Radical thinking is needed to solve the elderly care crisis

elderly handsFOR richer, for poorer, in sickness and in health – the promise seems straightforward enough. But how many of those tying the knot truly consider how much their lives would change if one spouse ended up as the full-time carer of the other? And just how much poorer they might be as a result?

“Nobody should face poverty because of the care they give,” said Green MSP Alison Johnstone at Holyrood on Wednesday, as her party proposed lifting Carer’s Allowance to £93.15 per week – far higher than the levelling with Jobseeker’s Allowance pledged by the SNP. She had stark statistics to back up the policy: according to Carers Scotland, one-third of carers struggle to pay utility bills and almost half have been in debt.

Meanwhile, a recruitment and retention crisis means Scotland is crying out for professional carers, at a time when the population is ageing, and local authority budgets are under severe strain. Against this challenging background, campaigners are seeking the extension of free personal care to those under 65 with debilitating conditions.

But throwing money at care would not be enough to guarantee every older person’s day-to-day life was happy, healthy and dignified

If money was no object, the solution might seem obvious – support family carers so they don’t struggle to make ends meet, and pay professionals a living wage for their physically and emotionally demanding work (including for “sleepover” visits during which they remain on call). But throwing money at care would not be enough to guarantee every older person’s day-to-day life was happy, healthy and dignified.

When elder abuse is mentioned, most probably think of heartless workers assaulting and humiliating those in their care, and being caught on CCTV. The tragic reality is that abuse of the elderly by family carers may be much more common, not least because it occurs behind closed doors, in private residences. A study published last year in the Age and Ageing journal found more than a third of family carers exhibited “potentially harmful behaviour” ranging from name-calling and shouting to rough handling and assault – and this was based on self-reports by carers themselves.

More than a third of family carers exhibited ‘potentially harmful behaviour’ ranging from name-calling and shouting to rough handling and assault

Living in poverty is likely to exacerbate stress for those with caring responsibilities, especially when they have given up paid work to care and have no idea when – or even if – they will be able to return to employment. But it is not the only factor to consider when assessing what kind of living situations are best for people with significant needs. During this week’s debate Labour MSP Colin Smyth paid tribute to the “unsung heroes” who save the state vast sums every day – estimated at nearly £11 billion in Scotland – by caring for their relatives. But not everyone wants to be a hero, sung or unsung, and not everyone is suited to caring.

So what’s the alternative? At the moment it appears there are only two stark options: stay at home, to be cared for by either relatives or over-stretched paid workers, or “go into a home” and become just another service user preparing for death. But what if there are third and fourth ways that allow old people to retain some independence while staying safe, or even add joy to their lives? And what models should local authorities be looking at when planning housing for future elderly generations?

A good place to start would be the Intergenerational Learning Center at Providence Mount St Vincent in Seattle, where during the week elderly residents live alongside pre-school children. Many of the youngsters are the offspring of the care home’s staff, and the waiting list for joining is years long. The centre is the subject of a documentary, Present Perfect, due out later this year, and clips show touching interactions between frail residents and the youngsters who treat them like grandparents. This is no passing fad, either – the model has been in place in Seattle for more than two decades and the idea of bringing young and old together has since spread to Oklahoma, Canada, Singapore and Japan. Closer to home, a three-day experiment taking Welsh pre-schoolers into an elderly daycare centre was recently filmed for a documentary, Hen Blant Bach, in which the participants teamed up to make hats, decorate cakes and tell stories (the title, which means “dear children”, comes from a Welsh-language song).

Future generations of old people will not be reminiscing about dance halls and wartime rationing – they’ll be digital native

While combining child care and elderly care makes sense on many levels – social, educational and perhaps even financial – it clearly also requires careful advance planning. A radically different approach is surely required if elderly care is to reflect huge changes to the way we live our adult lives. Future generations of old people will not be reminiscing about dance halls and wartime rationing – they’ll be digital natives who lived with Trump, terror and the move of The Great British Bake Off to Channel 4. Many more of them will be child-free and accustomed to living alone, but also better connected to peers thanks to smartphones and social media.

Our atomised modern society may appear to promote independence by supporting old people to live at home, but in fact it often leaves them entirely dependent on a spouse, son or daughter who may be unwilling to care or unable to cope. Decisions made now about the type of housing to build, and where to build it, could make the difference between how old people view themselves: as expensive, needy burdens, or as valued and included members of vibrant communities.

A version of this article first appeared in The National.

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