The price of longevity is degradation of the elderly

The care of the elderly passing from family members to institutions is one of the apparently irreversible  developments in all cultures today. It is not just a phenomenon of “Western” civilization but is a trend across the globe. As “joint families” have given way to nuclear families and as couples have both gone out “to work” and as the elderly desire greater independence and as people live longer, the responsibility for the care of the elderly has passed to institutions from ever-more burdened children or relations.

But a model for institutional care – whether by private players or the State – which works without the degradation of the elderly has yet to be found. I suppose the fundamental reasons are that

  1. to die quietly and with some dignity and with as little discomfort as possible is only of value to the dying,
  2. those who are “in care” have limited opportunities to make themselves heard, let alone to complain,
  3. those “in care” are no longer worth very much to the society they live in and are only seen as a cost,
  4. even for the relatives and children of those in institutional care, the elderly are seen primarily as “duties”  and they would rather not complain if the only solution is a responsibility devolving upon themselves, and
  5. for institutions providing care there is always a  financial benefit to not providing care and they get no “extra bonus” when they do provide care.

In fact in some of the models of care, profits are maximised by increasing the number entering care and thereafter by minimising the time they remain in care (i.e. till they die). Even where costs are covered by various insurance policies, the actuaries assess the total cost from when the care starts till the time care terminates with death. And clearly once a policy has been paid for, the shorter the period spent “in care” the better – for the insurance provider. I can’t help feeling that the institutional care industry is primarily for the owners (private or state), for the employees, for insurance companies, for politicians and for the relatives of the elderly. It should not be impossible for payments (or other benefits) to be connected to the documented delivery of quality of care. I hope that some day institutional care will be seen to be primarily be for those “in care”.

I am sure there are some institutions which do provide good care but there are none which do not have a fundamental conflict of interest between providing good care and the pressures they are under to cut costs (or increase profits).

The greatest fear I have of getting old is not so much the pain or suffering or sickness or debilitation but the degradation one may have to undergo.

Over the last year Sweden and the UK have been shaken by scandals in the institutional care of the elderly. And The Telegraph reports today on deaths by “starvation and thirst” in institutional care!

Forty-three hospital patients starved to death last year and 111 died of thirst while being treated on wards, new figures disclose today.

….. The Office for National Statistics figures also showed that:

  • as well as 43 people who starved to death, 287 people were recorded by doctors as being malnourished when they died in hospitals;
  • there were 558 cases where doctors recorded that a patient had died in a state of severe dehydration in hospitals;
  • 78 hospital and 39 care home patients were killed by bedsores, while a further 650 people who died had their presence noted on their death certificates;
  • 21,696 were recorded as suffering from septicemia when they died, a condition which experts say is most often associated with infected wounds. ……

……..

The longevity that we are now all subject to is pointless if it only increases the degree of suffering to be endured. Living longer must needs also provide an option for a quick and painless departure from this mortal coil. I would rather not die – when my time comes – of slow starvation or dehydration.

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