raises a number of potential methodological issues for current and future generations of gerontologists. Two prominent issues from the experience of researching ageing through austerity in Ireland are, first, the potential of longitudinal research and, second, the need for a life-course perspective when researching social policy development. Longitudinal research design is, of course, intrinsically linked to the life course as a theory of human development. In identifying critical issues for future policy, we have chosen to distinguish them into questions of methodology and challenges for theory. In short, the question of whether to use a longitudinal research design is methodological but is clearly indicated by the use of a life-course theoretical perspective; successful longitudinal research will reveal change over the course of a person’s life. It is this application of the life-course perspective to understanding ageing that represents a key challenge to theoretical development in future gerontological research. We now go on to explain how a longitudinal research design is central to addressing this challenge. The impact of economic downturns, such as Ireland’s boom to bust transition, will be felt for many years. Indeed, the full extent of the implications of the recession and of austerity for older people is likely to remain unknown for some time. However, we do know that generations of children born during the austerity programme will grow up in a country that is more indebted and less secure, both at a personal and societal level, than that of their parents (Carney et al, 2014). Ireland is not exceptional in this; many of the countries implicated in the European economic crisis have similar trajectories. In order to understand the impact of the recession, research will need to take a longitudinal approach, designing methods that will capture the impact of these cyclical effects. It is only through revisiting research questions with the same participants at regular intervals that we will begin to understand the long-term impact of cyclical effects of globalisation. Like Elder’s (1999 [1974]) Children of the Great Depression, longitudinal studies in human development undertaken during the recession of the early 21st century have the potential to demonstrate the longterm impact of intense periods of economic retrenchment on human development and ageing. Paradoxically, it is at times of severe economic retrenchment that investment in such long-term research designs is likely to be curtailed. Yet, if we do not begin to capture the temporal perspective, it will become increasingly difficult to separate out cause and effect between

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broad issues like demographic ageing, globalisation and rising inequality. A longitudinal research design – such as that pioneered in the large-scale quantitative ageing studies (eg The Irish Longitudinal Study on Ageing [TILDA]; the Belgian Ageing Studies; the English Longitudinal Study on Ageing [ELSA]; the Northern Ireland Cohort Longitudinal Study of Ageing [NICOLA]; the Growing Up in Ireland study; and the Study of Health, Ageing and Retirement in Europe [SHARE]) and qualitative studies, such as Changing Generations (see Timonen et al, 2013) – will allow us to judge both real and potential impacts of changing macroeconomic contexts on ageing populations. Longitudinal studies will also allow us to plan for the pensions and health-care requirements of the current generations of children who are growing up now. A particular strength of longitudinal studies is in providing us with the research evidence that is relevant to the life course of individuals and that can directly inform social policy responses that are capable of anticipating and avoiding problems such as poverty, social exclusion or under-resourcing in key areas like dementia or health promotion. Understanding the context, the mechanisms and the implications of life-course events, transitions and trajectories would position ageing researchers in such a way as to provide evidence to potentially effect useful and appropriate policy change. A longitudinal evidence base that adopts a stronger life-course approach is the first step in producing social policy that is better able to cope with future, as well as current, social problems. There is also a need to constantly pursue and develop new and innovative methodologies that can capture the evolving subjective and objective complexities of ageing experiences. As highlighted in the context of ageing and austerity in a number of chapters in this book, processes and outcomes of ageing are intertwined and compounded by the diversity of older people and the local and macro-contexts of their lives. Existing research methodologies and measurement indicators often fail to sufficiently represent this complexity. Whether we draw more directly on the perspectives of older people or on techniques of allied disciplines, the study of ageing and social policy needs to consider innovative means of working across and between disciplines in order to collect more complete information on, and conduct deeper analysis of, the real-life experiences of human ageing.

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Theoretical challenges A related but distinct issue is the evolution of social gerontology as a discipline (limited to the study of those aged over 65 years) to the study of ageing more generally. Throughout our studies of ageing in Ireland, we have observed lagged effects of deprivation experienced in childhood. Two of the most telling examples relate to gender inequality in pension income and educational attainment of people who are now in their 70s and 80s. Connolly (Chapter Two) demonstrated the relatively low educational achievement of people who were schooled before the introduction of free second-level education in 1968. Ní Léime et al (Chapter Five) argued that women are economically disadvantaged in old age because of their limited access to pensions financed by pay-related social insurance schemes. A life-course perspective on these two issues reveals that social policy would do well to consider how the behaviours and decisions made a person at a certain point in their life course can have significant longterm impacts on that person’s welfare in old age (Dannefer, 2003; Ginn, 2003; Dannefer and Settersten, 2010). Similar lagged gender effects are likely to be felt with regards to the high levels of unemployment experienced by men in precarious employment sectors during the recession of the early 21st century (Central Statistics Office, 2011a). A life-course perspective therefore demands that we, as gerontologists, question our assumption that the study of ageing requires us to focus exclusively on older people. In line with longitudinal studies, a lifecourse perspective is leading the field in terms of realising the potential of understanding ageing as an integral part of human development that affects everyone from birth to death. In a similar way, the chapters in this book on social citizenship, age-friendly communities and social exclusion raise important questions for how these constructs are actually constituted in the lives and contexts of different population subgroups as they age. Further theoretical conceptualisation and interrogation of such ideas and concepts is required here and would be of benefit to developing both academic understanding and useful policy intervention. Perhaps most challenging of all, a theoretical and cultural consideration of dementia, and how dementia is positioned and constructed in our society, is long overdue (Friedan, 1993). In this sense, the loss of autonomy, personhood and independence that accompanies current experiences of living with dementia may represent a reminder of how ageing can expose the vulnerability of even the most privileged (Fineman, 2008), revealing the universality of ageing as both a human experience and a policy challenge.

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Critical issues for future policy There is evidence within the various chapters of this book that testifies to the influence of an indifferent political culture towards ageing in Ireland. As outlined in Chapter One, this culture can sometimes be more engrained in the overarching Irish policy landscape for older people than any other discernible ideological agenda. This, in itself, is a critical issue that needs to be addressed in the context of future policy for ageing in Ireland. More broadly, however, there are a number of other critical policy issues that have emerged from our analyses that apply both to Ireland and to a range of other international contexts. Policymakers are increasingly aware of the gap between the growing number of people aged 65 years and over and the range of opportunities available to them as workers, volunteers or citizens. As health improves and life expectancy is prolonged, societies can expect to benefit from the efforts of older people as volunteers and workers during up to three decades of healthy and active life post-retirement. However, impediments to the participation of older people are poorly understood. One way to counter this trend would be to increase the capacity of the voluntary sector to use the skills and energy of this growing cohort of active and healthy older people in a manner that values and rewards their contribution in real terms. If we are to reduce dependency ratios, innovative policies that allow for phased retirement will become necessary. Apart from options such as part-time work, such a scheme might also offer opportunities for ‘retirees’ to volunteer part-time, offer professional skills on a part-time basis, start a new business or social enterprise, or retrain for an entirely different career. A key policy change allowing this to become a reality would be to allow for both security and flexibility in how people earn pension entitlements. Current pension policy reforms that increase the state pension age need to be questioned and modified as they are likely to disadvantage precarious workers, those engaged in heavy physical labour and women, who are most dependent on state pensions. A major challenge for policymakers is in educating about and raising awareness of issues that affect every individual as they age – sometimes referred to as gerontological literacy. In the US, there is evidence that people’s civic knowledge, like any other kind of knowledge, can become outdated: there are ‘people in their fifties and sixties who do not grasp that Medicare and social security are government programmes, or that they are recipients of government support’ (Hirshorn and Settersten, 2013: 208). Public awareness of the interventions available to dementia sufferers, before they lose the capacity to make autonomous decisions,

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is equally important. The necessity of contributing to a pension fund from early adulthood must also become part of a broader public awareness campaign. As illustrated at various points in this book, and exemplified in many ways by the example of the economic recession and austerity, macroeconomic forces and national and global contexts are entangled with local lives and local communities. However, this appears to be considered rarely in the development of social policy for age-related issues. Rising inequality will lead to increasingly dichotomous experiences of ageing for those with material resources and access to health care as opposed to those without. This chasm will affect older populations on both within- and between-country bases. Within countries, those with access to health care, good food, rest and a warm home will be more likely to ‘age successfully’, while those who have accumulated disadvantage during the course of their lives are more likely to need state policy interventions in old age. Similar inequalities are translated to the macro-context, leading to the most pronounced inequalities between people of the same birth cohort emerging between countries of the Global North and Global South. In Ireland, we see place-based, vertical inequality and gender inequality within the older population. Addressing inequality at both global and local levels will represent a significant challenge for social gerontology in the coming decades.

Conclusion Demographic ageing calls into question existing systems of welfare and policy provision. How we expect to move from childhood to adulthood and from work to retirement, and how we manage health and social security, are some examples of how ageing impacts at individual, family, community and political-economy levels. These issues are also affected by the contours of globalisation, changing family structures and the movement of the global locus of power towards the East and South. It is only by critically engaging with these macroeconomic and geopolitical challenges that we can begin to plan for the future through research, education and policy development. Certainly, in Ireland, and in other contexts of austerity, there is a need to continue to examine the impacts of the legacy of austerity policies for older people, at international, European and national levels, as they continue to unfold over the next number of years. In the introductory chapter, we stated that one of our central objectives in this text was to interrogate if the economic recession and

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austerity has, in fact, altered ageing experiences and the social policy landscape for older people in Ireland. There is a valid question around whether or not the key messages from the various analyses within the chapters of this book would be in any way different if the individual contributions were written without considering austerity, or, indeed, prior to the economic recession of 2008. With the exception perhaps of Chapter Three, it is fair to say that while the economic recession and austerity have intensified many of the social policy issues and challenges faced by older people, it has not necessarily introduced new challenges and new sets of dynamics. Of course, your experiences as an older person are also dependent on who you are and what your circumstances are as you age through economic conditions such as those experienced in recent times. Austerity-driven policy, analysed purely from the perspective of ageing, then, in some ways simply represents a continuation of the impactful indifference towards older people in Ireland that was outlined in Chapter One, and that has been present in the Irish social policy system for some time. While accepting that the state cannot afford to pay for certain things in some cases, ageing-related social policy issues in Ireland still suffer from a lack of prioritisation. There also appears to have been a politicisation of austerity in some instances, leading to a more cynical justification of a lack of resources for policy implementation – but this has impacted on more than just older people. We recognise that for some of the chapters, the link to austerity is perhaps more tentative. For this reason, in these cases, austerity should only be seen as a connection to just another contextual factor that must be considered within an already-complex and ambiguous social policy environment. Our focus on austerity, and the economic recession, however, has illustrated the need to consider the link between local and global processes, the reciprocal influences that can emerge from local and global contexts, and their impact on older people and social policy development. This book has questioned how ageing affects work and retirement, citizenship, health, place, disadvantage, and exclusion in one country context during a period of economic hardship. Each chapter provided a systematic assessment of the most up-to-date literature on the relevant policy area. New insights on the issue were followed by an applied analysis of the Irish case. Finally, by drawing out the implications of the Irish case for the experience of austerity in other national contexts, each chapter provides insights for an internationally shared understanding of global population ageing. After all, population ageing is likely to incrementally continue for the foreseeable future; meanwhile, there is

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every indication that periods of economic expansion and retrenchment will continue their cyclical rhythm. Using the single-country lens at a challenging time in Irish history has allowed this book to raise new questions for future policy planning in ageing societies. By taking this in-depth approach, the extent of the challenge presented by demographic change in economic recession and economic retrenchment can be identified, and future policy approaches imagined and, ultimately, designed.

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AFTERWORD

Austerity policies and new forms of solidarity Chris Phillipson

Introduction The financial crisis of 2008 and the economic recession that followed transformed much of the landscape around which debates on ageing were traditionally built. Yet, beyond acknowledging that a politics and economics of austerity would present issues for older people, research and analysis has been limited. Indeed, there has been something of a ‘structural lag’ (to use Riley and Riley’s famous phrase [1994]) between the onset of crisis and the recognition that the basis for developing policies for older people has undergone irrevocable change. In this context, the chapters in Ageing through austerity are to be especially welcomed as a major step forward in analysing the implications of what has been a profound change affecting older people and their families and the communities of which they are a part. In this Afterword, I will: first, highlight important elements of the debate about austerity, drawing on some of the illustrations provided in the book; second, develop a framework for understanding the impact of austerity politics on older people and related groups; and, third, consider the way forward for critical gerontology given some of the findings highlighted in the various chapters in this book.

Austerity and ageing: economic change and social consequences A key conclusion from the various chapters in this book is the highly contradictory impact of austerity on public policies targeted at older people. On the one hand, policies developed through the 1990s and 2000s focused on the need to promote positive ageing and the dignity of older people. On the other hand, the impact of cuts has been to weaken communities, increase inequalities and reduce the range of

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services available to support people in their own homes. Moreover, a further contradiction is that of a society increasingly aware of ageing as a demographic reality (see Chapter Two) but in an environment driven by an austerity economics that has steadily undermined the infrastructure – local as well as national – around which effective supports for older people are built and maintained. Reflecting the aforementioned, a number of issues emerge from the chapters and research studies discussed in this book. First, following Harvey (2014: 67–8), we might describe policies post2008 as illustrative of what he terms a ‘politics of accumulation by dispossession’, this taking over as the: primary means for the extraction of income and wealth from vulnerable populations.… The stealing back of privileges once acquired (such as pension rights, health care … and adequate services) has become a blatant form of dispossession rationalised under neoliberalism and now reinforced through a politics of austerity ministered in the name of financial rectitude. Ageing through austerity provides not only examples of this process (eg reductions in home-care services, cuts to local infrastructure), but also valuable evidence of people fighting back against cuts in key areas of support. This would appear especially important regarding the state pension (see Chapter Three), where political protest by older people (along with support from younger generations and lobby groups) has ensured stability for what remains the main source of income for the majority of older people. However, the chapters also illustrate the basis for a new way of thinking about ageing populations in general and relationships between generations in particular. Carney (Chapter Three, p 41) notes that older people ‘are now imbued with a reputation for political activism’. This is an important observation and may indicate elderly people breaking from the kind of ‘structured dependency’ highlighted in early work in critical gerontology (eg Walker, 1980; Townsend, 1981). This runs alongside evidence (eg from the research of Scharf et al [2013]) for strong backing from younger generations for the maintenance of support to older people, notwithstanding the sharp deterioration in their own living standards. This has important lessons for countries such as England, where there has been an extensive debate focusing on divisions between generations, with older people viewed as receiving an unfair level of protection from the effects of austerity programmes

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(eg Howker and Malik, 2010). Although the economic basis for such views has been challenged (see, eg, Portes, 2014), they do have social and political consequences, especially in diverting attention away from divisions associated with increased levels of inequality and the widening gap between rich and poor (Therborn, 2013; Equalities Trust, 2014). Moreover, as Blyth (2013) suggests in his history of the policy of economic austerity, this is surely a case of the rebranding of a private sector crisis as a state (or, in our terms, generational) responsibility. As Blyth (2013: 73) notes: ‘What was essentially private sector debt problems have been re-christened as “the Debt” generated by out of control public spending’. A consequence of this has been to focus attention on public expenditure and services rather than the economics that created the problem in the first place. A fourth issue identified in the book (and explored in detail in Chapter Eight) concerns the impact of social exclusion in the context of austerity policies. Social exclusion has re-emerged as a major issue for different groups of older people, notably, those with the lowest incomes, that is: those most reliant upon public services; those most involved in care tasks in the home and community; those – such as first-generation migrants – who have failed to build rights to pensions and related support; and those – especially the poor and very frail – most affected by a discourse focused around the burden of old age. These points are illustrated in considerable detail in the book, with the ‘human impact’ of the austerity programme especially acute for people diagnosed with dementia (together with their carers) (as outlined in Chapter Seven), older people living alone in rural areas and people who have experienced major forms of disadvantage over their life course. A final observation that might be made from Ageing through austerity concerns the importance of linking debates on ageing with the broader discussion about the impact of globalisation on the lives of older people. Of course, the Irish case is especially poignant in this regard: its economy torn apart by dependence on global markets interacting with a poorly regulated banking system (Lewis, 2011), but with global markets also acting as a magnet for those searching for secure employment. The latter (as highlighted in Chapter Six) is resulting in significant changes to the demographic composition of communities, with a weakening in place-based support networks and a reduction in the quality of local facilities. Although globalisation was an important underlying theme in research on ageing throughout the 2000s (see, eg, Baars et al, 2006), it has only been with the introduction of austerity policies that the processes associated with what Gray (2013) refers to as ‘disorderly globalisation’ – recession, conflicts and mass migration

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– have come more obviously into focus, with resulting awareness of their implications for the organisation of daily life, most especially, for low-income households.

Austerity politics and older people The various chapters in Ageing through austerity also point to a wider crisis of insecurity affecting the lives of older people in Ireland and across most countries of Europe. This theme was powerfully captured in the work of Tony Judt (2013: 385), who, in one of his final essays, made the observation that: Gone is the sense that the skills with which you enter a profession or job would be the relevant skills for your working lifetime. Gone is the certainty that you could reasonably expect a comfortable retirement to follow from a successful working career. All of these demographically, economically, statistically legitimate inferences from present to future – which characterised [Western] life in the postwar decades – have been swept away. One might question some of the underlying assumptions in this statement, but the argument illustrates the extent to which a different old age will almost certainly emerge from the ashes of 2008. Gerontology – and critical gerontology in particular – has, in some respects, struggled to respond effectively to the new terrain affecting different groups of older people. There are a number of reasons for this but one in particular deserves emphasis, namely, the interaction between population ageing on the one side and financial and market deregulation on the other. The current crisis is, indeed, one that reflects the instabilities of a market-driven economy, but one where the nature of markets is still receiving limited attention from critical gerontology. However, what Satz (2010) refers to as the ‘moral limits of markets’ is highly applicable to the difficult choices that people face in retirement and old age. For example, Satz notes that some markets are characterised by either very weak agency on the part of participants or extreme vulnerabilities for one of the transacting parties: the consequences of which may be either, or both, incomplete market knowledge regarding important goods or the possibility of exploitation or abuse in the provision of services. This point has been clearly illustrated by the switch in provision from defined-benefit (DB) to defined-contribution (DC) pension schemes, a changeover that occurred with extraordinary

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speed over the course of the 1980s and 1990s in the absence of effective regulation in many countries, lack of knowledge among consumers and exploitative behaviour (such as overcharging) on the part of providers (Phillipson, 2013; see also Chapter Five). However, the relevant point here is the move – rapid over the course of the 1980s and 1990s – towards what Polanyi, in the 1940s, termed ‘disembedded markets’, ‘those which were freed from extra-economic controls and governed … by supply and demand’ (cited in Fraser, 2011: 141). This development transformed the framework around which debates with respect to ageing have traditionally been located, as illustrated in the historic move from the public institutions supporting retirement and the welfare state to the private institutions associated with extended working and personal responsibility for health and welfare. This unravelling of the post-Second World War institutions that created and supported the idea of ‘old age’ has produced a new set of risks for later life. Western society seems beset, as it was during the 1930s and 1940s, with anxieties about the most appropriate way to respond to demographic change. Particular groups (notably, the ubiquitous baby-boom generation) have been singled out for drawing down what are viewed as a disproportionate share of resources (eg Willetts, 2010). However, the accuracy of such arguments is probably less important than the view that a particular group is about to reap ‘undeserved’ or ‘unsustainable’ benefits in old age. Concerns about the costs associated with ageing populations had a relatively low profile in the 1950s and 1960s in the context of full employment and the building of the welfare state (Kynaston, 2009). They surfaced again in the late 1970s with the onset of economic crisis and the rise of neoliberal governments, and have returned once more in the 2010s with economic recession and mass unemployment among the young. So, the question arising from this becomes: is it possible to reframe a public policy debate locked into ideas about generational debt on the one side and the expansion of markets on the other? Two interrelated possibilities might be raised here: one relating to the issue of ‘generations’; and the other that of ‘solidarity’ between different social groups. The first point is to suggest a different approach to using the idea of ‘generations’ as a way of thinking about changes in social relationships arising from demographic change. The late Philip Abrams (1982: 261–2) made the important observation that: Age is a necessary but not a sufficient condition [for generational groups]. Other factors, such as class, religion, race, occupation, institutional setting, in short all the

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conventional categories of socio-structural analysis must be introduced to explain their unique ability to make something of historical experiences. Furthermore, Abrams (1982: 262) went on to argue that, ‘In other words, the study of generations brings to light consequential differentiations within generations as well as between them.’ Following this, the argument that might be made is that generations are only significant in the context of the social structures that give them meaning. Karl Polanyi might be said to have anticipated this point in his 1944 book The great transformation, where he argued that ‘capitalist crisis was less about economic breakdown in the narrow sense than about disintegrated communities, ruptured solidarities and despoiled nature’ (cited in Fraser, 2011: 138). Generations, it might be argued, from the mid-20th century onwards, were underpinned by full employment, orderly transitions into and out of work, intergenerational mobility, and declining levels of inequality. However, these processes ground to a halt from the 1980s, were modified in the late 1990s and early 2000s, and have imploded once again – irrevocably perhaps with globalisation – following 2008. So, what might replace generations as a way of thinking about relationships at a societal level? One possibility – building on Richard Sennett’s (2012) work – is to ask the question: what kind of solidarity needs to be built in the context of increasing economic and social division? The answer to this may come in a number of forms: • Mutual solidarities, for example, building sustainable communities using the skills of different age groups in areas affected by deindustrialisation (Steinig and Butts, 2010). • Friendship- and neighbouring-based solidarities, for example, acknowledging the loosening of kin and increased importance of non-kin ties (Pahl, 2000). • Global solidarities, for example, the development of links with movements campaigning on abuses associated with globalisation and global corporations (Graeber, 2013). However, the key point is that encouraging new as well as traditional forms of cooperation – an important task as populations move from pyramids to pillars – is a necessary response to the instabilities faced by communities, local as well as global (Stiglitz and Kaldor, 2013). Moreover, what links these different solidarities may be less generations in a conventional sense, and more social networks that cut across age

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and family groups. In this context, the search for weak as well as strong ties may be the most important task facing individuals in their communities, and the analysis of these networks and the forms of solidarity that they generate is a key issue for social science to address. A further suggestion is to align debates around ageing with the emergence of what Wallerstein (2011) and Castells et al (2012) refer to (in an awkward but important term) as ‘de-commodified modes of production’. Conhill et al (2012), for example, highlight the degree to which practices such as voluntary activity, cooperative community groups and time-banks have become more significant in the context of the shrinkage of monetary-based consumption. Yet, empirical work on this issue, for example, a survey of adult participation in non-capitalist practices in Barcelona, reported much lower levels of activity among people aged 64 and over when compared with younger age groups. This is also mirrored in the skewed age distribution of participants in the global protest movements described by writers such as Mason (2012) and Graeber (2013). So, it may be that the current cohort of people in their 70s and beyond are doubly disadvantaged: experiencing reduced social protection on the side, and reluctant to engage in alternative economic practices on the other. Whether the cohort of baby boomers entering retirement will provide an alternative approach remains to be seen, but the interest in developments such as co-housing and agefriendly communities among this group suggests that a new form of politics of ageing might emerge. A final issue concerns what lessons there are for critical gerontology given a context of austerity and crisis facing vulnerable groups of older people. Here, the record has been less impressive than might have been expected. As indicated earlier, critical gerontology has not provided a detailed response to the challenge of 2008; indeed, this book is one of the very few to provide a detailed assessment at a countrywide level. Critical perspectives have had little to say about the impact of the savage cuts in income and services affecting older people in Southern Europe. Even in the case of Northern Europe, researchers have found it difficult to develop a convincing analysis of the impact and consequences of the recession. The reasons for this might usefully be reviewed and some arguments developed for making critical gerontology relevant to a post-2008 world. Two main factors probably have a bearing on the problems faced by critical perspectives: first, in contrast to when this approach first developed – in the late 1970s and early 1980s – the theoretical context appears less able to provide explanations for the problems that beset groups of older people. In the earlier period, Marxist and neo-Marxist perspectives

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(together with others drawn from European sociology and philosophy) were drawn upon to produce concepts such as ‘the ageing enterprise’ (Estes, 1979), ‘structured dependency’ (Townsend, 1981), ‘the social creation of dependency’ (Walker, 1980) and the ‘reserve of labour’ (Phillipson, 1982). These became incorporated into the framework around which a critique of the state (including the welfare state) eventually emerged. The contrast with the present period is striking, with a lack of engagement with ideas from within the humanities and social science restricting critical understanding of the broad impact of the 2008 crisis and its aftermath. A second factor concerns the way in which the welfare state operated as a pivot around which ideas associated with critical gerontology developed. Thus, in the 1970s and 1980s, the focus was on using perspectives from political economy and related strands to both defend the welfare state and to argue the case for its restoration. The situation post-2008 is much less straightforward, with few arguing for a return to a traditional welfare state, but with limited options emerging about what the range of alternatives (and how they might be funded) might be. Ageing through austerity provides a number of examples of how to further develop critical perspective and demonstrates the value of focusing on change at the level of the nation-state and its implications for a broad range of issues and services affecting older people. As a conclusion to the Afterword, one suggestion might be made for taking further the arguments developed in the various chapters. Key to this is for critical gerontology to return to its social science roots to develop new theoretical concepts relevant to the situation of older people post-2008. In many respects, we are stuck with concepts produced some 40 years ago, when the views about capitalism and the welfare state were radically different. The argument here is for a new political economy of ageing, one that incorporates a post-welfare state agenda and that is situated within a rigorous analysis of the consequences of neoliberalism for the lives of older people. Neoliberalism is invariably singled out as the source of the problems for older people but is rarely analysed in much detail. Mostly, we view neoliberalism as reflecting the decline or weakening of institutions in the face of market forces. However, Konings (2010: 6, emphasis in original) provides a useful alternative perspective, arguing that: It is only on an ideological level that neoliberalism has been about market disembedding or the subordination of politics to the market. Neoliberal practices have never been about institutional retreat or diminishing political capacities

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but, instead, about the construction of new institutional mechanisms of control. This argument provides a way of developing a new set of approaches for critical gerontology, where the emphasis is on exploring the multiple ways in which neoliberalism – at local, national and global levels – invents new cultural, economic and social connections in the vacuum created by the retreat of the welfare state. The range of instruments is considerable – from private pensions, housing and health, to leisure and cultural activities. Ageing post-2008 is being reconstructed through an austerity politics but through neoliberal practices. Ageing through austerity provides a starting point for developing new forms of social and economic analysis within the framework of critical gerontology. Chris Phillipson Professor of Sociology and Social Gerontology, Manchester Institute for Collaborative Research on Ageing University of Manchester October 2014

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187

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Index Page references for tables and figures are indicated in italics

A Abrams, Philip 149 action plan on dementia, An (O’Shea and O’Reilly) 105 active ageing 47–9, 60–2, 66–7 and age-friendly communities 84, 87 and austerity 57–60 barriers to participation 55–7, 61 definition 49–50 motivations and benefits 50–5, 60 and pensions 76 Active Retirement Ireland 59 Active Retirement Ireland study 48–9, 51, 53, 54, 55, 56, 57–8, 59 Age & Opportunity 59 Age Action Ireland 40 Age-Friendly Cities and Counties Programme 59, 85–6, 87, 93 age-friendly communities 3, 59, 79–80, 133, 136, 140, 151 and austerity 88–95, 125 international evidence 86–7 Ireland 83–4, 85–6, 93–5 origin and evolution 84–5 ageing 1–2, 142–4 and austerity viii, ix, 2–4, 7–8, 24–30, 43–4, 142–3, 145–53 and citizenship 34–8, 45–6 and dementia 97–112 future policy 141–2 and health status 22–3 and health system 26–8 in Ireland 17–30 methodological questions 138–9 and pensions 24–6 and place 81–3 and political activism 35, 40–1, 43, 44

and social care system 28–9 and social exclusion 113–29 and social participation and volunteering 47–62 social policies 10–14 and socio-economic situation 20–2 theoretical challenges 140 see also critical gerontology; demographic ageing ageing enterprise 152 agency 116–17 Alzheimer Society Ireland (ASI) 104 Alzheimer’s disease 97 American Association of Retired Persons (AARP) 36 Annan, Kofi 38 ‘at risk of poverty’ rate 7, 21, 22, 25, 119 Atkinson, A.B. 116–18 austerity ix, 2, 4, 45, 131–2, 142 and active ageing 47–9, 52, 55–6, 57–60, 61–2, 135 and age-friendly communities 80, 88–93, 94, 136 and ageing 2–4, 7–8, 38, 132, 133, 134, 142–4, 145–53 and community services 125–6 and dementia care 98, 100–1 and individualisation 12 Ireland 6–8, 23–30, 43–4 methodological questions 138–9 and pensions 63, 70, 72–6, 78 political implications 40–3 and social exclusion 113–14, 115, 116, 118, 127–8, 137 and social policy 13–14 and solidarity 42–3 see also economic recession

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communities exclusion from 126 see also age-friendly communities; social participation community care 28–9, 58–9 dementia 97, 99, 100–1, 102–5, 110, 112 exclusion from 124–6 Conhill, J. 151 Connolly, S. 49, 51, 56 Craig, G. 38 crime 90, 126 critical gerontology 5, 37, 44–5, 132 active ageing 49–50 lessons for 151–3 markets 148

Australia dementia 104, 106, 108–9 demographic ageing 19 life expectancy 23 social spending 25 Austria demographic ageing 19 life expectancy 23 social spending 25

B Bealtaine study 49, 54, 55, 56 Belgium demographic ageing 19 life expectancy 23 longitudinal research 139 social spending 25 Blyth, M. 147 Brenner, H. 11 Buffel, T. 86 burden discourse 1–2, 133 Butts, D. 150

D

C Campbell, A.L. 37 Canada dementia 108–9 demographic ageing 19 life expectancy 23 place 83 social spending 25 Care of the aged report (InterDepartmental Committee) 10–11 Carney, G.M. 35–6 Castells, M. 151 Catholic Church ix, 9, 39 Changing Generations 42, 44, 139 Charmaz, K. 42 Chhotray, V. 34, 35 Churchill, Winston 38 Citizen Information Board 28–9 citizenship 3, 31–4, 36–8, 45–6, 134, 140 and dementia 111 and globalisation 34–6 civic activities see political participation; volunteering clientelism 39 Cohen, G. 54 Collins, S. 41, 42

day care 104–5 dementia 3, 36, 97–100, 100, 111–12, 134, 136–7, 140 and austerity 100–1 community-based nursing 102–4 community-based services 104–5 diagnosis 101–2 framework 109–11 informal care 101 long-stay care 105–8 policy developments in other countries 108–9 public awareness 141–2 democracy 33, 34–6 demographic ageing 1–2, 3, 17, 19, 133, 142, 143–4 and citizenship 31–3 Ireland 8, 17–18, 18, 131 and pensions 63 and social exclusion 115 Denmark demographic ageing 19 home-care services 104 life expectancy 23 social spending 25 deprivation 118–21 disembedded markets 149 disorderly globalisation 147–8 Dublin Healthy Ageing Study 122 Dundalk 84, 85 Duvvury, N. 69, 73, 75–6 dynamism 117–18

190

Index

E

F

economic recession viii, 1, 3, 5, 6, 8, 9–10, 39 and age-friendly communities 80, 83–4, 86, 88–93, 94, 136 and ageing 2–3, 4, 29–30, 132, 133, 134, 142–4, 145, 151 methodological questions 138–9 and pensions 73–4, 75–6 and poverty and deprivation 119, 120–1 and social exclusion 113–14, 116, 117, 118, 119, 120–1, 122–3, 127–8, 129, 137 and social participation and volunteering 48, 52, 60, 61–2 and unemployment 140 see also austerity education 20–1, 21, 140 and health status 22 and loneliness 122 and pensions 74 and social participation 50 and volunteering 50 Elder, G.H. 138 The Elders 38 emigration 39 and age-friendly communities 90 and economic recession 6, 10, 29, 60, 61, 90 employment 47–8 women 3, 63–4, 67–9 employment policy 64, 66–7, 135–6 England 139 environmental gerontology 81 Esping-Andersen, G. 24 Estes, C.L. 37, 152 European Central Bank (ECB) 2, 6, 10 European Union (EU) active ageing 66–7 austerity 2, 4 healthy ageing 11 Irish bailout ix, 2, 6, 10 Irish membership 9 pensions 63 social exclusion 113 social policy 12 exclusion see social exclusion

Fair Deal scheme 28 family solidarity 42–3, 44 Ferge, S. 43 Finland demographic ageing 19 life expectancy 23 social spending 25 fiscal austerity see austerity France dementia 104, 107, 109, 112 demographic ageing 19 life expectancy 23 social spending 25 friendship-based solidarities 150

G gender 36 and employment 67–9 pay gap 68–9 and pensions 63–5, 71–6, 140 and social participation 50, 56–7 and volunteering 57 see also men; women generations 149–50 Germany demographic ageing 19 gender pension gaps 73 life expectancy 23 pensions 63 place 81 social spending 25 gerontological literacy 141–2 gerontology 148 see also critical gerontology; environmental gerontology; social gerontology Gilleard, C. 65 Gkartzios, M. 90 Global Age Friendly Cities 84 Global Social Initiative on Ageing 3 global solidarities 150 globalisation 133, 147–8 ageing and citizenship 34–6, 45–6 Goerres, A. 35 Graeber, D. 150, 151 Gray, J. 147–8 Greece age-friendly communities 90 demographic ageing 19 life expectancy 23

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pensions 70 social spending 25

H Harvey, B. 93, 125–6 Harvey, D. 146 Health Service Executive (HSE) 104, 124–5 health status 22–3 and place 81–2 and social participation and volunteering 50, 52–4 see also dementia health system 4, 26–8, 40–1, 58–9, 125–6 Higgs, P. 65 Hirshorn, B.A. 46, 141 Hobbes, T. 31 Holt-Lunstad, J. 53 Home Care Packages (HCPs) 104 house prices 75–6

I immigration 20 individualisation 12, 43, 49 Industrial Development Authority 39 inequalities viii, 30, 132, 134, 142 age-friendly communities 92 health status 22 socio-economic situation 20–2 see also social exclusion informal care 56, 68, 77 dementia 97, 99, 101 information and communication technologies (ICTs) 59–60 Ingram, H. 36 intergenerational relations ix, 7, 32, 33, 119, 131–2, 134–5, 146–7, 149–50 financial aid to adult children 29–30, 42, 44, 90 and social participation 54, 55 International Monetary Fund (IMF) 2, 6, 10 Ireland viii–ix, 3–4 age-friendly communities 79, 80, 83–4, 85–6, 88–95, 136 age-related social policy 10–14 ageing and austerity 5–8, 38, 131–2, 133, 134–5, 142–3

ageing and citizenship 35–6, 45–6 austerity ix, 6–7, 23–30, 40–4, 45, 88–93, 131, 133 citizenship 33–4 contextualising ageing 17–30 dementia 98–108, 100, 109–12, 136–7 demographic ageing 1–2, 8, 17–18, 18, 19, 134 economic recession viii, ix, 2–3, 6, 9–10, 39 economic success 5–6 employment policy 67 family solidarity 42–3 future policy 141–2 gender pay gap 68–9 gender pension gaps 71–6, 77–8, 135–6 in global political economy 9–10 and globalisation 34, 147 health system 26–8 life expectancy 23 longitudinal research 139 male breadwinner model 64, 71 old-age social spending 24, 25 pension system 24–6, 69–71 pensions 63–5, 77 place 81, 82–3 post-colonial heritage and political culture 38–40 poverty and deprivation 118–21 public social expenditure 24, 25 social care system 28–9 social exclusion 113–14, 115–29, 137 social participation 47–62, 135 welfare regime viii, ix, 24 women’s employment 68–9 Irish Centre for Social Gerontology 4, 5, 89, 132 The Irish Longitudinal Study on Ageing (TILDA) 128, 139 community services 125 financial transfers 42 health status 22 loneliness 122 political participation 123 religious services 124 volunteering 57, 124 Irish Senior Citizens Parliament (ISCP) 40, 41 isolation 121–3

192

Index

Italy dementia 99 demographic ageing 19 life expectancy 23 pensions 63, 70 social spending 25

J Judt, Tony 148

K Kalache, A. 84 Kearney, P. 22 Keating, N. 116 Konings, M. 152–3 Krugman, P. 9

L Levitas, R. 115–16 liberal welfare regime viii life expectancy 22, 23, 32, 47 and pensions 70 life-course perspective 138, 140 citizenship 45–6 pensions 64, 65 women’s employment 67–8 loneliness 53, 121–3 long-term residential care 28–9 dementia 97, 99, 105–8, 110–11 longitudinal research 138–9 see also The Irish Longitudinal Study on Ageing Luxembourg demographic ageing 19 life expectancy 23 social spending 25

M McCashin, A. 74 Madrid International Plan of Action on Ageing 3 Maître, B. 121 male breadwinner model 64, 71 Maltby, T. 49 Mannheim, K. 32, 46 marital status 19, 20 and social participation 50 markets 148–9 marriage bar 64 Mason, P. 151

material deprivation 118–21 men 19 dementia 99, 100 employment rate 67 feelings of personal safety 126 loneliness 122 marital status 19, 20 social participation 56–7 unemployment 140 mental health and place 81–2 and social participation 52 see also dementia Meyer, T. 73 migration see emigration; immigration Murphy, M. 74 mutual solidarities 150

N National Carers’ Strategy (Department of Health) 11 National Disability Strategy (Department of Health) 11 National Health Promotion Strategy for Older People 11 National Positive Ageing Strategy (NPAS) 12, 13, 58, 59, 61, 85 negative equity 29, 94 neighbourhood see communities neighbouring-based solidarities 150 neoliberalism viii, 12, 66, 146, 152–3 The Netherlands demographic ageing 19 health insurance system 27 life expectancy 23 social spending 25 New Zealand demographic ageing 19 life expectancy 23 place 82 social spending 25 Ní Léime, Á 48–9, 51, 53, 54, 55, 56, 57–8, 59 Nolan, B. 9 non-governmental organisations (NGOs) 11, 12, 59 Northern Ireland 39 age-friendly communities 82, 83, 88 longitudinal research 139

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Norway dementia 104, 109 demographic ageing 19 life expectancy 23 social spending 25 Nursing Home Support Scheme (NHSS) 28

O O’Launaigh, C. 122 older people see ageing Older People’s Council 85 O’Reilly, S. 105 Organisation for Economic Cooperation and Development (OECD) active ageing 49 neoliberalism 12 pensions 63, 66 O’Shea, E. 49, 54, 55, 56, 89–91, 105

P Pahl, R. 150 participation see political participation; social participation Patsios, D. 30 pensions 3, 4, 10, 24–6, 42, 43, 44, 63–5, 76–8, 148–9 and EU policies 66, 67 and gender 63–5, 71–6, 77–8, 140 and precarious employment 141 reforms in Europe and Ireland 69–71 personhood 108, 109 Pfau-Effinger, B. 73 Phillipson, C. 34, 88, 131, 132, 152 place 79–83, 94–5 see also age-friendly communities Plouffe, L. 84 Polanyi, Karl 149, 150 political activism 40–1, 43, 44, 60–1, 123–4, 134, 146 political participation 35, 37, 45–6 exclusion from 123–4 and social participation 54–5 political-economy-of-ageing approach 63–4, 65 population ageing see demographic ageing Portugal 70

positive ageing 129 post-colonialism 38–9 poverty 3, 7, 21–2, 22, 118–21 and participation 38 and state pension 24–5 precarious employment 4, 66, 76, 77, 78, 136, 140 productive ageing 49 public social expenditure 24, 25 public transport 55, 124

R Reagan, Ronald 38 recession see economic recession relativity 116 religious services 124 reserve of labour 152 residential care see long-term residential care respite care 104–5 Riley, J.W., Jr 145 Riley, M.W. 145 Roman Catholic Church ix, 9, 39

S Satz, D. 148 Scharf, T. 116 Scharlach, A. 88 Schneider, A. 36 Scotland 109 Sennett, Richard 150 Settersten, R.A. 46, 141 Shelley, E. 11 single-person households 19–20 Smeeding, T.M. 9 social care system 4, 28–9 social citizenship see citizenship social creation of dependency 152 social exclusion 3, 113–14, 127–9, 134, 137, 140, 147 agency 116–17 conceptual developments 115–18 definition 115–16 dynamic 117–18 from civic activities 123–4 from formal services 124–6 from neighbourhood/community 126 loneliness and isolation 121–3 multidimensionality 118 poverty and deprivation 118–21

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relative 116 social gerontology 34, 114, 118, 128, 137–42 see also Irish Centre for Social Gerontology social inclusion 113 social isolation 121–3 social participation 3, 47, 48–9, 134, 135 barriers 55–7, 61 benefits 52–5, 60 correlates 50 motivations 50–2, 60 social spending 24, 25 socio-economic status 20–2, 36–7 and social participation 50, 56 solidarity 42–3, 149, 150–1 Spain demographic ageing 19 family support 90 life expectancy 23 pensions 70 social spending 25 state pension 7, 21, 23, 24–6, 42, 43, 44, 69–70 Steinig, S. 150 Stoker, G. 34, 35 structured dependency 36, 146, 152 Study of Health, Ageing and Retirement in Europe (SHARE) 139 subsidiarity 9 Sweden dementia 104 demographic ageing 19 life expectancy 23 pensions 63 social spending 25

T third age approach 65 Third Age Foundation 59 Third Age volunteering study 49, 51, 56 Townsend, P. 44–5, 152 Travellers 119, 120, 128 Troika 2, 6, 10 Turner, B. 33

U UK age-friendly communities 81–2 austerity ix dementia 104, 106, 112 demographic ageing 19 intergenerational conflict ix life expectancy 23 pensions 63 social exclusion 114 social spending 25 unpaid work 54 see also England; Northern Ireland; Scotland unemployment 6, 29, 140 United Nations (UN) 11, 47 US age-friendly communities 88 ageing and citizenship 35–6, 37 dementia 106 demographic ageing 19 gerontological literacy 141 intergenerational conflict ix life expectancy 23 social spending ix, 25

V volunteering 3, 47, 48, 49, 124, 135, 141, 151 and austerity 57–8 benefits 52–5, 60 correlates 50 and gender 57 motivations 50–2, 60 voting 35, 40–1, 123

W Walker, A. 44–5, 49, 152 Wallerstein, I. 151 Walsh, K. 55, 88, 89–93, 120, 121, 123, 125–6 welfare state 31 widowhood 19, 20 Wilson, G. 38 women 19 dementia 100 employment 64, 67–9 employment policies 135–6 feelings of personal safety 126 loneliness 122

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marital status 19, 20 pensions 4, 63–5, 71–6, 77–8 voting 123 work see employment World Health Organization (WHO) 11 active ageing 47, 49, 50, 58 Age-Friendly Cities Programme 79, 84–5, 86, 93

Y years ahead, The (Department of Health) 10–11, 58

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“By illuminating individual, regional and societal disparities, this book helps readers rethink the consequences of altered political economies and practices, such as recession, on aging and generations.” W. Andrew Achenbaum, University of Houston, USA

Demographic ageing is identified as a global challenge with significant social policy implications. This book explores these implications, with a particular focus on the pressures and prospects for ageing societies in the context of austerity. The book presents a carefully crafted study of ageing in Ireland, one of the countries hardest hit by the Eurozone financial crisis. Providing a close, critical analysis of ageing and social policy that draws directly on the perspectives of older people, the text makes significant advances in framing alternatives to austerity-driven government policy and neoliberalism, giving a refreshing interdisciplinary account of contemporary ageing.

KIERAN WALSH is Senior Research Fellow at Project Lifecourse and Deputy Director of the Irish Centre for Social Gerontology, National University of Ireland Galway. GEMMA M. CARNEY is a lecturer in social policy and ageing at the School of Sociology, Social Policy and Social Work, Queen’s University Belfast. ÁINE NÍ LÉIME is a Marie Curie Fellow, and Research Fellow at Project Lifecourse and the Irish Centre for Social Gerontology, National University of Ireland Galway.

AGEING / SOCIAL STUDIES

ISBN 978-1-4473-1623-7

www.policypress.co.uk @policypress

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9 781447 316237

AGEING THROUGH AUSTERITY • Edited by Kieran Walsh, Gemma M. Carney and Áine Ní Léime

“With impeccable timing, Walsh, Carney and Ní Léime capture the intersections of population ageing and global economic recessions, using Ireland as the exemplar of the impact of austerity on older people.” Norah Keating, Director, The Global Social Initiative on Ageing, International Association of Gerontology and Geriatrics

AGEING THROUGH AUSTERITY Critical perspectives from Ireland

Edited by Kieran Walsh Gemma M. Carney and Áine Ní Léime

PolicyPress

2/23/2015 4:58:00 PM