If the care of older people is a national shame, why is govt not leading a national response?

There has been plenty of coherent and thoughtful responses to Jeremy Hunts comments on how we care for older people in this country, Mr Hunt would do well to read these as he might find them helpful.

The number of older people in residential care is minimal, especially since social care prioritizes supporting individuals to live at home, even if this does mean they might end up lonely, isolated and depressed, at least they are ‘independent’! There should be no one size fits all approach to the care of older people. Each is different, residential care for one might be a living hell but for another relief to unending loneliness. What is important is having a genuine choice and quality care.

However, older people can face even worse, many are maltreated and abused on a routine basis and this really does need to be addressed.

Having spent three and half years researching why the abuse and maltreatment of older people is so prevalent for my doctorate the one thing I have learnt is there are no easy answers. There really is no point in thinking we can return to a golden age where older people were valued and respected by families and wider society, I’m not convinced it ever existed, I’ve written on this before – read more here . Nor have I found this issue to be something specific to British culture. I’ve read research from around the world on the growing problem of “elder abuse” in both the developed and developing world. These have included, but are not limited to, America, Canada, New Zealand, Australia, India, Hong Kong, China (yes, China Mr Hunt),South Korea, Ireland, Sweden, South Africa and in Arab-Israeli communities. The maltreatment of older people is also widespread across Europe, including the UK, even in countries one might not expect, for example Italy where we have a romanticized notion of the stereotypical caring Italian family. The most surprising place for me to read of how older people are maltreated and abused was Tibet.

All the research suggests risk factors which increase the chances of older people being abused include being a female over the age of 85 years, suffering from cognitive impairment, poverty and isolation. In terms of who might perpetrate abuse and maltreatment, and where, it appears it can happen anywhere really, and anyone can be abusive i.e. family, formal and informal carers, strangers, friends.

Having discovered the abuse and maltreatment of older people appears to be a global phenomenon I have turned my attention to the question of what we can do about it. Since starting my research awareness of the issues older people face is now much more understood because of inquiries such as the Francis Review and numerous reports concerning care provision across both the residential and domiciliary sector from both public and private providers. There has also been a change of government, and a change in emphasis as the coalition clearly believe the protection and care of older people is everybody’s responsibility, in effect “Big Society”. Whilst I agree it is all of our responsibility, where I part company with this government is on its role.

Cameron and Co appear to believe an in-active state will stimulate and activate big society to take on more responsibility. However, this presupposes big society has failed in meeting its responsibility toward one another, and that we alone are the authors of our own destiny. I am not convinced it is this simple.

The legitimate role, and limits, of the state in individuals lives is ideological, and whilst this government seems to thinks by ensuring we have a small state big society will become the masters of their own destiny, in todays neo-liberal capitalist world I believe this is overly optimistic. We actually need leadership in Government and an active state to provide the conditions in which big society can thrive.

My research, so far, suggests state intervention could enhance older people’s experience of ageing in the future in 3 key areas. Firstly, the introduction of family friendly policies and work practices. Not unlike Sweden, Norway and Finland where a big state and big society work in partnership to combine a very strong economy with greater work/family life balance, equity and high standards of living for all where inter-generational support is achievable. This would help reduce social isolation and poverty, both of which are important because isolation and poverty increases the chances of poor outcomes for older people. Secondly, ethical, consistent and robust regulation of providers of services to older people. This is not limited to the provision of health and social care but also financial products such as pension/insurance schemes for example. Sadly an under regulated financial sector has led to many older people losing financial security. Again, with the link between poverty and abuse this is of major importance for older people in terms of protective factors in the future.

Lastly, and probably the area I feel most strongly about is a change in the values and ethics which underpin our understanding of care provision. Again, I have written on this frequently, the reconfiguration of care as a commodity, a product to bought and sold, a task to be completed demeans us all in how we view and express care. Care is increasingly viewed as a financial transaction where cost, affordability and profit are emphasised over care and compassion. The language of austerity has only served to harden our collective heart to older people as they are perceived as a financial drain on society. Linked to this final point is the issue of what we ‘want’ to afford as a society, I’m not convinced we cannot afford to fund a high quality system of care, is it more the case we do not want to because deep down we do not think investing in older people is of value?

It must be terrifying to be an older person today, old age is now more feared than death. Caring for older people should not be a task, a chore to be done, caring should simply be our way of being.