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Who Cares?

Older people deserve good care, but who are the carers?

Over Christmas, the most common topic of conversation among friends seemed to be the challenge of helping elderly relatives to sort out care.  I heard comments such as "My dad's 88, we've just arranged for a carer to drop round every day" and "Grandma is 94 and in assisted care, while Grandpa is 96 and has just moved into a nursing home, they're going to have to sell the house."

As people get into their 80s and 90s it becomes a lottery as to whether they're going to need full time care or not.  The older you get, the more likely you are to develop dementia, and in the latter stages of dementia full time care becomes essential.

The cost of full time care is eye-watering.  A recent report in the Guardian talked of a home dedicated to caring for Alzheimer patients that was "great value" at £1,400 per week compared to the £2,400 per week that some homes were charging.  £1,400 per week is £70,000 per year.

These days there are of course hundreds of thousands of retirees who can (in theory) afford this, many from relatively modest backgrounds, thanks partly to the property lottery. Those council tenants who used Right To Buy to purchase their terraced house in Battersea at a heavy discount in the 1980s are now millionaires. Their peers who did the same thing in Burnley, however, are not.

It's one thing to be able to afford care (by selling your home if necessary, or the family chipping in), but you also need people who will GIVE that care. The job of caring for an Alzheimer's patient is extremely challenging and requires particular skills, including patience and empathy when dealing with somebody who might be constantly confused and anxious.  Alzheimer's patients can be aggressive too, and have a tendency to wander - which means they have to be brought back to their room against their will.  Patients need to be fed, dressed and also cleaned - and we're not just talking a quick flannel wash, there might be soiled underwear to deal with several times a day.  And for doing all this, the carers are paid a pittance.

So who exactly are we expecting to offer this care?  In her late 80s my mum reached a point where she was going to need a level of dedicated care that nobody in the family could offer without giving up their job and making major adaptations to their house.  Luckily we were able to find a fantastic nursing home where mum spent her last two years.  The majority of the carers were Eastern European or Asian.  That was ten years ago.

For every one person needing full time care, as a rule of thumb there needs to be one person whose full time job is to do the caring (particularly once you take into account shiftwork, admin etc).  And the number of elderly people requiring full time care is growing rapidly thanks to a combination of greater longevity and the baby-boomers hitting their eighties.  In a few years time we're going to need millions of people to spend their working hours as carers or managers of carers.  Many of these will be a retired family member (spouse, sibling etc).  The rest will be people who are being diverted from doing other jobs - teachers, engineers, cleaners and the rest.

This will inevitably have an impact on the economy. But more to the point, we want those "carers" to actually "care".  Who are those future carers?  Are they you? Me?  Our children?  Migrant workers?  Is caring for the elderly a career that we expect a large portion of the next generation to aspire to?  Who is going to care for me, if the day ever comes?

It's easy to say that we all deserve to be well cared for until our dying day, but we also need to look at the numbers, and ask where those carers are going to come from - and why they should care.