Introduction

The title for this chapter has been carefully selected. Older people who require support on the grounds of disability or increasing age are likely to experience a range of transitions. At one end of the continuum may be the shift from independence to the acknowledgement of the need for a modest degree of support in maintaining daily life; at the other may be the move to 24-hour support within a care home. At various points in between, individuals may move to live with family, may toy with alternative models such as co-location or may access various forms of telecare support. This chapter explores both the transition from independence to a degree of dependence on support from others within the same place, reflecting the current focus on ageing in place, and the transition through a physical move, for example to extra-care housing or a care home. The discussion will relate to the core elements of independence, well-being and choice at the heart of the adult social support agenda. It will include an exploration of the impact on family members at key points of transition, and will highlight how those involved in supporting both older people and their unpaid carers can contribute to optimising the benefits of transition and minimising the more negative aspects of the experience.

It should be remembered that not all older people move in old age, and that for those who do move the motivations are varied and often complex. At one end of the spectrum will be the individual remaining in the home they have occupied for many years, perhaps accessing a modest amount of domiciliary support. At the other end of the spectrum a single individual may experience moves encompassing sheltered housing, extra-care housing and a care home, concluding perhaps with hospital-based palliative care. A concept often referred to in this context is the ‘escalator of care’. Nonetheless, only 4% of the UK population aged 75 to 84 and 17% aged 85 and over currently live in a care home.