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.

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