How our society treats the elderly is one of the issues thrown up in the midst of the coronavirus pandemic, when considering how we treat our most at risk groups. This demographic has been let down by our government, as is true in other highly developed countries. It is a direct result of societal attitudes towards ageing and the Western compulsion to contain the burden of age in institutions.
How we got to where we are now
The origins of aid for the elderly in England are directly linked to the origins of relief for the poor. This comes in the initial form of Tudor poorhouses, with a real development in the Poor Law of the 1800s which provided some shelter for those who could not support themselves in the form of workhouses.
This residential option was not viewed favourably due to the relief being bundled with negative connotations of the aged, the poor and the sick. In 1892 for example, only a third of the population over the age of 65 had required relief at some point throughout the year.
It is not until 1930 that we see the abolition of the old system of workhouses with an appreciation that they were not meeting the widening needs of the elderly. By 1948, the majority of workhouse buildings were converted into care homes but the question remaining is: has our use of these institutions to carry the ‘problem’ of ageing really changed?
Two crucial shifts occurred. The first was in 1920, which saw a drastic increase in the number of people living in care homes — from 26,000 patients in 1921 to 55,000 a decade later. The second began in the 1980s when private care homes were on the rise — now comprising 84 per cent of all such homes.
Currently, the Care Quality Commission inspects care homes at least every three years and the standard of care provided has been on a positive trajectory throughout the twenty-first century. Abuse within these institutions however has been making headlines in recent years, with an 82 per cent increase in 2018 from 2014. This is partly due to better reporting but nonetheless represents the astounding reality that abuse is a swelling tragedy.
Standing West and looking East
Looking to other cultures we see different attitudes resulting in unique practices. The overarching influence of Confucianism throughout Asia can be seen through everyday action. The core principle is that of filial piety, meaning to respect one’s parents and act accordingly towards the elderly living inside or outside of the family unit.
In Indian culture elders are viewed as the heads of family and have distinct roles within it. These include helping to give to charity and aiding the upbringing of children. There is also a distinct stigma attached to sending the elderly to care homes.
Similarly, Chinese grandparents are go-to babysitters for young professional couples due to a combination of factors. Most interestingly, the country’s previous one-child policy has meant that many couples would have a child at a young age to insure its health. As a result, it’s often the case that both parents are in full-time work while grandparents provide childcare support.
Another interesting fact is that the Chinese Elderly Rights Law introduced in 2013, urges adult children to visit their parents in a bid to tackle loneliness. Despite being riddled with inadequacies, it states that adult children should ‘never neglect or snub elderly people’, demonstrating an attitude that this responsibility is binding.
Studies have shown that economic development and industrialisation are strongly associated with less favourable attitudes towards ageing as a whole. How societies modernise also plays into this. In highly industrialised societies we see a break from the traditionally valued modes of production. The societal position of older people with traditional skills becomes undermined. It is not as simple as asserting a West/East or developed/undeveloped dichotomy between differing attitudes. Rather, it depends on a complex mix of values and belief systems, alongside economic processes that contribute to the formation of particular attitudes towards ageing and a society’s subsequent treatment of the elderly.
The inadequacies of Western care
The utility of care homes cannot be rebutted completely. Seventy-three per cent of Bupa care home residents in the UK are receiving ‘nursing care’ which may be difficult to achieve at home. There are, of course, also circumstances in which care homes offer the best option as a compromise between reduced freedom and necessary medical attention.
That aside, we really should be placing the needs of the elderly higher on our to-do lists instead of shifting the responsibility to another physical space. This is especially so during the present coronavirus pandemic when the elderly have clearly been treated as a mere afterthought by countries that pride themselves on their progressivism.
Take Sweden, which ranks 8th in the Human Development Index. The elderly in its care homes have made up half of the total number of fatalities during this pandemic. This has resulted from such policy recommendations as allowing care workers to not wear protective equipment, including masks, unless dealing with a resident they suspect to be infected, and instead of ordering only asking people to take social distancing measures.
Similar worries face the UK over PPE and testing of those working in care homes with vulnerable residents. This concern was reflected in a letter to Matt Hancock, signed by various organisations including the Alzheimer’s Society, Marie Curie and Care England.
One result of this lack of testing alongside the economic incentive to keep care homes open is that deaths of the elderly are often attributed to other diseases. This group of people are simply not given the visibility that comes from being represented in national statistics. Their hurried inclusion into the data six weeks into the crisis reads more like an apologetic afterthought.
In March, there were horrifying revelations of the Spanish army discovering care home residents having suffered from being ‘dead and abandoned’. No other image so clearly confirms the general indifference for the elderly in this scramble.
Our ageing population is the outcome of medical and social progress. But alongside this progress the sense of responsibility has been lost. We must retrieve the elderly from the outskirts and peripheries of our towns, and back into the social fabric and the family. They should reclaim their status as valuable and valued members of our society who are also amongst the most vulnerable.