Ageing Without Children

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An AWOC take on “Care”

Last night BBC 1 showed “Care” which told the story of Jenny a single mother and her sister Claire struggling to care for her widowed mother Mary after she has a sudden stroke which leaves her unable to communicate properly and with vascular dementia. This blog gives an AWOC take on what unfolds (spoilers ahead).

The first thing to say is that during 90 minutes, I counted 30 times where Jenny and/or her sister Claire were shown as offering support and/or care and/or advocacy. Jenny in particular is shown repeatedly comforting her mother when she’s showing signs of distress and fear, taking the time to work out what it is she wants, visiting her, and physically intervening when e.g. Mary tries to eat a tea bag. In a pivotal very upsetting scene, Jenny and Claire sit through a case conference to discuss Mary’s discharge, while Mary who can hear but can’t verbalise her thoughts makes increasingly loud incoherent cries of sadness, fear and anger. Jenny eventually grabs Mary’s wheelchair, takes her from the room and back to her house resolving to care for Mary herself.

The key thing throughout the whole drama is that Jenny is shown as caring about her mother in a way no one in health and social care does. People in the NHS and social care are shown as doing their jobs with greater or lesser degrees of sympathy for their role in the process, but Jenny is the only one who cares how Mary feels. For people ageing without children, especially those who are also without a partner, it is that that we worry will be most glaringly absent; someone who cares about us rather than for us. Yes we will get fed, bathed and dressed but who will be there to actually care how we feel? To worry if we’re scared? or sad? or angry? or to celebrate with us if we’re happy?

The other main component shown was the importance of advocacy; Claire especially is shown as arguing with the hospital and care staff about her mother’s treatment and options e.g. when they are trying to discharge Mary home, Claire points out her confusion and inability to do things for herself. As the drama plays out, Jenny cannot manage Mary’s care at home and tries to find her a suitable nursing home. Eventually she finds one which is shown in stark contrast to the urine soaked one Mary is in briefly while Jenny’s home is adapted but of course it’s far more than the local authority who are funding Mary’s care will pay.

The owners mention Continuing Health Care; the sisters take on the care services in order to secure CHC funding for Mary which they get and Mary is able to go into the much nicer nursing home. Of course without anyone to advocate for her, Mary would have stayed in the first care home, the one where the manager tells Jenny they can’t cope because the owner won’t pay for more staff. People ageing without children are 25% more likely to go into a care home as their unpaid care networks made up of wider kin and friends tend to fall away as needs increase.

A contrast is also drawn between Jenny a single mum who is shown always with a home setting and Claire her sister who we learn is childless (we discover near the end her lack of children isn’t a choice) and is often shown at work or out having fun. Claire is portrayed as being unable to cope with her mum and leaving the vast majority of the care to Jenny. In reality, people without children are between 20-40% more likely to be the carers for their elderly parents  Childlessness and upward intergenerational support: cross-national evidence from 11 European countries https://www.cambridge.org/core/journals/ageing-and-society/article/childlessness-and-upward-intergenerational-support-crossnational-evidence-from-11-european-countries/56F1FF0ED1A2BD301430F8563AACAF6F and it was beyond disappointing to see childless women portrayed yet again in such a stereotypical way. The “tightrope generation”, those people caring for their parents but without the safety net of their own children really are the forgotten carers.

Overall, it was impossible to watch Care and not be left deeply worried and upset about the future for people who don’t have a Jenny or a Claire. Time and again they were shown as being able to give information that only they would know, information about Mary’s personality, interests and hobbies, how she was before the stroke, what kind of food would encourage her to eat, what things might cheer her up. Often they would offer physical comfort; a hug, stroking her hair hand, brushing her hair, something again paid for carers are unlikely to have time for or even be allowed to do. It showed how hard it is, how determined you have to be, how you have to care a huge amount of someone to be willing to go to the lengths they went to for their mother.

The care system is underfunded and unloved and hard enough if you have someone caring about and advocating for you. Without that, it is almost unimaginably difficult.

We have to do better; for people with family, for people without, for all of us. This cannot be the social care future we want.

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“Most people’s children don’t look after them anyway”

If I had a pound for every time someone has said that to me since AWOC was set up in 2014, I wouldn’t have to work for free! Insisting that most older people in the UK are not helped, supported or cared for by their adult children seems to be a firmly held belief, not just by the public but the Government as well. Jeremy Hunt has repeatedly said that children should take on more responsibility for caring for elderly parents

“We need a wholesale repairing of the social contract so that children see their parents giving wonderful care to grandparents – and recognise that in time this will be their responsibility too.[1]

and the Government’s entire social care policy for older people seems based around the idea that adult children are not doing enough to help and they must do more.

But what does the evidence say? Are older people not supported by their children as the government and many people in society claim? Below are some of the statistics around this issue

  • The majority of the 6.5 million carers in the UK – 40% – are looking after either a parent or parent in law [2]
  • a quarter of people aged from 45 to 60 provide active day-to-day support to their mothers and fathers, essential to enable them to continue living independent lives[3]
  • “Most care for older people is not provided by the state or private agencies but by family members, at an estimated value of £55 billion annually. However, as the baby-boomer generation ages, a growing ‘family care gap’ will develop as the number of older people in need of care outstrips the number of adult children able to provide it. This is expected to occur for the first time in 2017”[4]
  • More than 80% of disabled older people receiving informal care and living in private homes are being cared for either by their adult children or spouse or both of them together. The ‘oldest old’ are predominantly cared for by their children, whereas married older people predominantly receive spousal care[5]. T
  • The above statistic needs to be considered in the context that not only are more people ageing without children but that the numbers of people living alone is also increasing: 28% of UK households are single person households and over half (51%) of all people aged 75 and over live alone [6].
  • Numbers of older people in care homes between 2001 – 2011 (most recent figures) has remained static at around 291,000 despite an increase of 11% of people over 65 from 8.3 million to 9.2 million

The facts show that adult children are not on the whole as people or the Government seem to think, routinely abandoning their parents to look after themselves or as the media often like to describe it “dumping them in a care home”. Caring for an elderly parent is hard, time consuming and exhausting and yet every day millions of people up and down the country are doing it. And yet still the myth persists that people are simply not doing enough for their elderly parents. It would be interesting to examine why the belief remains so strong despite the evidence but that’s for another blog.

The question is, why does this matter for people ageing without children?

It matters because if the level of support, help and care provided by adult children is misunderstood or flat out denied, the issue of who will support, help and care for people ageing without children is also easily dismissed. If wider society and the government doesn’t believe that older people if they need it are generally (not always obviously but as the statistics show, mostly) helped, supported and cared for by their adult children, then it is easy to continue to insist that people ageing without children will face no particular difficulties over and above those with children will face in later life. It means people ageing without children will continue to be over looked and ignored in debates on ageing and the future of care, and the government will continue to push the line that the future of care for older people rests with their children.

By 2030, 2 million people will be over 65 without adult children and we know thanks to research from the International Longevity Centre that “the adult social care sector in England faces a gap of 200,000 care workers by the end of this Parliament because of restrictions on immigration and a failure to attract British workers. Longer term, the sector could face a shortfall of 1 million workers in the next twenty years [7]” How do we face up to these triples challenges of more older people without adult children to offer help, support and care, ever more stringent criteria for social care and a diminishing social care workforce? We can’t leave it till 2030, we have to start planning now both as individuals ageing without children but also on a national and local level. 2030 is really not that far away.

[1] http://www.conservativehome.com/platform/2015/07/jeremy-hunt-mp-we-must-reduce-the-number-of-elderly-people-who-live-and-die-alone.html

[2] Carers UK “facts about carers” policy briefing May 2014

[3] http://www.telegraph.co.uk/women/mother-tongue/9241689/2.4m-parents-juggling-elderly-care-and-childcare.html

[4] THE GENERATION STRAIN COLLECTIVE SOLUTIONS TO CARE IN AN AGEING SOCIETY Clare McNeil and Jack Hunter Institute for Public Policy Research

[5] Current and future challenges of family care in the UK  Andreas Hoff Zittau/Goerlitz University of Applied Sciences  March 2015

[6] Households and families Jen Beaumont Edition No: Social Trends 41 Editor: Jen Beaumont Office for National Statistics

[7] http://www.ilcuk.org.uk/index.php/publications/publication_details/moved_to_care

Numbers of elderly needing care will soon outstrip relatives able to help

Guardian, 24 April 2014

“Numbers of elderly needing care will soon outstrip relatives able to help: IPPR thinktank estimates 2 million aged over 65 in UK will lack informal care from adult offspring by 2030”

People in deckchairs, Brighton beach

Photograph: David Sillitoe for the Guardian

Within four years 800,000 people in the UK may need care, and 20,000 will have no family to help, says the IPPR.

The scale of the gathering social care crisis has been underlined by new figures showing the number of older people is expected to outstrip the number of family members able to provide informal care for them for the first time in 2017.

Within four years, it is predicted, 800,000 people may be in need of care, including 20,000 with no family to care for them, according to a report by the centre-left thinktank the IPPR.

By 2030 there will be 2 million people aged over 65 without adult children to look after them, up from 1.2 million in 2012, and about 230,000 of them will be in need of more than 20 hours’ care a week and will have no informal support.

The average annual cost for an older person who pays for 10 hours of home care and receives five meals on wheels a week has increased to £7,900 a year – up almost £740 since 2009-10 – and nursing homes now cost an average of £36,000.

The report will accelerate private discussions under way in the Labour party about how it can integrate social care and health services, and whether this will require any kind of earmarked extra spending.

Labour says it has rejected plans for a 1p increase in national insurance contributions, an idea being touted by the former welfare minister Frank Field, but Ed Miliband is known to want to make the future of the health service a big issue at the next election.

Labour is examining a range of funding options in the light of the widely expected shortfall in health and social care funding over the next 10 years.

An independent commission on the future of health and social care in England, overseen by the King’s Fund health thinktank and chaired by the economist Kate Barker, could influence Labour thinking.

The director of the IPPR, Nick Pearce, has supported the idea of an earmarked tax, saying the public might be willing to support extra taxes for health care – as they did in the past when the same measure was introduced by Gordon Brown and Tony Blair.

By underlining the likely extra pressures on social care due to demographic change, the IPPR’s latest analysis will put pressure on those who are resisting extra spending to propose an alternative.

It suggests that by 2030, an estimated 230,000 older people in England who need care of more than 20 hours a week could be left without family to help.

It adds that the number of people aged 65 and over without children to care for them will almost double before the end of the next decade and that by 2030, there will be more than 2 million people in England without a child to care for them if needed.

Older people will also be under pressure not simply to act as providers of care to their spouses and partners, with some analysis suggesting that they will also have to increase the care they provide by 90% over the next 15 years.

The IPPR suggests the financial costs of care are especially acute in the UK since levels of employment for women with children and those over 50 are lower in the UK than in many other OECD countries.

The report argues that plans for new non-state networks of social care, including friends and neighbours, need to be assembled soon since adult children will not be able to meet demand, or else the level of demand on the NHS will spiral out of control.

It calls for an end to the generational segregation of care so that children and elderly people are not always looked after at different sites, pointing to models of linked care in Germany.

It also proposes a system of care coordinators providing a single local point of contact to replace the care management currently provided by adult social services. .

The report shows 800,000 older people who need personal care are not receiving this, either because eligibility criteria have been cut back – 87% of councils are now providing care only for those with “substantial” or “critical” needs – or because they are unable to afford paid care.

Clare McNeil, the report’s author, says: “The supply of unpaid care to older people with support needs by their adult children will not keep pace with future demand. Thousands of people in their 60s and 70s today could be left to cope on their own when they need care in the future, with overstretched services unable to make up the shortfall.

“Britain needs to build new community institutions capable of sustaining us through the changes ahead and to adapt the social structures already in place, such as family and care, public services, the workplace and neighbourhoods.”

Source: http://www.theguardian.com/society/2014/apr/24/elderly-care-outstrip-relatives-ippr-2030