Libraries have shut, spare rooms are taxed and social care budgets slashed - so how are we meant to look after the elderly?

About four million older people live alone in Britain. That total will rise

Boyd Tonkin
Friday 03 July 2015 16:10
Vulnerable consumers are defined as those with poor literacy skills, those who have caring responsibilities, people with disabilities, dementia or the old
Vulnerable consumers are defined as those with poor literacy skills, those who have caring responsibilities, people with disabilities, dementia or the old

Like some phantom limb, severed long ago but still prone to aches and twinges, the Big Society continues to trouble the Government. This week, Jeremy Hunt felt its ghostly throb. The Health Secretary scolded us all for failing to help the swelling numbers of lonely elderly people and warned that “taking care of older relatives and friends will need to become part of all of our lives”.

Speaking to the Local Government Association, Hunt deplored the eight “lonely funerals” conducted each day by councils for those who die without any known relatives or friends. He painted a picture of widespread selfishness and indifference: “Despite many local examples of innate British kindness and decency, the national picture is far from kind and far from decent.”

So: I’d like to heed Hunt’s charitable call, and host a lonely neighbour over a tough time; as they leave hospital, perhaps. I’ll need a spare room in order to do that. If I occupy social housing and claim benefit – as many of those who live closest to vulnerable seniors often do – I may no longer have that space. Since 2012 Hunt’s colleagues have penalised such scope for generosity through the “under-occupancy penalty”, aka the bedroom tax.

Meanwhile, the Association of Directors of Adult Social Services reports that the social care budgets on which isolated elders depend will fall next year by £1.1bn. That will make a total of £4.6bn, or 31 per cent, in reductions since 2011. Elsewhere, more than 300 of the libraries that succoured the lonely old have shut. More than ever, the twitching residue of the Big Society agenda looks like an attempt to offload responsibility for the damage wrought by state austerity on to what Hunt called “the busy, atomised lives we increasingly lead”.

Still, Hunt and his government did not by themselves unleash the social forces that have impelled millions to get on their bikes to work, to study, to travel, and so to quit the streets and towns where their closest elders live. Any nation that boasts – as the UK currently does –a record employment rate of 73.2 per cent, with 68.5 per cent for women, will feel as the downside a nagging loss of cohesion and solidarity.

The chronic loneliness endured by about 900,000 elderly people in this country injures bodies as well as minds. When Hunt previously described the health effect of loneliness as the equivalent of smoking 15 cigarettes a day, he wasn’t plucking some headline-friendly figure from the air. The calculation comes from a meta-analysis of 148 separate studies of the links between social connectedness and mortality.

According to a report by Age UK Oxfordshire for the umbrella body the Campaign to End Loneliness, the risk of Alzheimer’s “more than doubles in older people experiencing loneliness”. Vulnerability to heart disease also worsens. Isolation may affect cognition too, as “the brains of lonely people become more vigilant for social threats and more focused on self-preservation”. This suspicion itself inhibits social contact and so tightens a vicious circle.

Try to combat an entity as broad as loneliness and, like that ageing warrior Don Quixote, you risk tilting at windmills. Happy solitaries exist in every age group. Some traditions – such as sannyasa in Hinduism – carry the understanding that people as they age may gladly cut some inessential bonds to focus on their own journey. But, in this most intimate of realms, the absence of evidence may not equal the evidence of absence. Older people raised in the mustn’t-grumble school of stoicism will hesitate to disclose such a private burden.

Social isolation, however, can be measured, and mitigated where planning and funding allow. In another study for Age UK and the campaign, “Promising Approaches”, Kate Jopling rounds up a heartening panoply of projects that offer advice, referrals, stimulation and companionship. They range from “smart visits” in Cheshire to assess individual needs or “digital inclusion” in Leeds, to Gloucestershire’s “village agents” – less sinister than they sound – and my favourite: HenPower in the North-east. In this scheme, “hen-keeping is the catalyst for further creative and meaningful engagement between active older people”. “What I like about HenPower,” says Tommy Appleby, widowed after 25 years caring for his wife, “is that you’re not entertained, you’re involved.”

Don’t write these ventures off as chicken feed. Those Gloucestershire agents saved local care providers an estimated £1.3m over a year. If you factor in the avoidance of the care costs that come with depression, befriending services can save from £35 up to £300 annually for each client. Research into group activities for older people found that the overall yearly health costs per person amounted to £943 less than for a control sample.

Jeremy Hunt, however, wants families and friends to do the heavy lifting. He cites China’s “elderly rights law”, which mandates punishments for relatives who “neglect or snub” their seniors. Guilt-burdened Westerners like to indulge in fantasies about cultures where a caring, sharing model of cross-generational support apparently survives. Hunt – whose wife, Lucia Guo, is Chinese – has regularly tapped into this tendency by lauding “the reverence and respect for older people in Asian culture”.

With three or more generations happily sheltered under one loving roof, the state can withdraw. Explaining the allure of this ideal, medical sociologist Yow-Hwey Hu notes that, in theory, “it promises the most humane living environment, the best care possible (because it comes from one’s own blood)… at the lowest possible cost to society”. Those Confucian values of filial piety do indeed endure in hearts and minds. However, a growing body of evidence suggests that Asian practice may no longer match the rhetoric.

Hunt himself noted that, in Japan, a special term – kodokushi – signifies a “lonely death”. The same country now worries that the ancient scourge of obasuteyama – the expulsion of discarded female elders; granny-dumping, to be crude – may be making a discreet comeback. Mayumi Hayashi, who researches elderly care in Britain and Japan, cites a Japanese report revealing that half of family carers “had subjected frail older relatives to some form of abuse, with one in three acknowledging feelings of ‘hatred’”. More hopefully, she has also explored the Japanese tradition of mutual aid through “time credits” as a potential resource for lonely elders.

Among Chinese communities, investigations hint at a far from wholly harmonious picture. After examining the suicide rate among elders in Taiwan, much higher than in the West, Yow-Hwey Hu and Yah-Jong Chou concluded that its level “does not support the orthodox supposition that the elderly in the East Asian system are better off than their more independent Western counterparts”.

In China itself, Ninie Wang built up her Pinetree Care Group first as a residential provider, then as a source of at-home support for old people. Their adult children may rush through lives just as frantic and “atomised” as those Hunt condemns. Wang writes that “the myth of filial piety has long been a luxury for most families”. In reality, too many “neglect the needs of their loved ones”. In Taiwan, Hu and Chou found a popular new saying among older people: put your trust in “old savings, old friends and a good old body”.

So the Chinese option may be a sentimental mirage. When I ask Anthea Tinker – professor of social gerontology at King’s College London – about Hunt’s East Asian prescription, she warns not only that hyper-mobile modern China may be abandoning it. Even in the past, “we don’t know how much of it was what people chose, and how much was enforced”.

Closer to home, she reports that a wide-ranging European study discovered that “the most lonely old people were in fact in Greece” – despite the large proportion of multi-generational households there. Conversely, “the least lonely were in Scandinavia, where there is the highest rate of people living alone”. “Living arrangements” in themselves do not cause or cure social isolation. Elders can languish with their kin in the next room or flourish with them half a world away.

As Professor Tinker also emphasises, countless families in Britain do sink huge resources into keeping their senior generations in touch and in shape. “Don’t ignore the extent of family care in this country.” She endorses the recent home-share initiatives that place space-poor youngsters in the houses of company-poor oldsters: they can work well given “careful matches” between host and guest. Meanwhile, public policy must above all promote “the recognition of carers – especially middle-aged women, who are caring for both children and parents. They are the people who are being torn in two directions”.

About four million older people live alone in Britain. That total will rise as the senior age cohorts expand: up 39 per cent for 65 to 84-year-olds by 2032, and 106 per cent for the over-85s. In this light, the isolation-busting interventions we now have look like a drop in a leaky bucket. This is not to disparage their value and ingenuity. In Exeter, for example, Age UK runs a “Men in Sheds” project that brings older chaps together to repair and recondition garden tools. It sounds terrific, but please don’t invite Jeremy Hunt down to inspect the shed. He has his hands on quite enough axes, pruners and loppers already.

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