Older Age: A Time of Truth

The title for this blog echoes a publication celebrating its 50th anniversary this year. In 1971 Michael Wilson’s The Hospital – A Place of Truth was published by the ‘University of Birmingham Institute for the Study of Worship and Religious Architecture’. The snappy title of the Institute does little justice to the work it sent to print. Wilson’s study is the first thorough, academic and professional enquiry into the role of the hospital chaplain. It took place between 1967 and 1971, and is well-written, with a scope that is broad and deep. Inevitably couched in the culture of its time (and a national church which didn’t enable women to be ordained), there is a wealth of valuable insight and evidence in its 385 pages. For example, we learn that the first Muslim chaplain had been appointed the year before publication. This landmark research remains a seminal example of an approach which is still relevant to chaplaincy today. In particular, Wilson asked all constituencies in the hospital and local community about what they found important concerning the presence of a chaplain. If you wish to know more about the publication James Woodward’s “The relevance of Michael Wilson’s chaplaincy research for healthcare chaplaincy today” is well worth reading.

In the 1960s institutions had very clear boundaries. In many cases staff lived on the site of the hospital. Today those boundaries are more porous and there is a constant but incomplete drive to make health care about a pathway rather than a place. For example, it has long seemed inequitable and undesirable that the experience of end of life care should depend so much on location. The contrast of final days spent on a busy general medical ward and those spent in a hospice bedroom, could not be starker. Despite all the efforts of skilled and committed staff, we are still working to make palliative care equally excellent in all settings.

Nevertheless, I would argue that place in now relatively less important when it comes to care than it was in the 1960s. While still significant settings, hospitals are not the kind of ‘total institutions’ once described by Erving Goffman. When considering older age I’m inclined to focus more on the experience than on the location. Whether in homes or places or care, many characterises of ageing remain the same.

Nearly a year ago I reflected on the conundrum of how institutions embedded in almost every community seem to be politically invisible. Despite the fact that most scientists and politicians have visited these communities, or have relatives living in them, it appears that we choose not to think about the realities of their complex operation. In March 2020 wild and wholly irresponsible assumptions were made about the safety of care homes in a pandemic. In September 2021 the supposed solution to the funding of social care almost entirely misperceives the needs of these vital care settings.

“Staff are dealing with their own ageing whilst also observing the ageing of their patients and the reaction to this of the relatives. None of this is particularly easy and spiritual practices seemed to help staff manage these complexities”

Mowat, Harriet. “Gerontological chaplaincy: the spiritual needs of older people and staff who work with them.” Health and Social Care Chaplaincy (2013): 27-31.

Ageing confronts us with truths about ourselves, and about our neighbours. These truths are not always easy to contemplate. It can feel in contemporary British society that we side with Shakespeare’s characterisation of our final years: ‘second childishness and mere oblivion’. Yet this is to allow our fears to avert our gaze before we can take the time to understand ageing and its effects with greater insight. It is the time of truth in as much the mastery of self, and in particular the suppression of desires, may give way as our cognitive capacities change. While relatives may often say their relation is ‘different’, sometimes that transformation reflects a clearer sense of identity and personality. Unsurprisingly we may fear this kind of truth for ourselves as well. A controlled temper may lose its restraint as the years progress. The truth is not always easy or comfortable. Yet ageing may equally well diminish a sense of fear and trepidation. There has been more than one centenarian sky-diver.

Last week I was reminded in one of the reading options for Morning Prayer that ageing can be seen in a number of ways. There is not, and never has been, only one interpretation of getting older.

“For old age is not honoured for length of time, or measured by number of years; but understanding is grey hair for anyone, and a blameless life is ripe old age”

Wisdom 4:7

It feels that in the UK Government’s settlement for social care an opportunity has been missed to learn the truths of the experiences of older people. The focus has been on finances and asset-preservation, rather than the understanding and retention of wisdom. The elderly are a political problem to manage, not a wealth of personality, love and experience to value. Somehow we need to achieve a breakthrough in how we relate to older people in our society. The cloak of invisibility needs to be removed so that we can see ageing as an important time of truth for us all – and not just for others.

The Aged Poor

There are many different things that can make us feel our age. From the commonplace of wistful reflection that police officers are looking younger, to the telltale bits of IT equipment in a film. ‘Look, it’s an Amstrad green screen’. In a world where the pace of technical change is ever faster this calibration of time is ever clearer. From the first appearance of computers, to the desktop PCs, then laptops and tablets, the clues to different decades are there to see in every movie. Seeing a production of Educating Rita at the York Theatre Royal last week was to behold a vanished academic setting. No computer; one-to-one tuition; books (and whisky) everywhere.

The consequences of ageing appear, ironically, to be timeless. Even as the UK government attempts to grapple with the question of how to fund social care, they are tackling a problem that is both ancient and modern. The Aged Poor in England and Wales is the title of the report written by Charles Booth and published in 1894. That was two years before the birth of my paternal grandfather who, like so many of his generation, troubled the exchequer very little (he died aged 69, having been predeceased by his wife). Yet demographics were changing and the question of how to support a population living longer into retirement was becoming more pressing.

“but for those who are not able-bodied, and these include almost all the old, each Board of Guardians is at liberty to adopt its own rules and to change them at will, or to act without any rules at all”.

Booth, C. (1894). The aged poor in England and Wales. Macmillan and Company.

In Booth’s report nearly 30% of the over 65s were receiving either indoor (Workhouse), or outdoor, relief. This sort of dependency and survival on minimal rations was not the kind of old age people wanted, either for themselves or for others. Rather than a life of comfortable leisure, the thought of retirement stimulated apprehension and fear. Not only were financial resources limited, but the NHS was decades away, leaving many dependent on charitable support and care – or to get by without health care altogether. As a curate in the 1990s I would meet older people who had harrowing memories of relatives suffering from illnesses which either lacked effective treatment altogether, or where treatment was unaffordable. It is not a situation to which any of us would wish to return.

Since social care lacks the coherence of a national service such as the NHS it can still feel potluck as to the quality of the care many receive. When I was involved in these decisions for my mother a few years ago, as her dementia advanced and her health deteriorated, the access to social care seemed haphazard. At the time when she needed to move from a care home to a nursing home I recall talking to a local manager who told me there was a room available but that ‘three people are interested in it’. What should have been a process focused on the needs of an older person suddenly took on the character of house buying. Would I get everything sorted in time, or would we be gazumped?

It is hard for people to understand the pressures and anxieties that the current situation creates for people seeking care. At a time when people are vulnerable and distressed the last thing we need is a system that is chaotic, and where there is no central co-ordination of supply and demand. Given that most of us will find ourselves in later life at some point, and in need of support, our inability to provide a decent level of care across society is symbolic either of a failure in self-care, or a fear to contemplate what we might one day need. Either way it is detrimental to us all if this situation is simply allowed to continue until it falls apart.

We are promised that later this week the UK Government will bring forward plans for social care. There is anxiety that while this may appear to be one thing it will turn out to be another. In other words, that the NHS will in fact receive the lion’s share of any increased funding. Yet instead of pitching one sector against another, we need both the NHS and social care to work together. One can never achieve its ambitions without the other; and older people can’t be left to fall between the gaps in service provision. The world has moved on since Charles Booth, but unless we have the political will to grasp this age-old challenge, we risk perpetuating a shameful dereliction of care.

It is likely that our unwillingness to resolve the way we support an ageing population reflects wider attitudes to older age. Age discrimination is frequently described as a widely tolerated part of society, and implies a failure to recognise the worth and dignity of people as they age. Just as in Educating Rita, where the student is also a teacher, we need to understand that socially constructed roles are often less clearcut than they seem to be at first sight. We should never underestimate the value of people in later life or the lessons their lives, and even their needs, can teach the rest of us.