1. CAFÉ Older women’s thoughts about, and use of, food support services Transforming Care Copenhagen, 26-28 th June 2008 Drs Lee Hooper & Kathleen Lane, University of East Anglia

2. CAFÉ – changes around food experience Policy and focus Methodology Participants Patterns of service use Urban/rural differences Changes in use over time What do women value? How did women find services? What services were missing?

3. CAFÉ – changes around food experience Policy focus – 40 years of promoting care at home in UK Study of women aged 65+ living at home but who do not cook from scratch (basic ingredients) most days We intended to look at care, help, support needed, but women voted with their feet didn’t feel they needed care - wanted to discuss services and support Vulnerable women’s perspective

4. CAFÉ methodology a qualitative study in Norfolk, England, with women aged 65 years and older (mean 82) exploring: the meanings of food how these meanings alter over time feelings around cooking less potential for intervening to restore greater contact with food service and service needs qualitative data: semi-structured interviews; meal observations; small group interviews

5. CAFÉ participants Purposive sample: 20 individuals/20 in focus groups 20 lunch group/20 no lunch group 31 urban/9 rural including lower socioeconomic groups (30 non- professional occupation, 27 council or housing association home) 34 living alone (not all had children, many living a great distance away) 19 in sheltered /residential accommodation 17 rely on others for shopping

6. CAFE- Patterns of service use Jayne (rural) Sunday pub meal with friend Ready made meal, 3-4/week Wiltshire Farm Foods Weight Watchers or M&S Visits sons for lunch (2-3x/year) Chinese take- away meal, 1/month Lunch club, 1/month Blue – informal Red – state Green – market Purple - voluntary Thanks to Susan Baines - categories

7. CAFE- Patterns of service use Jayne (rural) Sunday pub meal with friend Ready made meal, 3-4/week Wiltshire Farm Foods Weight Watchers or M&S Visits sons for lunch (2-3x/year) Cooks from scratch, 2/week for self Chinese take- away meal, 1/month Lunch club, 1/month Blue – informal Red – state Green – market Purple - voluntary Tesco’s free shopping bus (not used) Cooks for daughter, widowed friend

8. CAFÉ– services issues Older women juggle a large number of different services From the state, voluntary, private and informal (relatives, friends, neighbours) sectors They are organised and in control of these services and feel in control of their food provision, NOT in need of care They also provide many services to friends, relatives and neighbours Women in rural areas have fewer service choices and transport in particular is more difficult

9. CAFÉ– choosing a service Margaret: “I enquired after the sort of door-to- door thing, but I didn’t take it any further because it seemed, I didn’t get the feeling they really loved their job” Abigail: [Wiltshire Farm Foods] “I used to, but I don’t, not now…I got a bit fed up with them…same-ish. But I usually get some microwave meals from Tesco’s” Helen: [meals on wheels] “one of the reasons eventually why I gave up. Because they came out here at five past eleven and I didn’t want my lunch at five past eleven”

11. CAFE – what services exist – around food shopping? State – lunch club transport, scooters, carers Market – busses, taxis, supermarket busses, shops deliver, supermarket wheelchairs, doorstep milk delivery Informal – neighbour, relative, friend Voluntary – community transport systems Issues Portions Help - reaching shelves, wheelchair, sitting down

12. CAFE – what services exist – around food shopping? Those who miss out: Ella: “transport’s getting a bit dodgy” and “I look forward to going and sometimes they’re very, very late in coming and are they coming? And you’re sitting there with your coat on all ready to go…” Helen: “I can’t [go to the shop].. I’m wheelchair bound you see. I’ve got no-one to push my wheelchair regularly…” Honey: “I just don’t feel like going down there [to the bank]. If I had the scooter I’d be there and back, …but I can’t park it here, so I can’t use it.”

13. CAFE – what services exist – around cooking & preparation? State – carers help with cooking, washing up, opening tins, adapted equipment Market – microwave oven, higher oven, lower shelves, new fridge or freezer, stools, walkers Informal – daughter helping with formal meal Voluntary – accompanying with cooking and preparation Issues Kitchen adaptation is expensive Sheltered accommodation kitchens often very small, poor storage facilities

14. CAFE – what services exist – around cooking & preparation? Support levels Meals on wheels or lunch club Delivered ready meal (company, family) Ready meal (frozen or tinned) bought locally Ready main dish plus fresh or frozen veg Several frozen components Fresh foods plus cook-in sauces Cooked from scratch with support Cooked from scratch on own

15. CAFE – what services exist – eating? Lunch clubs and day centres Pubs, cafes, restaurants Eating with friends, neighbours, relatives

16. CAFE – what do women value? Women valued (almost universally): Lunch clubs and day centres Transport services Mixed reactions to: Ready meals Shopping by carers, neighbours, family Meals on wheels

17. CAFE – how to find services Deena: “if I see something, I … scribble down the telephone number… then ring them up “ Helen: “the adverts often being better than the programmes…I take note the things I seen on there…Home Farm, I had a leaflet through the door, that was why I thought I’d try them. The County Council one was advertised in the newspaper…often the nurses are quite helpful with things” Jemima (blind): “several of them… had Meals on Wheels – and they said to me, ‘Why don’t you have Meals on Wheels, Jemima? You’ll get a good meal.’ So that’s when I changed”

18. CAFE – how to find services Women vary in how they collect service information Several women Kathleen met did not know about important services, such as delivered ready meals or transport systems As women are actively managing their services they need a comprehensive, reliable information source

19. CAFE – what is needed? Information centre to gather and give out information on services from ALL sectors – ideally run by older people and which can feed back into the services and mould them Importance of women shopping in person Women need and want to see what is on offer, get out of the house, choose their own apples Services for rural women are crucial

20. Contact details Dr Kathleen Lane ( kathleen.lane@uea.ac.uk ) Centre for Applied Research in Education and Dr Lee Hooper ( l.hooper@uea.ac.uk ) School of Medicine, Health Policy and Practice University of East Anglia Norwich NR4 7TJ www.cafeproject.co.uk