sitting on backless forms, or benches. They had no privacy, no possessions, not even a locker. After I took office I gave the old people comfortable Windsor chairs to sit in, and in a number of ways we managed to make their existence more endurable.’ In 1947 a Nuffield Committee argued that the character of workhouses needed to change, and that elderly persons should be accommodated in small homes to enhance their care.
The Second World War made life much harder for older people. As families became separated‚ or lost their main breadwinner‚ the problems faced by older people were compounded. People soon realised that the ‘poor law’ provision of the time was woefully inadequate. In 1940 a group of individuals‚ as well as governmental and voluntary organisations, came together to discuss how this situation could be improved and formed the Old People’s Welfare Committee. With the birth of the welfare state in the 1950s‚ local and national government money became available to fund local work with older people. In 1971 the committee became completely independent of government and got a new name—Age Concern. High unemployment in the early 1980s caused Age Concern to join in government job- creation and training schemes. It drew attention to the plight of older workers who were unable to return to work because of long-term unemployment or redundancy. Age UK, a new charity combining Age Concern and Help the Aged, came into being in spring 2010.
The transition of the term ‘elders’ to ‘the elderly’ was probably due to the industrial revolution and improved health, leading to an increase in the number of older people. The economy had to be revised to accommodate an increased share of the population no longer in the work force. The first state pension in Britain was paid on the 1 January 1909, recognising the needs of the elderly. But it was just 5 shillings a week—
In the present system calculating your state pension is quite complex. The state pension age for men is 65, and that for women is increasing from 60 to 65 in 2020. For both men and women, the state pension age will then increase from 65 to 68 between 2024 and 2046. A single person on a basic state pension currently gets a maximum of
Before the Second World War there was virtually no interest in old peoples’ mental or physical health. Old age psychiatry was recognised as a speciality by the Department of Health only in 1989, but it is now a rapidly growing speciality within psychiatry. Dementia often brings critical needs for care, but sufferers who own more than
Even so, there is a very high contribution by families to caring for the elderly. An estimated 6 million people in Britain provide unpaid care for elderly spouses, parents or disabled children. That’s nearly 10 per cent of the population. These carers get virtually no financial reward, though there have been unfulfilled promises by the previous government. They rarely get even one week’s holiday. Huge numbers of carers make a contribution to caring in later life. Wives and daughters are more likely to help with caring, as males hire carers rather than doing it themselves. Over 1.5 million carers are themselves aged over 65 and an estimated 8,000 are over 90. Increasingly, care involves very frail couples, where the traditional boundary between carer and cared-for becomes blurred. At present individuals and the state split the costs of paid care roughly 50/50. But paid-for care is dwarfed in scale by support provided by unpaid carers, usually family members. In April 2010 the Labour government published a White Paper on care for the elderly that proposed that no pensioner will have to stump up the fees for care homes if they are there for more than two years.
As many as one third of the over 85s need help climbing steps, and a quarter with bathing or showering. Both the government and local authorities want many more people to stay in their homes with support, rather than going into more expensive care homes. That policy has been welcomed by campaign groups, but they are now questioning whether enough effort is going into regulating home care, and whether local authorities are trying to provide it on the cheap.
There are over 21,500 care homes, nursing homes and residential homes providing adult and elderly care throughout the UK. In England an estimated half a million physically disabled elderly are living in care homes or long-stay hospitals, and most of these are paid for by the state. The sick are treated free on NHS, so the NHS is responsible for meeting the full cost of care in a care home for residents whose ‘primary need’ for being in care is health based. But if one is simply frail and needs to enter a care home one must pay, unless one’s assets are less than
Some one in four of the elderly in developed countries will need long-term care of some kind, an enormous number. In the US, most elderly Americans live in homes they own—90 per cent live in their own home and most are satisfied with their living arrangements, and nearly half of those over 85 still live in their own homes. Just 4 per cent of adults aged between 75 and 84 live in an assisted living facility, and for those aged 85 and above it is 15 per cent. About half of retirees in the US expect to not move from their home. For decades, Americans have depended on nursing homes to care for them in old age. But as the population rapidly ages, more care is shifting from institutions to homes, and more responsibility is shifting to families—a change of major proportions. Sweden has one of the oldest populations—5 per cent are 80 or older, and, remarkably, 94 per cent of all Swedes over 65 years of age still live in flats or houses. When planning housing and housing areas, Swedish municipalities are required to ensure that they are adapted to the needs of older people and those with disabilities. A further goal is for commercial and public services to be easily accessible so that the elderly can continue living at home and looking after themselves.
In China, it is seen as a great shame to put a parent into a nursing home and many are living alone, since there is only one child per family to look after them. The cost of sharing a home with a relative is, for the most part, borne by them and not the state. There are some advantages, such as grandparents caring for the young while the parents are at work. China has more than 40,000 elderly care institutions with about 1.7 million beds for its population of 145 million over 60, of whom over two thirds live in rural areas. Dementia is very high in China and so many more nursing homes are needed. About 13 million people aged over 80 are now in dire need of care. About one third or half of the elderly in large cities are without support from their children or a livelihood.
For Holocaust survivors, ageing presents an enormous challenge. In Israel there are 50,000 Holocaust survivors living below the poverty line. Having survived Hitler and the Nazis, they are now struggling with a new obstacle, the ageing process. Many are now widows and widowers; they can feel isolated, depressed, alone and anxious. Each individual’s ability to cope with the challenges of illness and ageing is complicated by the suffering, loss and deprivations they experienced during the Holocaust. One son reported: ‘My father had to be put on a feeding tube because he couldn’t swallow. He kept asking me—Why are they doing this to me? They’re starving me like the Nazis did at Auschwitz.’
Seventy per cent of care in the home in the UK is now carried out by private companies. All councils have a duty of care to appoint only those private companies whose record of competence they can verify. In the UK the choice of those who will care for the elderly has recently been severely criticised: the NHS has had a special kind of auction to appoint organisations which will care for the elderly, particularly those with dementia, and those involved were asked to reduce their costs and then participate in reverse auctions, where bids are driven down, not up—the lowest bid being the winner of the contract. To choose a carer on such a criterion seems immoral, and one company that won such an auction had the contract removed a few weeks later as their caring was so poor. To ensure that
