It is perhaps ironic that despite the statistical overlap between older people and people with disabilities, there has been little joint working between the two groups. The literature on ageing and disability has increasingly recognised a distinction between the ageing experience of people with early-onset disabilities and the experience of older people who develop impairment in later life (Hasler 1991, Verbrugge 2002). According to Verbrugge, "people who incur disability at birth or in childhood are said to 'age with disability', and those free of disability until mid- or late-life are said to experience 'disability with ageing'" (2002, p.1). The fact that services for people with disabilities and older people are segregated exemplifies this distinction.
A number of commentators argue that there are distinct issues for people with early-onset disabilities. People who enter the ageing process with a disability may have their primary identification as a disabled person already firmly established (Gilson & Netting 1997, p. 292). They may have different life experiences from non-disabled people: fewer social supports, lack of an employment history, few assets for retirement, and [in some cases] pre-existing high dependency (Bigby 2002, p.232). People with disabilities often age within a service system rather than external to it (Bigby 2004, p. 244). For highly dependent people with disabilities, the loss of parental carers in mid-life will be a significant factor. Bigby concludes that "the pertinent issues in aged care are largely irrelevant to people ageing with a disability" (Ibid., p. 244).
Conversely, older people often choose the ageing community as a primary identification, rather than the disability community (Priestley & Rabiee, 2002, p.605). Since impairment is seen as a normal part of ageing, older people do not tend to see themselves as disabled (Priestley 2003, p.155). Some writers even suggest a conscious effort on the part of ageing advocates to distinguish disability from ageing (Kennedy & Minkler 1998, p.758).
Bigby (2002), whose work largely focuses on people with intellectual disabilities, argues for adopting a specific focus on people who are ageing with a lifelong disability. In her most recent work, she recommends a distinct set of policy directions for people ageing with a disability. These include realising the overarching principles of equal rights, choice and self-determination, the adoption of a leadership role by disability services, and systematic bridging of gaps between services (Bigby 2004, p.255).
Other researchers have argued for a 'common agenda' between the disability and ageing communities. The interest in independent living and consumer-directed services by the ageing sector in the USA has led to discussion of a 'common agenda' (Rusinowitz 1999). A key focus of this common agenda is the development of consumer-directed services, primarily personal assistance services (Ibid., p.2). As previously discussed, an increasing number of ageing community providers in the USA are supporting more consumer choice and control in services (Ibid., p.3) Their desire to reduce costs for care for the ageing population is leading them to incorporate service orientations from the disability sector. In the UK, Priestley & Rabiee identified an extensive list of issues around which there is common ground for political alliances between the two groups (Priestley & Rabiee 2002, p.603).
The common status both groups enjoy under Ireland's equality legislation, as well as common principles apparent in international human rights legislation, provide a basis for solidarity around equal and human rights. Clearly there is scope for joint working between ageing and disability groups on common issues of concern. In addition, the following policy initiatives are relevant to both groups and offer opportunities for collaboration.
Person-Centred Planning offers a service orientation framework that facilitates changes over the life course. The NDA's publication Person-Centred Planning in the Provision of Services for People with Disabilities in Ireland (2005a) describes the elements of this approach. Based around developing a life plan for the individual, Person-Centred Planning is flexible and responsive to changing needs, grounded in a social model and a strengths-based approach and takes into account the wider network in terms of support and of needs. This makes Person-Centred Planning particularly appropriate for managing life transitions. It focuses disparate services around the holistic needs of the person, and recognises the needs of the wider family network (NDA 2005a). The NCAOP has long advocated person-centred care (see Delaney, et al. 2001), and has recently reiterated this by calling for long-term care that is oriented around the needs of the individual (NCAOP 2005c, p.16). The NCAOP argues that the role of assessment is the cornerstone of long-term care, and that such an assessment should be 'holistic, person-centred and encompass medical, social, psychological and financial domains' (Ibid., p.17-18). Policy guidance by both the NCAOP and the NDA thus advocates a move towards person-centred provision.
The National Council on Disability (NCOD) in the USA cites the key factor in the successful implementation of 'living communities' as the formation of strategic partnerships (NCOD 2004, p.129). They highlight the example of the San Mateo Strategic Plan, where several agencies joined together to create a strategic plan which would address the needs of both older people and people with disabilities. Implementation of the strategy depended on consolidating administration between disparate agencies, using incentives to stimulate changed behaviour in individuals and corporate entities, providing funding which encouraged integrated, consumer-directed and community-based services, and accessing public-private partnerships (NCOD 2004, pp. 130-132).
In Ireland, the move to community-based services for people with disabilities will help to bring about 'livable communities'. So too, implementation of the access provisions of the Disability Act 2005, improved enforcement of building control legislation, and other developments such as creating accessible transport have a major role to play. There exists a need for further intervention in the area of housing to ensure both people with disabilities and older people have the maximum opportunity to reside in their local community. Developments would be greatly aided by a coherent and comprehensive National Disability Strategy. Council and Community Development Boards could also play a key role if, in addition to implementation of the Barcelona Declaration, the goal of creating 'livable communities' was incorporated into their strategic plans.
In Ireland no initiatives have yet been undertaken to provide user-directed services. As reported above, user-directed services have been implemented in the USA, Germany, Austria, France and the Netherlands. Some countries provide cash benefits to users to pay for services, others provide a budget for each user. If a comprehensive needs assessment system for people with disabilities in Ireland is implemented, on foot of the Disability Act 2005, this may provide the administrative basis to enable user-direction in Ireland. This suggests that such a system would be implemented through the Department of Health & Children. Further detailed exploration of the administrative requirements is needed in order to enable its implementation here. In addition, lessons need to be learned from the experiences in other countries. Issues such as how service users can be supported to manage services effectively, how to ensure quality and accountability in services, how to develop a well-trained labour force of personal assistants and other workers, and how to protect against fraud and abuse all require consideration (see Simon-Rusinowitz, et al. 2002 for further discussion).
A key question on the ageing and disability agenda must be how to ensure effective integration and co-ordination between the service sectors for older people and people with disabilities. In the United States, integration and co-ordination was driven legislatively. Amendments to the Older Americans Act and the Developmental Disabilities Act in 1987 mandated access to generic aged services for older people with disabilities and collaboration between the two service systems. At the same time, co-ordinated policy was supported by the establishment of several university-affiliated programs for developmental disabilities and by the establishment of the Rehabilitation Research and Training Centre Consortium on Ageing and Developmental Disabilities (Bigby 2004, p.250).
In Ireland, lack of co-ordination between Government departments has already been raised as a difficulty with policy implementation in disability services. Decisions need to be made so that both options of 'ageing in place' and inclusion of people with disabilities in mainstream ageing services are provided. Such decisions should be guided by the expressed preferences of older people with disabilities.