It could be you
Richard Comber on how the crisis in nursing care is adding to the horrors of senile dementia
Do you suspect you soon may be going to lose your marbles? And are you over 65? Or do you suspect your elderly parents may he going to lose theirs? Is this loss of faculties likely to be a serious one? Then do not inquire in New Labour's New Britain for whom the bell of despair tolls. It tolls for thee.
The care of the elderly mentally ill is in meltdown in much of the country and can only get far worse. It is a national disaster, made worse by the old and infirm who lack the energy and means to defend themselves. It is callous and shameful.
I was a community psychiatric nurse until I retired earlier this year with exhausted relief. Every day I came across tragedies which make the admirable Dr Theodore Dalrymple sound like an optimist. No wonder all who work in the field of dementia in the elderly are scared stiff they are going to 'catch it' from patients. Statistically, 15 per cent of the population will suffer from dementia eventually, usually either Alzheimer's or stroke dementia, and nearly half of that percentage will suffer very seriously. Demographically, the 'dementia bomb' is about to explode.
What is likely to happen? It all depends on the severity. Cases vary in degree and type. Many milder forms can be cared for at home if help is available. The worse the symptoms, the bleaker the prospects of any decent care. One of my carers, aged 80, has just had her grossly confused old husband placed in a specialist home 40 miles away. She cannot drive, has no children, few friends nearby and is severely arthritic. The old man cries for her at night and she for him. But she is relatively fortunate. She found a firstclass private home with devoted staff, who admitted him ahead of a long queue. True, it costs her £550 a week, hut her modest capital will pay for that until it is so reduced that social services will reluctantly begin to make a contribution. She is now utterly burnt out mentally and physically.
And why is this establishment so far from her home? Because I and my hardworking social-worker colleagues have, over the past year, filled every decent specialist nursing home in this area for miles around. We have to cast our nets further and further afield.
The number of old people is growing alarmingly. Guiltily, I must admit that now officially includes me; being 65, I am one of the 'young old'. (The 'middle old' are those aged 75-85 and the 'old old' are those over 85.) I am now one of the patronised. And never mind a half-century of paying tax and national insurance, I may one day be part of the problem. Or you, dear reader — and sooner than you think.
The explanation for the nursing-home crisis is threefold. First, many homes have closed down or are thinking of closing down. If their patients are state-funded, then in some areas they are expected to care for them at little more than cost. The reason for inadequate funding is simple: the government is well aware that brain damage in the elderly is a subject most people do not care to think about. This administration is obsessed with spin and image. Sadly, senile dementia does not have the heart-string appeal of sick children, obstetrics and gynaecology, cancer, heart disease, etc. And since all — yes, all — the National Health budget could in theory be spent just on keeping old people going, guess which area loses out in priority. Guess which medical consultancy area is least able to attract doctors. Guess which area of nursing is the hardest one to fill with good staff who will stay in their jobs. And guess which area of health will in the end need the most 'investment' (i.e., your money) in future years.
Second, legislation and grotesque paperwork have overwhelmed homes to such a degree that they can hardly keep up. Much of the pedantic verbiage is so badly written that it is impossible to implement. Some directives contain bossy hyper-regulation, and have been drawn up by people who never have done and never will do the real front-line care.
Third, and worst of all, there is a postShipman hysteria about being seen to 'cover ourselves' in the NHS. Staff are terrified of being sued, maliciously reported or aggressively confronted by contentious relatives. So moribund old people in hospital and nursing-home beds are having their decrepitude extended to the limit. No wonder beds are being 'blocked'. Bed shortages can only get much, much worse. Because of our society's terror of death, doctors are striving officiously to keep the dying alive. It's an unwritten but widespread policy. Numerous horror stories abound.
Pneumonia used to be called 'the old man's friend' but, alas, not any more. Recently, one of my confused old patients was in an intensive-care bed at enormous cost with all the resources, including antibiotics, to extend her life-expectancy further. Her personality has long ago disintegrated. The result is cruel to her and to her family. Political correctness and the avoidance of litigation are increasingly paramount.
Much of the money that will be spent on elderly mental health in the future is already earmarked for administration. The NHS thrives on chaos. The more chaos there is, the more managers are employed to sort it out. Already the system is awash with pseudo-professional, pseudo-managerial jobs with arcane and important-sounding titles, such as community care plan co-ordinators, interface facilitators, quality assurance supervisors, mentorship supervisors, integrated pathway co-ordinators, project team facilitators, clinical governance supervisors, and so on. These jobs are secure, well paid, well pensioned, and skilfully and convincingly justified. The emperor is well clothed. Until the money is redirected into real jobs — such as front-line, handson nurses and care assistants — it will continue to be wasted.
But there is hope. More and more of us are becoming aware of the misdirection of our money by the public sector under this government. To preserve a decent society it is vital to encourage the availability of good nursing homes. If this generation does not defend our old people from shame and indignity, it will have to pay the price itself in its own suffering in the future. Young people often believe they are immortal, but they too will wither and grow old. You can't ignore reality for very long.
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