The cost efficiency of misery
Rich from Arbitrary Constant has a useful short piece setting out the three main options in the government’s social care green paper for paying for the care home needs of the elderly, and comparing it with the Conservatives claims that they can do it all cheaper through its insurance-based ‘home protection scheme’.
Unsurprisingly, the Association of British Insurers is all for this kind of thing, and even Age Concern have weighed in with their general, party neutral support, content ‘that at long last this issue is at last central to the political debate.‘
Suddenly, it seems, both parties are getting on top of this troublesome issue of the funding of elderly care, and whoever wins the election will put in place a suitable scheme. That’s just as well with the demand for care home places now on the rise.
The only little sticking point is that an old person’s home can be a very, very miserable place to end your days, and that both parties should be ashamed of themselves for the approach they have taken, which is simply to accept that old people are the detritus of society, and that government’s role is to dispose of them safely and with the minimum of cost.
I’d like Phil Hope (Labour) and David Willetts (Con) to read this - probably the best article I’ve seen in the Guardian for two years - and then think again. Here’s an excerpt:
If you ask them how they like it here, most of the six widows, born during the first world war or the 1920s, will insist that they are all right, that they can’t complain, that the food is lovely and the nurses wonderful. It is hard to determine whether this is stoicism or a self-protective determination not to focus on the reality of their situation: that they have been sent here by their family or doctors because they can no longer look after themselves, and they are unlikely to go anywhere else before they die.
It is only when they move away from the group, and talk quietly with a care assistant or a visitor, that the guard begins to come down.
“I think I’d like to go to my daughter. I suppose so,” Lois, a mentally sharp woman, forced into a wheelchair by a stroke, admits with some reluctance. When she arrived here two years ago, the plan had been that her daughter would convert her garage into a granny flat, but nurses say the subject is no longer raised and a two-week stay has stretched into two years. Lois understands the decision: “They’ve got their own life. I don’t want to put a burden on her.”
The article – proper Guardian journalism for once, not the kind of pointless, soulless crap regurgitated daily by Toynbee and her cronies – is full of this, the stoicism of a group of old people condemned now to die in lonely misery, whatever the decent efforts of the decent staff.
It doesn’t have to be like this, though. It isn’t in many other European countries.
According to the Survey of Health, Ageing and Retirement in Europe:
‘Significant differences between southern and northern Europe exist with regard to living arrangements, family structure, proximity and contacts. In Denmark, for example, only 13 per cent of respondents live with their offspring. The corresponding figure for Spain is 52 per cent, and more than 80 per cent of people live in the direct vicinity of their children. A similar contrast is apparent in terms of the amount of contact parents have with their children: while 42 per cent of Danes see their parents every day, the corresponding figure for respondents in the Mediterranean countries nudges 86 per cent.’
Further, only 1% of the oldest Swedes and 4% of Danes live with a child, compared to 23% of Italians and 34% of Italians.
(Note: Britain is not included in this survey work, but the report identifies Britain and the US alongside the Nordic countries as ‘weak family’ countries.)
If Spain, Portugal and Greece can arrange their societies so that older people get to live and then die with and around the people they love, rather than withering away in sterile care homes, why can’t we?
Of course the answers are complex, but at root it seems to me that family structures are at their weakest where ‘Anglo/Nordic’ capitalism is strongest, where increasingly ‘flexible’ labour is exploited to such an efficient degree through long and stressful work hours, that work and the ‘struggle to survive’ become the dominant feature in increasingly nuclear family lives, and blood ties become secondary to material need and aspirations, themselves discursive constructions of a capitalism bent on growth at all (social) costs.
As Lois says in the excerpt above ‘ They have their own life’, recognising that in 21st century British capitalist society, there is no room for the encumbrance of family.
So instead of tax breaks to enable people to look after their elderly parents, and instead of a decent living wage that will allow people the freedom and time to re-engage with the complex joys of a close-knit extended family, we get an insurance scheme to pay for a better class of misery in death.
This is heartbreaking, and truthfully I don’t see an immediate way out of it beyond the (counter-intuitive?) one of a universal demand for higher wages or a social tax on corporations.
I think it is important to note that a system which allocates income to individual labourers exacerbates the stress placed on families. It is in the interest of capitalism that labouring families take on the burden of young and old, because rather than being paid for out of that element of our surplus value taken by the capitalist, they are paid for out of our wages.
Which, I suppose, is what gives socialism its anti-family feel on occasion. And I’m certainly guilty of that – because there are two sides to the story. There is the side of the labouring family laden with dependents, and there is the side of the children and elderly, who ultimately become chattels dependent upon the goodwill of people to whom they may hold no stronger attachment than mere genetics.
Neither lot can be universally happy.
Dave
Thanks for that.
This was a tentative, exploratory piece, as I don’t know the answers either, and perhaps it’s a bit much to ask Messrs Hope and Willets to have answers ready.
There’s so much to say if we are to explore it further that I’ll need to come back to it when more time allows the other side of midnight, but in the meantime I’ll just pick up on your view, expressed in the last full para (if I read you right) that in general people hold an attachment to their blood relatives that is ‘no stronger tha mere genetics’.
I don’t quite get this. Are you saying that there is some kind of social pressure to feel ‘attachment’ to people we would not in other circumstances feel such an attachment to, and that this is in some way unjustified? Or are you saying that ‘genetic’ rules do apply, and that is what we have to take into account.
This is an open question, as it stretches my ability to cope philosophically with the relationship between my commonsense (ie. I love my children and would do anything in the word for them) and the analytical perspective I seek about the way common sense is socialized/hegemonised.
Is that clear? If not, I’ll have another go after I’ve picked up the ones I love from school.
Personally I think the nuclear family is a construct rather than genetic. As previous eras of human civilization have demonstrated, the bond between direct offspring and parents is not always at the centre of social organization – as it tends to be in our world.
But what I mean is, that the social construct of the family conditions us to rely on people we may not even like, or, the opposite: we are relied upon by people we do not even like and in either case, without genetic connection, would not choose to associate with.
I’d like to join the “don’t have the answers club”, but what I do know is that an acceptable standard of life for elderly people is going to be bloody expensive. We mustn’t see them as a homogenous mass, and that means giving people options between living on their own, with families, or in a communal setting – all with enough support to make each a viable option. Practically speaking that means creating spare capacity in each area, too. Oh, and old people’s homes should be palaces – they should have trips organised regularly, they should book string quartets to come and play concerts in their halls, and they should never just plonk people in front of the tv all day because there aren’t enough staff to care for people properly.
I don’t want to force people to have to work for a day longer than current, but I also think our older people are an untapped resource and there must be ways of them contributing to society without doing the same kind of work they did during their youth.
On a practical note, I have done a fair bit of asking specifically for older people’s perspectives on the Labour government recently, and what comes out as the most important achievement even for those who’ve made huge gains financially through the winter fuel payment, minimum income guarantee etc is the free bus pass. I think that says a lot – about mobility, independence, freedom etc. So along with tax breaks for carers & a decent living wage I’d add improved, free, public transport which is more attuned to the needs of older people, Paul.