Society
Help for the aged
Jef Smith
Last week I went on an old people's outing. It didn't actually rain, it's true, but when at the end of the afternoon I reported to the hotel where 250 of us were to sit down for a fish and chip tea, a chilly row of pensioners were huddled under a wall trying to keep out of the wind. There was a momentary flurry when six people couldn't be found places at tables, but this was nothing beside the time a coach windscreen broke on the way home, or a man collapsed at tea, or an old lady caught short did it on the floor — all catastrophes that have overtaken earlier outings of this season's twice-a-week series. I suppose transporting East Londoners down to a breezy beach for 12ip day trips is a job worth doing, but when we stopped on the way home at a pub where the men drank beer rapidly and their wives bought eggs and strawberries from the carpark stall at prices above those in town, I asked myself how considered a response this is by a social services department to the enormous needs of a most needy group.
A good deal of what the elderly require differs little from what anyone needs — enough money, efficient medical care, decent housing, a circle of friends — and the diversity of agencies providing these merely reflects the complexity of social life. To provide services reserved for the aged would create precisely the arbitrary separation that it should be the aim of an integrated community to prevent. On the other hand the special vulnerability of old people demands for them a measure of positive discrimination. Only a part of the possible provision is under the direct control of social services departments, but an energetic director can effectively press for priority, in the planning of services for the community at large, for the only slightly different needs of the aged as a group. Modern corporate management practices in local government have made it possible for a director of social services not only to run his own department but also to be the spokesman for social planning in the work of other sections of a council. The intermeshing consultative mechanisms now being worked out between the social services and the shortly-to-be-reformed health service will establish a similar advisory duty in respect of each area health authority. It may be far more effective to work in this way for the marginal modification of existing community resources than for separate provision for a special group. Wardened flats managed by a housing department allow for a healthier degree of independence and normal living than the relatively institutionalised regime of an old people's home. Adequate retirement pensions provide a surer route to continued financial independence than ad hoc increments via concessionary travel permits or cut-price entertainments.
Nevertheless there are areas in which the needs of old people, if not unique, are certainly disproportionately demanding. A domiciliary chiropody service bestows enormous relief on its beneficiaries; meals on wheels, patchy and inadequate though the service often is, head off many cases of otherwise serious malnutrition. The aged too are heavily over-represented among the chronically sick and disabled; though some are severely handicapped, many can be helped to an immediately happier life through quite minor aids to daily life or their living environment.
The problem every social services department faces, however, is that of locating the aged and making services available to them. It is popularly imagined that lists of the over-sixty-fives in an area can be easily compiled, but this is far from the case. Individual census data are of course not available and electoral registers provide no clue to age. Even the record of council house lettings may provide no more information about the inhabitants of a property than the name of the head of the household. All but a tiny minority of children pass through school and 95 per cent of the population are registered with a general practitioner, but the social services have no equivalent to these enviable screening mechanisms.
In an attempt to develop comprehensive information on the aged — anyone over retirement age may be regarded as by definition at risk — some authorities have made progress towards the compilation of registers. There are many mechanical problems both in establishing a first list and in keeping it up to date, and one is left with the impression in some areas that so much energy is expended in getting names onto a record that little is subsequently available in the way of actual services. The register syndrome is in fact a perfect product of the bureaucratic mind; we have seen it at work on the sick and disabled over the last year. Unless registration is a direct route to services or at least the key providing rapid unquestioned access in the event of need, it becomes an end in itself, a pointless clerical exercise. Indeed, the term itself is probably a disincentive to many. The debate about universalism and selectivity which hangs over so much of the welfare state's provision lingers here too. Should we aim at minimal services for all old people or does the reality of scarce resources oblige us to look first at those most acutely in need?
The greatest and most widely experienced need of the elderly arises from the problem of loneliness. Although more systematic planning of the location of accommodation can help to preserve the contact between growing-up children and their ageing parents — for example, the flight of young couples from city centres in search of a place to live could be arrested if priorities in housing allocation were adjusted — there will remain for the foreseeable future a pool of old people for whom the loss of family, widowhood and declining mobility will lead inevitably to progressive isolatj,on. How can a social services department help these clients? Certainly professional social work cannot be made available to them all, and recent research has shown that its contribution is in many respects only marginally more effective than that of much less highly trained visitors. Volunteer schemes undoubtedly have a part to play though they require very efficient administration if regularity of visits is to be preserved — volunteers, and not only the young, are notoriously unreliable. Social work's devotion to face-to-face contact, however, needs to be more directly challenged, and group work has received less attention from the professionals than it merits.
Previous page
