It’s been several months since I contributed to Empty Plates Tomorrow. The main reason is that I have been and remain very busy looking after my parents, who are both in their 90s. Earlier this month, I took them to a care home for a temporary stay, to see how they liked it. The experience was so bad for them that I removed them after only five days, and that’s it for care homes as far as we are concerned. Fortunately we have a choice. What about all the older people who have nowhere else to go?

My father had two falls and came back with a sprained ankle, a shear wound on his left leg and grazes down his right arm. He got stuck in the lift and was terrified that no one would ever come and let him out. My mother returned with a urinary infection, because the personal care provided was inadequate, nowhere near the excellent standard upheld by the county council’s domiciliary care team, who wash and change mum at home.  They soon settled down again at home, but their short stay raises several questions:

• Why do we incarcerate elderly people in institutions?
  

Unannounced visits into care homes often reveal dispiriting realities of neglect and oppression. The neglect may be unthinking, by omitting to help those who cannot feed themselves, or by forgetting to provide sufficient fluids to drink. The oppression comes when residents are shouted at for getting in the way of staff routines, or are deliberately left waiting when they need to visit the toilet. Sometimes you receive the impression that the residents are impediments to the smooth running of the business.  The use of the word ‘home’, as in ‘care home’ is comforting for those who send the elderly there, but often misleading because residents have few of the freedoms they would enjoy in their own homes.

• Why do we allow care of vulnerable elderly men and women to be a profit opportunity?

The marketisation of ’services’ has gone too far, in my opinion, when the very survival of people who can no longer look after themselves is deemed a market opportunity. Unlike babies, some older people are not cuddly. They may swear, dribble, shout and moan, but often these are reactions to the stressful situations in which they find themselves, and which they no longer have the capacity to question. Or if they do question, no one listens. The quest for profits tends to include continuous efforts to cut costs. I was horrified to learn, for example, that in care homes only one meal a day has to be cooked, and so proprietors keen to make money can exploit this by relying on fillers such as bread and margerine.

• Why do so many families need to offload the care of their older members?

The tangle of reasons why families no longer care for their own elderly obviously includes family breakdown and geographic dispersion, and also the cultural expectation of individual fulfilment, a life path prioritising personal ambitions. Personal ambitions come to an abrupt end in most care homes, though. In too many cases the residents are no longer perceived as people with interesting life histories, but as depersonalised patients with ‘problems’, waiting to die. What we don’t know about we can often shunt to the back of our minds, and in the interests of ’security’ care homes these days are often locked, keeping residents in and the neighbourhood out. So families don’t need to think too much about the experiences of older members who are put away in care homes, because they can maintain a state of blissful ignorance.

• Why is there not a greater choice of care options?

I discovered a scheme in France, called ‘Villa Families’, which keeps elderly people — generally over-80s — in their own neighbourhoods, living in specially designed villas, constructed in a public-private partnership non-profit scheme. A villa consists of two semi-detached homes, each housing a host family and usually three elderly people. The host families cover for each other in emergencies, and there is also accommodation for substitute carers to allow the host families to take holidays, and to enable friends and relatives of the elderly residents to stay in the villa. I would like the Villa Families concept to become widely known and applied in the UK. See ‘VillaFamily: Providing Care for the Elderly in Rural France’ by Philippe Loubens, case%20study%20villa%20family.pdf.

Also, for those families willing to care for their elderly, there should be a wider choice of properties suitable for extended families, which means that planners and builders have to think beyond the conventional range of properties built for one, two, three or four people.

I have not even started to consider the economics of elderly care, but it is worth pointing out that many of those who struggled to buy their own home have to sell it to pay for care.  In 2008, 45,000 care home residents in Britain sold their homes to pay for care, according to the Daily Telegraph (‘Record numbers sell home to fund care’, by Laura Donnelly, www.telegraph.co.uk, 21st February 2009). So every year thousands of people have to sell the proceeds of a lifetime of saving to pay for institutional care that they accept reluctantly in the absence of any better option. Anyone in England with assets of £23,000 or more in 2009-10 — the figures are slightly different in Scotland, Wales and Northern Ireland — does not qualify for any state help with the costs of care.

Is it any wonder that there are so many demoralised, confused elderly people in our United Kingdom?

You may ask why I appear to be asking the nation to spend more on caring for the elderly when the whole tenor of Empty Plates Tomorrow is to prepare for a era when we will all have to reduce our use of energy and raw materials, buy less, shop less, spend less. I don’t think I am asking for that. I think that often we are spending on the wrong sort of care, or indeed are spending on neglect. In future families  and local communities will have to take over more of the work of caring for elderly members, who when happy in their familiar environments can often contribute wisdom from long perspectives.

Sir Gerry Robinson’s two-part series on dementia care, screened on BBC2 in December 2009, was devastating, but much of the response that I have seen was focused on a perceived need for better staff training. We need to recognise, I would argue, that care in an institution is not inevitable, that care is not a product, and that accepting a scenario of ’staff’ and ‘patients’ tuns old age into a pathological state.