Fifteen-minute home-care visits are indefensible, so why do we allow them to happen?

The next cohort will be different. The baby boomers have a far stronger sense of entitlement

Click to follow
The Independent Online

What does it tell us about our attitudes to our old folk that we think their needs can be addressed in a 15-minute visit by a home carer? The elderly person too often must choose between being helped to get washed, get dressed, go to the toilet or have a hot meal prepared. Disclosures forced under the Freedom of Information Act  have revealed that these whirlwind 15-minute visits are being authorised by three-quarters of the nation’s 152 local authorities.

Two years ago, the Health Secretary, Jeremy Hunt, pronounced that 15-minute care visits were “completely unacceptable”. Yet today their use by local councils is undiminished. 

A survey of more than a thousand care workers has found that 500,000 pensioners are receiving visits so brief that nursing staff do not even speak to them. And these are some of the most vulnerable members of our society, prey to isolation, loneliness and depression. More than half were stroke victims, 51 per cent had mental health issues and 42 per cent had Parkinson’s disease.

Strikingly the carers’ trade union, Unison, noted that many of those being cared for were veterans of the Second World War – men and women often feted by the government for their wartime efforts but now condemned by those same politicians’ spending cuts to subsist in a home-care system that denies them dignity.

One of the qualities of that generation was an understated stoicism which combined unflagging determination and ungrudging sacrifice with uncomplaining fortitude. Theirs was the era whose Keep Calm and Carry On morale-raising refrain has been reduced, in our era of post-modern parody, to a mere opportunity for marketing cheap commercial tat.

The next cohort will be different. The baby boomers who became the Me Generation have a far stronger sense of entitlement. They are better educated and electorally savvy. They will not put up with the kind of treatment their parents have accepted with political docility. Yet they, too, will be subject to the same demographic reality and the same dominant philosophical worldview.

Most industrialised countries are ageing. Fifty years ago, only 12 per cent of the British population was over the age of 65; within the next 15 years the proportion will rise to 18 per cent. Our society allocates resources on a predominantly utilitarian model. Politicians seek to provide the greatest good for the greatest number.

In practice, that places a lower value on the life of the older person. Once we are too old to maintain economic productivity, society’s default logic is that it is a waste of resources to spend too much on us. Older people are assumed to benefit less from aggressive medical treatments. Rationing becomes overtly ageist. Medical bureaucrats do cost-benefit analysis which they express in Qalys (Quality Adjusted Life Years), which disadvantage the elderly since, by definition, they have fewer years to live than a younger person. Older people are routinely excluded from clinical trials. And they often need complex treatment of several conditions at once which is less amenable to simple analysis by medical bureaucrats. 

Much of this is based on bogus assumptions. It is dodgy economics. It is true that the NHS spends four times more on those over 65 than on people under that age. But older people should not be categorised as economically inactive; they are significant consumers of goods and services. Moreover, an ageing population with a smaller child population should expect savings in education to offset the increased spending on health and social services for the elderly. 

It is also dodgy ethics. The idea that older people have somehow had “a fair innings” when they near their life expectancy – currently defined at around 80 years – is, in effect, a form of passive euthanasia. The vulnerable should be protected from “efficiency savings”, not targeted by them.

There are several grounds of ethical objection. One is justice. Older people have contributed to society throughout their lives and, under the “fair innings” argument, are to be deprived of assistance when they need it most. In the words of one pensioner objecting to a council that wanted to levy a £25.92 fee to come out to pick up old people who had had a fall: “We have paid taxes all our lives for health services – this was supposed to be our insurance, but now we are being asked to pay again”. In the case of the war generation there is a greater social debt. 

But the greatest objection to this reductive view of the elderly is that it offers an impoverished view of what it is to be human. Properly understood that means respecting the dignity, independence, autonomy and choice that are essential to our well-being and our relationship to others and to society. Most of us understand that intuitively. Half a million pensioners may depend on local councils to pay for their home care but three times that number can rely on family and friends for support. We do not make them choose between washing, eating and conversation.

Yet the signal that public policy sends out, on home care and health care alike, is that the elderly, with their degenerative diseases and impaired capacity, are a “problem” or a “burden”. Our systems of governance are institutionally ageist. No wonder studies show that a significant number of old people fear becoming a burden on their families and wider society. It is time we brought public policy into line with private intuitions.

Paul Vallely is visiting professor in public ethics at the University of Chester