Of carers and careers

‘The most serious social policy issue in decades,’ is how the Centre for Social Justice (CSJ) describes the ageing population and, in particular, its need for social care. Yet there’s quite astonishing apathy when it comes to planning for what’s about to hit us – the 1.7 million more people who will need social care over the next 20 years and projected doubling of those with dementia in the next 30 years.

The CSJ, a think tank founded by Iain Duncan Smith, highlights this paradox in its Interim Review of Older Age, a 250-page assessment of the state we’re in. Recommendations will follow in a final report due out next year.

Why aren’t we better prepared? Is it that nobody wants to think about ageing? That we can’t imagine it will happen to us? Is it the fault of the financial services industry, for not coming up with insurance products? Should governments have worked harder to resolve the tangled relationship between healthcare (free) and social care (means tested)?

The fact is that the soaring demand will come at a time of spending cuts and falling numbers of unpaid carers. The Centre for Social Justice attributes the latter largely to family breakdown, which is certainly a factor although there is also a more general atomisation, a feeling that individuals’ duties are first to themselves and their careers. Old people and our kind of capitalism don’t go very well together, unless the old people happen to have done extremely well financially earlier in life.

In a recent poll for ippr, the Institute of Public Policy Research, 45% of those asked said they would prefer professionals to provide care while a majority felt they should not be compelled to pay for care of their relatives. Many people believe social care is, or should be, the responsibility of the state. Unfortunately for them, the state is much less convinced. (The government’s recent Vision For Social Care talks a great deal about individuals, community groups and the Big Society.)

The scale of the problem is terrifying, the lack of preparedness more terrifying still. And every single discussion about it concerns money. We might find it easier to think about the issues if we looked down the other end of the telescope, if we started by asking: What would good social care look like? How might it genuinely involve both the social, and caring? Then maybe people would find care less horrible and overwhelming to think about, and we could begin to have a sensible debate.

Worth remembering

Nora Ephron

If you’ve ever rummaged frantically through the accumulated rubbish in your brain for someone’s name at a party, you will relish Nora Ephron’s latest book, I Remember Nothing. Ephron, who wrote When Harry Met Sally, Sleepless in Seattle, Heartburn and, most recently, Julie and Julia (which she also directed) has published a new collection of blogs, columns and jottings, in several of which she addresses the depradations of age with her characteristic wit and verve.

The articles are of variable length and some seem rather more tossed off than others, but Ephron is incapable of being boring. The opening piece, which gives the book its title, is stylishly constructed and full of good jokes about the awfulness of losing your memory: ‘I used to think my problem was that my disk was full; now I’m forced to conclude that the opposite is true: it’s becoming empty.’ Ephron goes into a store to buy a book about Alzheimer’s Disease and forgets its name; she spots a woman in a Las Vegas Mall and wonders why she recognises her, only to recollect that she’s her sister, the person she is there to meet.

In one of the best passages, she describes attending an anti-Vietnam march in her youth – or rather, not attending it because she spent most of the day in a hotel room having sex with the lawyer she was dating at the time.

Norman Mailer wrote an entire book about this march, called The Armies of the Night. It was 288 pages long. It won the Pulitzer Prize. And I can barely write two paragraphs about it. If you knew Norman Mailer and me and were asked to guess which of us cared more about sex, you would, of course, pick Norman Mailer. How wrong you would be.

Ephron blogs for The Huffington Post and the pieces in the book reflect a wide range of interests – her love of journalism; the alcoholism of her parents; her online Scrabble addiction; and a moving piece about her identity having been defined for most of her adult life by the fact of being divorced. But it’s the pieces about ageing (Ephron is 69) that bookend the selection and give it resonance. ‘You lose close friends,’ she writes, ‘and discover one of the worst truths of old age: they’re irreplaceable.’ This is a particular, spiky, charming take on ageing, fiercely individual but very recognisable.

Purpose Prize winners 2010

Allan Barsema

A former homeless alcoholic and a housekeeper are among this year’s winners of The Purpose Prize, a $100,000 award for entrepreneurs over the age of 60.

The five winners, announced today, were selected by a panel of judges chaired by Sherry Lansing, former CEO of Paramount Pictures and the first woman to head a Hollywood studio.

Sherry Lansing

Among them is Allan Barsema, whose alcoholism cost him his marriage, his home and his job, and who lived for a period from a trailer pulled behind his car. With help from his parents, he managed to stop drinking and to re-establish himself in work; and when, 10 years later, a homeless man barged into his construction company, he decided to set up a room for homeless people in his offices. At the end of that year, 2000, his work with the homeless had become so consuming that he devoted himself full-time to his centre, Carpenter’s Place. He settles 300 long-term homeless people in accommodation each year and has set up an innovative online system to coordinate services for the homeless, Community Collaboration, which has been adopted by 140 agencies in five states.

Margaret Gordon

Margaret Gordon started reading environmental magazines in the house she cleaned and began to link pollution from the nearby container port to the one in five children aged between one and five in her home town of West Oakland who were being rushed to the emergency room  with asthma. Her analysis and campaigning has reduced diesel fumes and pollution from West Oakland’s port and she has been appointed by the Mayor to monitor toxic emissions.

Barry Childs

Barry Childs is a former corporate executive who has set up a project to provide care and schooling for children, mainly orphaned by AIDS, in Tanzania, which has ended up helping whole communities.

Inez Killingsworth

Inez Killingsworth worked for the Cleveland Board of Education before she started fighting banks that had mis-sold mortgages and were turfing people out of their homes, demonstrating to them that they were wrecking whole neighbourhoods as well as individual lives. By fighting foreclosures, she has helped more than 10,000 families keep their homes. She has appeared in front of Congress and become a national spokesperson against shady mortgage practices, and a campaigner against the hefty penalties imposed by banks for missed mortgage payments.

Judith B Van Ginkel is a professor of paediatrics who, at the age of 60, created a home visits programme for first-time mothers at risk, half of whom were clinically depressed, and two-thirds of whom had witnessed violence or been victims of violence. Mothers in the programme are visited from the time when they first discover they are pregnant to when their children are aged three and can access help with health concerns, literacy, parenting and education.

Judith B Van Ginkel

So, five people with very different backgrounds, but a common desire to achieve something for others in the later part of their lives. You can see short films about all the $100,000 winners here; and there is more information, including about the five more $50,000 winners here. Oh, and please, Europe needs a Purpose Prize, too.

Design for living

People of 80 or 90 plus who are eking out their lives in nursing homes with very poor quality of life are, according to New York geriatrician Mark Lachs, an indictment of society’s priorities. ‘I would argue,’ he writes, ‘that the “life extension” these people have experienced – a good deal of it the result of technology – is as big a failure of medicine as any 40 year-old dying of breast cancer or 50 year-old perishing of a heart attack.’

Dr Lachs is the author of Treat Me Not My Age which, despite its title, isn’t mainly a book about ageism in medicine, but about how to avoid becoming one of those people with half-lives, detached from the world, fading away even while being kept alive by the ‘miracle’ of modern science. Some of Lachs’ prescriptions are familiar – he emphasizes the crucial role exercise plays in delaying immobility – but he also draws on fascinating work being done at Cornell University’s Weill Medical College, where he is professor of medicine, on the ways in which design can allow people to remain at home and connected to the world.

Architects typically base their designs on the body measurements and movements of people aged between 20 and 50 with no visual impairments. In an ageing population, this is a serious problem for housing, not to say discriminatory. Sometimes the modifications that would, for example, prevent falls – using contrasting colours for seating and carpets, or ensuring that there is good lighting in hallways, especially between bedroom and bathroom – are inexpensive and, once you have been alerted to them, glaringly simple.

Mark Lachs’ book led me to the Environmental Geriatrics website of his department at Cornell and to its offshoot This Caring Home, both of which are full of tips for intelligent design for homes. It’s worth looking at the multimedia course, which is aimed at medical students but is fascinating for anyone, to see what it’s like to go downstairs with perfect vision, then again with glaucoma or macular degeneration.

Older and wiser?

But not if you're over 55?

A couple of items of news pose the intriguing question of what impact an older population will have on politics. To take the more trivial first, research in the UK suggests that over-55s are blocking the development of wind power, consistently leading campaigns against wind turbines that would benefit future generations. On a rather more serious scale, Republican success in the US midterm elections is being widely attributed to the voting patterns of an older electorate.

In the past, there has been quite a lot of hopeful propagandizing for the view that the radicals of the 1960s will turn into the public-spirited utopians of the 21^st century. Theodore Roszak, once the chronicler of the counter culture, speculated in his recent book, The Making of An Elder Culture, that upcoming generations of older people would be like no others we’ve seen.

‘The old are not a good audience for a dog-eat-dog social ethic,’ he wrote. ‘If anything, they create an ambience which favours the survival of the gentlest.’

Yet the ambience of the midterm elections was overwhelmingly angry. The tea party movement is the outgrowth of that anger and, according to Ed Pilkington of the Guardian, who spent much of the campaign on the Tea Party Express bus, the average age of those attending its rallies was over 50, with pensioners particularly visible.

In Florida, where 35% of voters are aged 65+ (compared to 23% across the nation) Marco Rubio was the tea party’s most prominent success. The 65+ vote across the United States went Republican by a 20 point margin. Not so much for liberals to cheer about there, then.

The British writer Fred Pearce has speculated that rather less testosterone in world affairs could turn out to be a very good thing and that the ageing population may bring about ‘a permanent end to patriarchy,’ given that it will probably be dominated by women. Anyone who assumes that this will mean a less confrontational, more empathetic and environmentally conscious group of elders should look at the research published in the last couple of days, which suggests that only six out of 10 over-55s support the development of wind farms, compared to 86% of 16-34-year olds and 100% of under-24s.

So will the very large group of older people associated with the ageing population be more idealistic than the old have ever been before? Or will they carry into old age qualities that owe more to those other babyboomer features, self-centredness and a sense of entitlement?

After Tuesday’s elections, the ambitions of those who believed, with Theodore Roszak, that ‘free-market economics and the elder culture are not a good fit,’ must feel rather shakier. The hopefulness that characterised the presidential elections in 2008 has evaporated. Apart from anger, the defining attitude of the electorate as expressed to exit pollsters was pessimism.