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Is Our Care System Really Fair?
There is something about the way we care for older people in this country that has never quite sat comfortably with me.
I didn't expect to become emotional writing this piece, but I did. At one point, I found myself in tears. Because when you strip away the figures and the politics, we're talking about people. Our parents. Our grandparents. And, one day, perhaps us.
You can work for fifty years. Pay your taxes. Pay National Insurance. Save carefully. Buy your own home. Do everything you were encouraged to do to provide security for yourself and your family.
Then, if you are unfortunate enough to reach a point where you can no longer safely care for yourself, you may discover that much of what you spent a lifetime building can be used to pay for your care.
And care is certainly not cheap.
I understand that care homes have enormous costs. Buildings have to be maintained, heated and insured. Food has to be provided. There are regulations to comply with and, most importantly, staff have to be employed around the clock.
But when families are paying substantial amounts for residential or nursing care, I think they are entitled to ask a very simple question:
Where is all that money going?
Because too often the people actually delivering the care don't appear to be seeing enough of it.
This isn't an attack on carers!
I want to make this absolutely clear. This isn't about blaming care assistants, nurses or other frontline staff. Quite the opposite.
I've seen carers who are kind, compassionate and incredibly patient. I've seen people doing difficult, intimate and emotionally demanding work while trying to look after several residents at once.
The problem is that kindness cannot compensate for chronic understaffing. One pair of hands can still only do the work of one pair of hands.
If a member of staff has too many people to care for, something inevitably has to give. There may be less time to sit and talk. Less time to notice subtle changes. Less time to encourage somebody to eat. Less time to help someone maintain their independence rather than simply doing something quickly for them.
Care can gradually become a series of tasks. Was the person washed? Were they dressed? Did they receive their medication? Did they eat? Were they put to bed?
All important, of course. But surely care should mean more than keeping somebody clean, fed and safe and in my experience with a loved one, I am sorry to say - even those basics were neglected. My loved one was in a secure dementia unit: I received a phone call one evening telling me she was missing, and 2 hours later she was found on a main road, having walked 7 miles in her slippers.
People need people
Imagine reaching your eighties or nineties and leaving the home where you may have lived for decades.
Your furniture has gone. Your neighbours have gone. Perhaps your partner has died. You may have lost some of your independence, mobility or memory.
Suddenly, your whole world might consist of one room and the people who walk through its door.
At that point, ten minutes of somebody's undivided attention isn't a luxury. It's human contact.
A conversation matters. Being asked what you would like matters. Someone noticing that you haven't been yourself today matters. Having your hair brushed the way you like it matters. Being taken outside to feel the sunshine on your face matters. Being spoken to, rather than spoken about, matters.
These aren't extravagant extras. They are part of maintaining someone's dignity.
We should value carers properly
If we expect people to look after some of the most vulnerable members of society, surely those people deserve excellent training and proper remuneration.
Caring for somebody with dementia, for example, requires more than simply being a kind person.
Staff need to understand dementia. They need to recognise that behaviour may be communication. They need to know how pain, fear, infection, dehydration, unfamiliar surroundings or overstimulation can affect somebody who cannot easily explain what is wrong.
They need communication skills. They need time. And they need support themselves.
Yet we have somehow allowed care work to become a profession that can carry enormous responsibility without always receiving the status or reward that responsibility deserves.
We entrust carers with our parents. Our grandparents. Eventually, perhaps, ourselves.
Why wouldn't we want the people doing that job to be among the best-trained and properly valued members of our workforce?
Then there is the question nobody likes to talk about: money
This is where the system can feel particularly cruel.
Someone may spend their entire working life being careful with money. They save rather than spend. They buy their home. They put something aside because they don't want to be a burden on their children.
Then illness arrives. And suddenly those savings can become the means by which their care is funded.
There is something deeply uncomfortable about that.
Of course, care has to be paid for somehow. There is no simple solution, and an ageing population makes the question increasingly difficult.
And this is where difficult questions about fairness inevitably arise. At a time when billions of pounds of public money are being spent on the asylum system, including accommodation and support for people awaiting decisions, some older people and their families are being asked to contribute enormous sums towards their own care.
This isn't about blaming people who arrive in Britain seeking asylum, many of whom will have their own difficult stories. It is about questioning the priorities of the system itself.
How do we explain to someone who has worked, paid tax and National Insurance for fifty years that the home and savings they spent a lifetime building may now have to fund their care?
A compassionate country should be capable of helping people who arrive here in genuine need without losing sight of the people who spent their lives contributing to it.
Perhaps the uncomfortable question isn't who deserves our compassion?
Perhaps it is: why should compassion for one group ever require us to compromise the dignity and security of another?
A generation that deserves better
There is another reason this troubles me.
Many of the people currently living in care homes belong to generations who worked incredibly hard.
They raised families without many of the conveniences we take for granted. They contributed to their communities. They paid into the system. Some lived through war and rationing. Others worked physically demanding jobs for decades.
They were teachers, factory workers, nurses, farmers, shopkeepers, cleaners, engineers, mothers, fathers and grandparents.
They had lives before they became the person sitting in Room 23.
And perhaps that's what we sometimes forget.
Old age shouldn't erase the value of everything that came before it.
What would good care look like?
I don't think the answer is simply to criticise care homes.
There are wonderful homes and exceptional carers, and running a good care service is undoubtedly difficult.
But I do think we should expect more from the system.
I would like to see carers paid in a way that reflects the responsibility they carry.
I'd like better and continuing training, particularly around dementia, communication, mental wellbeing and end-of-life care.
I'd like staffing levels that allow people to provide care rather than simply complete tasks.
And I'd like greater transparency about where the considerable sums paid by residents and families actually go.
Most of all, I'd like us to stop thinking of residential care as somewhere people simply go to wait out the final chapter of their lives.
They are still living.
Because one day, it could be us
Perhaps that's the thought we should all hold onto.
One day it could be my chair beside the window. My photographs on the bedside table. My name written on the door.
I might be the person who needs help getting dressed. I might tell the same story three times. I might need someone to remind me where I am.
And if that day comes, I don't need luxury. I don't need a chandelier in reception, beautiful brochures or expensive furniture.
I would want something much simpler.
Enough staff. Well-trained staff. Staff who aren't exhausted and rushing from room to room. Someone who has five minutes to sit beside me and see the person I still am.
Surely, after a lifetime of contributing, working and paying into society, that isn't too much to ask.
And surely the people providing that care deserve to be properly valued too.
Because how a society treats people when they are at their most vulnerable says an enormous amount about that society.
Growing old should not mean losing your savings, your dignity and your voice all at the same time.
And I think we need to start talking about it.
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