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Our society pays a good deal of attention to the needs of newborn babies and disabled children, but woefully little to the most vulnerable people at the other end of life. A frail old age is deeply uncomfortable to contemplate. But The Times's three-part investigation into nursing homes, which starts today, suggests that we are failing the elderly on a massive scale. Building a more humane care system is an absolute moral imperative.
It is also a practical one. Around 2.5 million older people currently need some form of care and support. Their numbers are set to grow exponentially. This year, one in three people will reach 50 or over. By 2051 the over-85s will hit around four million in Britain. With dementia likely to affect one in three, many of us will be destined for a nursing home. So younger people need to start now to make the case for better care. The elderly do not live to tell their stories and argue for reform.
Policymakers face three main challenges. First, the quality of care in nursing homes is alarmingly variable. While staff in many homes are working flat out in tough conditions, elsewhere the notion of “care” seems to be devoid of compassion. You cannot legislate for love. But minimum care standards must surely be raised so that no person is left undernourished, dirty or infantilised. It seems that government is overregulating in some areas, such as size of rooms and water temperature, and making some homes uneconomic, while underregulating the actual standards of personal care, which should be paramount.
The second problem is the apartheid that currently excludes many families with savings from basic information and support. Around half of Britain's 440,000 care home residents are “self-funding”. This means that they have more than £22,250 in property and savings, so must finance all or most of their care themselves. Those people and their families are currently regarded as being outside the system: they receive no information or advice from the State in trying to find suitable placements for their loved ones, and get little support if they try to challenge poor standards of care. Yet it is precisely those people who should be helping to drive up standards.
The Government is set to introduce a new complaints system in April, which should help. But many families will still be baffled by the sheer complexity of the care system. They need help to navigate it. Ministers need to make good on their promise, in their forthcoming Green Paper, to bring those people into the information loop and to make the system more equitable.
The third, profound problem is how to finance the costs of care. Local authorities already restrict care to people whose needs are deemed “critical” or “substantial”, leaving around a quarter of a million very needy people with no help from councils at all. As people live longer, and dementia becomes a growing problem, it would be fantasy to expect government to fund all care needs. But there are clearly questions about whether care homes, some of which are making considerable profits, represent good value for money for local authorities. The Government must also address the disincentives to save built into the current system, and consider whether some form of social insurance will eventually be needed.
The luckiest in old age will be those who can rely on families and communities. But dementia can create unbearable pressures. Outside help will be needed; help which is not just about money but also about compassion. How to ensure compassion, in a individualistic world, will be one of the chief tasks of this Government and the next. A society that leaves many of its oldest citizens frightened and neglected should not call itself civilised.
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