By Minette Marrin (THE TIMES, 02/04/06):
Elder abuse is a clumsy American expression meaning hurting old people, physically and emotionally. It is chilling to think this is so common that people in the social care business need a snappy name for it. It’s also chilling to think that political correctness has made such a ridiculous effort to avoid the dread word “old”, as if it were a kind of obscenity. “Elder” indeed.
This past week has dispelled any fading doubts I might have had that wilfully abusing old people was common. We seem to have moved quickly from a society where ties between generations were strong to a culture of institutionalised elder abuse.
Last Monday the Healthcare Commission, the Audit Commission and the Commission for Social Care Inspection jointly published a report that said old people were being failed by the NHS and other public services, which were riddled with “ageism” — another nasty new word for a real evil.
According to this report, old people are subject to “patronising and thoughtless attitudes” from some doctors and carers. In hospital they are moved from one place to another, their meals are whisked away uneaten for lack of help, and despite the government’s promise of long ago to end mixed sex wards, old men and women are thrown in together to suffer indignity and shame as well as all their other problems. The care they receive after leaving hospital is erratic and inadequate.
One hardly needs a report to be convinced of that. It is pretty much what happened to my mother, not long before her death. It is what all too often is done to old people.
Two days after this depressing survey, another even more depressing report emerged. The King’s Fund published a review of England’s social care by Sir Derek Wanless. This demonstrates clearly what most people know: social care for old people in England, like healthcare, is miserably patchy, often miserable and often unavailable. Wanless said the system of means-tested personal care is a postcode lottery causing “anger and distress” to millions of old people. Home help goes only to the most needy; many who need just a little help in the home get no assistance from social services and many of those who qualify for services cannot afford the charges. The quality of these is variable and sometimes “unacceptably low”.
In an injustice that is bitterly resented, people with savings or homes worth more than £20,500 have to use them to pay for residential care, which — by contrast — is free for anyone with no assets. It does not pay to be prudent. Saving has become senseless. And Wanless finds that some social services departments force old people who don’t need residential care to go into homes so the council can seize the value of their property. About 70,000 people a year have to sell their houses and go into an old people’s home.
In short the system is “unsatisfactory”, with “serious shortcomings” and prevents old people from “thriving”. But we knew this too. I cannot count the readers’ letters I’ve had on such matters over the past 15 years. The real question is why everyone has tolerated this elder abuse for so long.
The answer is money: everyone senses how expensive proper care for the old would be. Wanless makes many worthy recommendations; he sets out a new system to help people live independently for as long as possible, and which avoids means testing. Every old person who needs help would get a generous personal care package, and the state would pay five-sixths of it. The elderly person would pay the rest, unless unable to do so — only then would means testing be used. This sounds wonderful, utopian and impossibly expensive.
The present inadequate deal costs £10 billion a year and the proportion of old and very old people is growing fast. The number of old people with high social care needs will increase by more than half by 2026. Wanless suggests that the sum should triple to £30 billion a year by then. But even such a huge increase does not seem likely to be nearly enough to meet the real need.
Personal care is eked out in hours — a visit here and there, once or twice a day. Each hour costs the council, in real terms, anywhere between £10 and £20, including administration, travel and high agency fees. But what a frail old lady needs is not just a rushed 45 minutes bathing and dressing. She needs company, attention, amusement — and increasingly the old and very old live alone. She needs someone around.
Traditionally families provided this and millions still do. This represents a huge saving to the taxpayer, yet such a carer’s allowance is only £45.70 a week. That is for 35 hours of caring, and can easily be cut off under complex rules and regulations. It will be stopped, for instance, if the carer earns more than £82 per week, or if he or she receives a state pension worth more than that. Without getting into the complexity of the carer premium, compare £45.70 for a 35-hour week of personal care from a family member or friend, with £48 for only four hours per week of professional personal care from social services, in a typical case reported last week. Startling isn’t it? It almost amounts to carer abuse.
Under the Wanless suggestions old people would get much more paid professional care and it would be heavily subsidised. But the point still stands out. It is hugely cheaper, and no doubt usually much better, if family carers look after old people. But the disincentives are extreme.
First there’s the opportunity cost. Caring means forgoing a job (above £82 per week), and so probably being unable to contribute to a mortgage or to save for old age — a nasty irony. Then there is tax. It seems both unjust and stupid to tax people who care for the sick and disabled as heavily as those who don’t. They are saving public money at the cost of their own financial security, yet they get no tax breaks for doing so.
Abolishing inheritance tax on legacies to family carers would be an obvious start; in that way the family home would indeed pay for the care of the old, within the family. Giving long tax holidays to family carers would be another sensible move. So would paying cash to those carers for whom a tax holiday would be insignificant. Tax relief would help foster family responsibility, but the current financial incentives are to neglect the old, consigning them to abuse.