E Jane Dickson: Someone has to pay for care for elderly people

An ageing population saddled with debt may think differently about responsibility

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Voltaire knew a thing or two about providing for his old age. Having lent money to cash-strapped heads of state in return for various pensions, the octogenarian philosopher took care to recoup his investment. "I advise you to go on living," he wrote to his friend, the ailing Marquise du Deffand, "solely to enrage those paying your annuities."

It was a good joke in the 17th century. Now, as state provision for the elderly once more hits the headlines, it rings distinctly hollow. When, as part of the Queen's Speech in November, the Government announced its Personal Care at Home Bill, it was hailed as the first step towards a new national care service; for the first time, old people deemed most in need (an estimated 400,000) would, regardless of personal means, be offered free care in their homes. This week, however, it was calculators at dawn, as Health Secretary Andy Burnham was called on to defend his costings for the proposed Bill in a two-hour appearance before the Commons Health Select Committee.

The Government has earmarked £670m to fund the initiative (a figure critics suggest falls short of the mark); £420m is to come from existing Department of Health budgets while local authorities must make up the total from "efficiency" savings. Councils have warned that the natural consequence of such efficiencies will be cutbacks in other frontline services such as road maintenance, libraries, leisure centres and social work. The sabre rattling from the shires reached its crescendo, however, with the threat of raised council taxes. In Hampshire it was estimated that, if a reduction in local services were to be avoided, householders could face an increase in council tax of up to £20 per annum.

We have grown used to the inevitability of death and taxes. Death or taxes is a new refinement. While standards in care homes differ hugely, as hugely as the degree of care and support offered by families, it seems clear that too many old people are turning their faces to the wall in unfamiliar institutions. And it doesn't seem to me that 38p a week is such a swingeing personal efficiency for council tax payers if it allows our frail elderly people to live healthier, more dignified lives in the familiar comfort of their homes.

A deal of political rhetoric has been expended on rekindling family values, but not enough is done to support those who choose to look after their parents in their old age. When my grandmother was recovering in hospital from a minor infection, she was offered a choice of care homes. My mother, who wished to bring Gran home, was told it was "too risky" (this in a ward where Gran had been allowed to clamber from her bed and break her hip). My mother prevailed, but not without a struggle worthy of its own mini series , and Gran lived out her days with every attention love could devise. I am baffled as to why such arrangements should not be encouraged by local authorities. There again, care homes are a multimillion-pound industry and little revenue can be expected from the Government's proposed reforms.

Come the election, of course, the pros and cons of Personal Care at Home may prove academic. Andrew Lansley, shadow Health spokesman, holds the compassionate conservative line ("While in an ideal world we want to give free care to as many elderly people as possible, it is simply not affordable") and the Opposition's published policy for the elderly centres, so far, on raising the inheritance tax threshold to £1m. It's a canny move, as much of the sound and fury directed against means-tested care for the elderly seems rather less concerned about the welfare of said elderly than about what they may leave behind.

It is certainly true that having to sell the house they live in to pay for care is a source of keen anguish to those who have worked hard all their lives to provide for their families, and Labour is, I think, to be applauded for its humane (if less than impeccably socialist) stance in this regard. Sterner minds might point out that the bulk of personal wealth these days is less likely to derive from traditional sweat of the brow than from decades of rising property prices, and it will be interesting, too, to see how things pan out when the last of the "prudent generation" passes on. An ageing population saddled with debts and negative equity may think very differently about the responsibility of the individual.

And yet we continue to behave as if warm days will never cease. One in five Britons is already over the age of 50 and yet we live in collective denial of ageing. We were sold the line that 40 was the new 30. Then it turned out that 60 was the new 40 and somehow we fooled ourselves into believing we could accumulate the deficit. So it's a severe blow to our third age abseiling plans to find out that 80 is still pretty much 80, with all the natural shocks that elderly flesh is heir to. Leon Trotsky, no stranger to the nasty surprise, expressed it perfectly: "Old age is the most unexpected of all the things that can happen to a man." If the politics of the past decade has taught us anything, it is that we should prepare for the unexpected.

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