A new way of caring for the elderly is bringing hope to a British city

For 12 years after her husband died, Norma Fitzgerald tried to maintain her independence by living alone in an apartment on the outskirts of Hull, northern England, even as her mobility deteriorated as she reached her mid-80s.

One day in the spring of 2022, she suddenly felt dizzy. Her legs gave out and she collapsed on the floor of her apartment, unable to find the strength to get up.

She lay there for two days.

Finally, a neighbor realized she hadn’t seen her in a while and called an ambulance.

“They had to force the door open,” Mrs. Fitzgerald, now 87, recalled. She was severely dehydrated and spent the next five days in a hospital.

As the British population ages, almost 19 percent of the population is over 65, according to the British newspaper The Guardian 2021 Censuscompared to 16 percent a decade earlier, the needs of an increasingly vulnerable elderly population are weighing on the country’s healthcare system.

Along with the National Health Service (NHS), many older people also rely on what is known as social care, a mosaic of private and public support plagued by chronic staff shortages, a lack of care home beds and cuts to local budgets.

The lack of easily accessible social care, which includes everything from home care workers who help with washing and dressing to full-time residential care, means that falls or treatable health problems can lead to longer hospital stays. That increases pressure on the NHS, when earlier intervention or home support would have been more appropriate.

But what happened to Ms. Fitzgerald after she was released from the hospital is an example of an approach that could change the way older adults with complex health problems are cared for, experts say.

In the past, she would probably have been sent home with little further care apart from her GP. Or perhaps she would have had to move into a full-time home, causing her to lose her independence.

Instead, she was referred to the Jean Bishop Integrated Care Center in Hull, a facility that opened five years ago as a one-stop shop for vulnerable older people. It is the first of its kind in Britain and brings together doctors, physiotherapists, social workers and other professionals under one roof. Over the course of a few hours, a patient can see a number of doctors and undergo diagnostic tests if necessary, including x-rays and blood tests, and receive a personalized care plan – all for free.

On a sunny morning in June, Mrs. Fitzgerald sat knitting a red and gray blanket in the center’s bright, cheerful waiting room. She was taken by ambulance – all patients are offered transport if necessary – from her assisted living home to a doctor specialized in elderly care, a pharmacist, an occupational therapist and a social worker.

Many geriatric health experts believe that this type of ‘integrated care’, with a multidisciplinary team addressing all issues that can impact well-being, from loneliness to immobility, is the future for older people with complex health needs in Great Britain.

Dr. Dan Harman, a geriatrician and one of the center’s clinical leaders, sees his job as preventing a crisis, rather than simply reacting to it, as in Ms. Fitzgerald’s case. The center contributed to a percentage of 13.6 percent reducing the number of emergency department visits and hospital admissions among the over-80s and a 17.6 per cent fall in the number of emergency department visits by patients in care homes in the area between 2019 and 2022, according to NHS data.

In the long term, this could lead to substantial savings for the healthcare system and local government, while giving patients more control over their care.

“Older people were kind of in the wrong places in the health care system, especially in the emergency department,” said Dr. Harman. “A lot of people get stuck there unnecessarily because we didn’t provide the support in the community.”

Integrated services like these are still rare in Britain, where the social care system is under extraordinary pressure. Following the 2008 financial crisis, the Conservative-led government oversaw a period of prolonged austerity in which local authorities economize on social care sharply, which leads to an increase in the number of hospital admissions of people over 65. The pandemic and recent high inflation have increased the pressure.

Unlike the National Health Service, social care is not free for most people and is often difficult to navigate. Anyone with assets worth more than £23,250, or about $29,000, who needs social care must pay for it themselves or rely on help from family or charities. Many older Britons say they are concerned about high out-of-pocket costs.

The crisis in the sector is not new. A government contract was awarded in 2011 independent assessment, led by economist Andrew Dilnot, stated that the system was “not fit for purpose” and was in urgent need of overhaul. More than a decade later, the report’s recommendations have been ignored, Mr. Dilnot said in a recent interview with The New York Times.

“The pressure that the pressure in social care is putting on the rest of the health service has certainly increased,” he said, adding that without adequate provision the number of people staying in hospital when a different environment would be better, “ can increase. rising incredibly quickly.”

His report recommended a spending cap to limit the amount someone would have to pay on social care over their lifetime and protect people from potentially astronomical bills. But the government has postponed introducing a limit until October 2025.

Mr Dilnot said that while integrated care programs such as the Jean Bishop Center were useful and could improve the experience of older people through earlier interventions, they would not prevent the huge financial costs that older people faced when they needed long-term care.

“Basically they won’t do much unless we address what happens when you face a catastrophe,” he said.

For now, charities like Age UK, a British organization for older adults with local branches across the country, often step in to fill the gaps. The charity offers services ranging from advice phone lines to house cleaning and community meetings. There is also a befriending service that matches older people with volunteers who visit them weekly.

Alan Walker, 96, was referred to the friendship program to combat the loneliness he experienced while caring for his wife, who suffered from dementia and could no longer speak.

“It’s very difficult sometimes,” he said.

Through the program, Lucy Henn, 28, came every Friday afternoon to spend time with Mr Walker. It was something simple, but it significantly improved his quality of life, he said.

One summer afternoon she stopped to make a cup of tea, which she placed next to Mr. Walker in the living room where he spent most of his days. “We talk about all kinds of things, don’t we?” Mrs. Henn said laughing.

The costs of the care workers, who came four times a day to help, were high, Mr Walker said, but he and Jean had done a lot of financial planning to ensure their savings would last.

‘You think you’re saying to people: ‘Look, you see what’s happening to me. It could happen to you,” he said.

A few weeks later he was transferred to residential care as his needs increased. His wife, Jean, died in late August, and Mr. Walker died in October.

The expectation that people would be able to save excessive amounts of money to cover the costs of long-term care, including residential care, was unfeasible, said Mr. Dilnot, the economist.

“Most people cannot possibly have savings that will be sufficient if they and their partner end up needing ten years of residential social care,” he said. “It’s not a cost-cutting problem, it’s a risk pooling problem,” he added, referring to the concept of spreading health care costs across the population so that no individual faces the risk of unaffordable bills alone.

In October, the lawmaker responsible for social care, Helen Whately, praised the Jean Bishop Center and said the NHS and Age UK were looking at ways to roll out their integrated care model more widely.

“The future of healthcare is as much about what happens outside the hospital as what happens inside it,” Ms Whately said.

For many seeking care, and for their loved ones, like Emma Gawthorpe, 46, the priority is the present. Her father, Alan Gawthorpe, 72, was diagnosed with Alzheimer’s two years ago. As they waited for his appointments at the Jean Bishop center, she told The Times that the service had made a significant difference after they struggled to get help in the early months after his diagnosis.

“It was a lot of jumping through a lot of hoops, and sometimes you have to be very firm,” Ms. Gawthorpe said. “And unless it happens to you, you don’t know about it.”