Is a home where the heart is?

I haven’t got many responses to my posts about care.

It may be they are boring or that people who understand the topic don’t feel I have much to add to their specialist insights, but I wonder whether it’s also because many of us find the issues depressing or intractable.

In an attempt to be provocative I suggested last week that a characteristic of a hypothetical good society would be that the decision to make financial or other major sacrifices in order to provide care to a child or elderly relative would be seen as voluntary, buttressed by social norms and expectations rather than – as it is now - effectively forced on people as a result of inadequate collective provision.

My point was not that people shouldn’t make such sacrifices or commitments but that in a healthy society we would be seen to choose to do so, in part because the development of the future generations and provision to the frail and vulnerable are understood to be in the interests of, and the responsibility of, wider society. Thus the decision to put caring first would strengthen what is sometimes called ‘the economy of regard’ rather than being a forced response to a deficit (lack of public funding or affordable market provision) in the formal economy.

Although we may tend to assume not much can be done about it, at least the major sacrifices that millions of carers are expected to make are sometimes recognised as an inadequacy of the system. Arguably more disturbing is our acceptance of another aspect as being natural or functional; this is the scale of residential provision.

The Care Quality Commission estimates the number of – overwhelmingly elderly - people in English care homes as 375,000. It is estimated that around four in five of these people have dementia or other memory problems. Although there are too many examples of scandalously poor care in homes, we less often discuss the whole idea of warehousing old people in this way. Yet, as this recent report from the Alzheimer’s Society shows, people tend to have very low expectations of the quality of life offered by residential care. It is hard enough for well paid well supported professionals to try to provide the kind of empathy and reassurance loved ones are able to offer, but despite the efforts of the more conscientious providers and managers, residential homes are largely staffed by low paid workers with high rates of turnover.

Surely if an alien from outer space were to visit our society they would be horrified at the effective removal of hundreds of thousands of people from the society into residential warehouses where they are simply managed unto death. The current economic crisis downturn aside we tend to view modern history as a progressive process whereby more people are able to enjoy more opportunities and a better quality of life, but it is difficult to see how the way we treat the frail elderly today can be seen as an advance on the combination of familial and communal provision that would have been made in pre-industrial societies.

As the Alzheimer’s Society research indicates, most of us are very gloomy about the prospect of having ourselves to join the ranks of those in residential care. But instead of this driving us to demand reform based on the kind of life style we would like if we were frail and forgetful, we simply cross our fingers and hope it won’t happen to us.

For the time being I am not intending to write any more of these posts about the problems of our care system. My hope was that demonstrating how many and how profound the problems are might stimulate some insight into how we reframe public discourse away from individual issues and reform proposals and into a deeper consideration of what the care crisis says about us, and how we might need to think differently if we wanted to create a care revolution.

I have to admit that the spark of indignation has not yet lit the flame of enlightenment, but I’m working on it.