‘Dementia will bankrupt us,” an eminent doctor told me anonymously on my recent travels through the NHS. I was surprised, because this was a paediatrician, not a geriatric consultant. But, like most doctors, she is keenly aware of what most of us never see: the approaching tidal wave of old, sick people; the warehousing of more and more bodies without minds.
In hospitals and clinics around the country I have seen magnified the struggles of my own ageing relatives, their options slowly ratcheted down by their various ailments, terrified of slipping down the slope towards the grim finality of a retirement home.
I have met grossly overweight patients in their fifties who are developing diabetes but cannot see the prolonged period of multiple problems ahead. I was in an inspiring ward last week at the Queen Elizabeth Hospital, Birmingham, where patients in various stages of dementia are looked after spectacularly well, their filmy eyes full of gratitude. But good care is very costly and these patients now occupy about one in four hospital beds.
When my grandfather was a clergyman ministering to people on their deathbeds in Devon and Somerset in the 1950s, many of those he saw had stopped working the land only a few months before. After years of physical work, they retired, contracted pneumonia and departed to meet their maker. Now medicine is conquering pneumonia and much else. But a longer, sicker old age is more and more likely.
It has become orthodox to proclaim that we should celebrate living longer. But not all my relatives feel that way now that they are experiencing the reality. I shudder at the statistic that one in six of us will live to be 100. I’m not sure that I want to.
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The unpalatable truth — that someone will have to look after us all — jars with the selfishness that has come with prosperity. Unlike people in many Mediterranean countries, who still expect to look after their relatives, most British families have no intention of letting a grumpy grandfather move into their home. But they do want to get their hands on his money. In fact, they seem to regard it as a right that someone else should pay for his retirement home, while they keep the inheritance. This is neither moral nor affordable. Who do they think will pay?
The debate is skewed by the deeply ingrained belief that no one should have to sell their home to pay for care. The premise of the Dilnot report, published this week, is that it is a “scandal” that anyone should have to sell their main asset to provide for themselves in old age. Andrew Dilnot, a shrewd thinker, has made a series of ingenious proposals for pooling risk between the lucky and the unlucky in old age. His insurance scheme aims to ensure that no one going into residential care would have to spend more than 30 per cent of their assets (some spend 90 per cent now).
But more than 70 per cent of English people already have an insurance scheme: their house. If we make homes sacrosanct, we protect the richest, those with capital, at the expense of those whose incomes will have to be taxed to bridge the financial gap (which Mr Dilnot puts at about £2 billion a year, but could be more). This doesn’t seem fair either.
Mr Dilnot is rightly trying to mend the system for funding care, which is hugely overcomplicated and arbitrary. By dragging into the light the unsettling statistic that each of us may face care costs ranging from £20,000 to £150,000, he has forcefully demonstrated that there is no free lunch.
The ageing phenomenon requires a change in mindset. A lawyer friend has a client whose father has convinced the local authority that he is mad to increase his care benefits. The father has achieved this by running around naked, screaming abuse. Was this an heroic act committed by a man willing to sacrifice his dignity to preserve the wealth that he had worked all his life to achieve? Or were these middle-class people conspiring to force other taxpayers to subsidise one man’s needs, apparently in the belief that it is not their problem?
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At the heart of the issue is the resentment felt by people who have worked all their lives, and put by, towards those who haven’t, with assets of less than £23,250, who get free care. Fairness demands that everyone chips in something. But the scale of what is happening means that there is simply no alternative to taking more responsibility for our own lives and spending more of our own money.
The babyboomers who are retiring at the moment are the wealthiest generation we have yet seen. Many have final-salary pensions, which are rapidly becoming extinct. Many bought houses that appreciated in value beyond their wildest dreams, thanks to inflation. The argument that they will be discouraged from saving if they have to pay anything like the real cost of their care is weakened once you realise how basic care is at the bottomend of the scale. Fear is a great motivator, as is the knowledge that it is all a lottery in the end.
Much of the recent debate — and the Dilnot report itself — has focused on the financing of residential care. But going into a home is what many elderly people fear most. We should be trying to keep them out of nursing homes for as long as possible.
That means rewarding people who keep their families together, not those who shunt them off to the nursing home.
So waive VAT on the granny flat that a daughter wants to build for her mother. Help people to release equity in their homes to buy a stairlift that could keep them there. Change the law so that adults who care for their parents cannot be disinherited in favour of someone else (some have lost their home) when the parents die. Support the many grandchildren who are looking after their grandparents in this country.
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Shrinking living space, the increasing number of women going out to work and the rise in particularly difficult illnesses, such as Alzheimer’s, all make it harder to keep families together.
But we must regain some sense of responsibility. In South Dakota children have been made to pay for the medical care of their parents. In Singapore those aged over 60 who cannot maintain themselves can apply for an order that their child should do so. France has l’obligation alimentaire, a limited duty to support members of your wider family.
In Britain each of us needs to think about how we would like to be treated — and plan for it.