The Care of the Old
By ANGUS MAUDE, M.P.
THE problem of the support and care of old people is becoming every year more serious ; its seriousness, however, is at present apparent only to those whose connection with politics, local government, medicine or social work has forced the problem upon their notice. Moreover, the ability of the State to cope with the problern 'is becoming more doubtful. The economic difficulties appear increasingly alarming. A hundred years ago there were one millimi people in Great Britain over the age of 65, and they represented less than 5 per cent. of the total population ; for every old person there were nearly 13 of working age. Today there are more than 5} million old people in the country; they represent nearly 11 per.. cent. of the population, and there are only about six people of working age to support-each one. In 25 years' time there will be 8+ million over the age of 65-16 per cent. of the population, and with only four workers to each of them. The cost of State retirement pensions, now about £273 million, will then be more than £500 million a year.
Economists and others may well wonder how this bill is to be met. The economic implications are obvious: no matter how diligently people save during their working life, nor what proportion of the State retirement pension is financed by compulsory contri- bution, the money incomes of pensioners can be converted only into that quantity of goods and services which the active workers are prepared to produce for them. If the proportion of pensioners becomes very high, and the productivity of workers does not sub- stantially increase, the money claims of pensioners will inevitably be scaled down by the simple process of an inflationary rise in prices.
The symptoms visible today are not encouraging. The cost of living is steadily rising, with the result that old people find it increasingly difficult to subsist on their pension, even when aided by the National Assistance Board. The natural reaction has been a simple demand of pensioners' organisations for an increase in rates of pension ; a basic figure of £2 a week is their current aim. To the pensioner an increase in rates appears the only remedy against the increasing cost of living. The inflationary effect, how- ever, would be almost too appalling to contemplate. In short, only a combination of three things will ever- solve this problem. The rise in the cost of living must somehow be halted ; the productivity of workers must be continually increased ; and the unbalanced age- structure of the population must be redressed by an adequate birth-rate. Unfortunately, the third requirement will not be fulfilled if the clamant needs of old people are met at the expense of young potential parents. There is, indeed, a very real danger of a political conflict between the needs of old and young ; and, since there are many millions of old people, all of whom have votes, it is not difficult to see on which side the scales are weighted. This is not, of course, to say that the present position of old people cannot, or should not, be substantially improved. What is certain, however, is that most of the steps which must be taken lie outside the range of State welfare services, and that any substantial addition to the financial burden cannot be contemplated.
So long as the proportion of old people in the population remains unhealthily high we must help them to play their part in contri-
buting to their own support. This problem is in part medical, in part industrial. Before the war, when mass-unemployment over- shadowed all other political and economic problems, early retire- ment from work was considered to be desirable in the interests not only of the individual but of the economy. Now, when the work to be done far exceeds the capacity of the available labour force, the economic arguments for early retirement have disappeared.
It is now also realised that there are strong medical arguments against premature retirement in individual cases. Elderly people who are suddenly bereft of interesting work which is within their physical capacity often become prematurely senile and infirm. Industry as a whole has hardly yet begun to organise the provision of suitable jobs for elderly workers who would be willing to con- tinue work beyond the present retirement age. A recent survey of the medical problems of old age by a committee of the British Medical Association made it clear that the useful life of elderly people could be greatly extended. At present far too many old men and women are rendered permanently infirm or bedridden by the lack of special hospital facilities designed to cure them of passing ailments and send them out fit and healthy to lead normal lives. There is an urgent need for more specialised geriatric* hospital departments. Old people are competing for hospital beds with other patients, to the great detriment of both. It is almoi certain that if the medical problems were solved the physical and mental con- dition of the elderly in this country would show an improvement so marked that the retirement age for men could be raised quite soon to 67, and probably to 70 in the course of a generation. The economic arguments for capital expenditure on this part of the National Health Service are therefore overwhelming.
The problem of housing for old people can be more easily solved. At present it is probable that not more than 2 per cent. of the old live in institutions. Of the remainder probably more than half live with their children, but no doubt this proportion would be reduced if the housing shortage were less acute. There are not enough institutions of the right kind, and most local authorities look forward to the day when they will be able to provide more homes of the type envisaged in the National Assistance Act, 1948. Many local authorities keep a close watch upon the conditions in com- mercially-run homes, but some of them are still very bad. So are some of the charitable institutions ; but it is only fair to add that most of the charities were founded to meet conditions quite different from those of today, and there is a strong case for a revision of the terms of many trusts to enable the trustees to undertake neces- sary reforms.
The proportion of old people living in institutions will, however, always be very small. Further, if medical care of old people is greatly improved, far more of them will be able to live in their own homes without having to rely on the daily care of their children. It is often said that there is a large number of old people living in houses too big for them who would willingly move into smaller dwellings if they could be provided, thus releasing houses for young and expanding families. It is -possible that the number who would be ready to make such a move is smaller than is commonly sup- posed, for old people will often put up with considerable incon- venience in order to keep spare rooms to enable their children and grandchildren to visit them. But there is certainly a demand for many more small, easily-run homes for the aged than at present exist. These should not, however, be planned in such a way as to segregate numbers of fit and healthy old people into colonies. It is most desirable that the young and the old should live in a neigh- bourly relationship which makes it possible for old ladies to look after their young friends' children during periods of domestic crisis, and for young people to help the old in their occasional difficulties.
Even though the size of the problem is not yet fully realised by the general public, progress is steadily being made in nearly all fields. The interest and munificence of the Nuffield Foundation have resulted in the publication of the results of some important research and in the undertaking of some most promising welfare work. There is now a National Corporation for the Care of Old People * Geriatric—concerned with old age. and large numbers of local branches of the National Old. People's Welfare Committee. The task will always have to be shared by the State bodies, local authorities and voluntary organisations ; by far the greatest scope for fresh work is to be found in the voluntary field. Many local authorities are running excellent services for the provision of home helps, home meals and home nurses, but they will probably never be able to cover the whole field even with these services. The provision of old people's clubs, outings and visitors is primarily the responsibility of voluntary bodies. There is an enormous amount of most valuable work which could be undertaken by individuals. If every family which is not directly responsible for the care of an aged relative would " adopt " one old person in its neighbourhood the welfare problem would quickly be solved. Old People's Welfare Committees will Out enquirers in touch with lonely old people ; the most important task is then to pay regular visits, designed to ensure that the pensioner is well and happy, and to assist with the provision of company and comforts.
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