seem like the kind of risk we should expect people to take on for themselves. Supposing the settlement went rather differently. Supposing older people themselves were required to take on part of the risk–perhaps paying for up to two years of care, which is the average time older people spend in long-term care. Beyond that period the costs would be fully covered by the state. One major advantage of such a scheme is that it would deal with the issue of unfairness. Though there is still a one in four chance that long-term care will be needed, it is reasonable to ask people to plan ahead for such an eventuality. But the cost would not be open-ended and, if prepared for by saving or by taking out an insurance policy, would not require people to realize major assets, such as selling their house, which is currently a cause of huge resentment. Though many people might not like such a system, they could not say it was unfair. Nursing contributions could then be restricted to those who elect to stay in their own homes-a further discouragement, if one were needed, to going into a nursing home.
The reason for the anger on the part of older people was so predictable and so unnecessary. The government was trying to choke off the cost of long-term care to the statutory sector, which is what governments do. But to older people, as well as their carers and children, it seemed as if the government thought people were going into nursing homes for fun, as if it was some kind of luxury item, like going on exotic foreign holidays. But for most older people, going into a nursing home is the last stage on a journey to death, much resented, much feared, the last thing most of them want to do. It was completely unnecessary for older people to become distrustful of a new government that had come in promising to do something about a situation that was generally agreed to be appallingly unfair. All the accusations were thrown into the ring: older people had paid their taxes, older people had given service to King and country during the war, older people were being abandoned, older people were being neglected, older people were being badly treated by the NHS and were now not even being helped when they needed long-term care. But underneath all this there was genuine resentment. Older people had paid their taxes on the basis of care ‘from cradle to grave’ and this undertaking had been broken without any debate, without consent from those for whom it had, apparently, been made. Older people had trusted the new promises of the welfare state from 1948. And that trust was being betrayed.
People do not choose to go into long-term care, even though their relatives sometimes think it is the best option. People want to stay in their own homes and remain independent for as long as possible. Sometimes this is not possible. Did the government not understand what an awful decision it is to have to give up one’s home, to embark on a one-way journey into a care home, to surrender one’s privacy, to have no control over one’s own life? Did they not understand that care homes and nursing homes are a necessity, not a luxury? Could there not have been some sympathy, some generosity, here? Instead, there are cases, time after time, of the Ombudsman finding that guidance on NHS funded care has been misinterpreted to save the NHS money, with a particularly heavy judgment in April 2000 that lead to considerable payouts by the NHS. The scandals about payment are legion, with an excellent campaign being run sporadically by the Daily Mail, ‘Dignity for the Elderly’, about the perversity and unfairness of the system. Since the government has paid out over £180 million in compensation to people who should never have had to pay their fees at all, it has been argued that ‘this is just the tip of the iceberg…The system is failing the most vulnerable members of our society, many of whom fought for our freedom and paid taxes throughout a long and productive life…More than 70,000 are selling their homes every year to pay nursing home fees often amounting to hundreds of thousands of pounds.’* The Daily Mail has not been alone in taking up the cudgels on behalf of older people. No one wants to be in a care home, and this is where government has made such a huge mistake.
Grey Power
From the resentment caused by the government’s reaction to the Royal Commission on Long Term Care, after years of surprising political inactivity amongst older people, there has grown the beginnings of a grey-power movement. It does not yet have real political teeth, but they will come. Though the organisation of the grey vote is not in the league of similar movements in the USA, the voting figures, which show that older people vote more than younger people, make governments nervous. If older people voted more on self interest, then governments would be in trouble.
And there are signs that older people, who have not hitherto voted on sectional interests, are beginning to change. They see themselves as having to bear the risk of the costs of long-term care, and they cannot see how they can trust a government that has, in their view, reneged on a promise to remove the inequities of the present system. Worse than that, they are beginning to ask whether they can trust any government to treat them fairly. The 75p increase in the old age pension in 2000 met with a furious response. As Gary Younge pointed out, in a hard hitting article in The Guardian shortly after that famous increase, the government’s determination to keep the pension increase index linked ‘was more than a mathematical calculation. There was political arithmetic there too.’* The assumption, as Younge makes clear, was that old people would complain but that they would not fight back.
But the government got it wrong. Older people did fight back. The National Pensioners’ Convention is growing. On the question of council tax, some older people have simply refused to pay. In March 2002, one old lady, 102-year-old Rose Cottle, furious at the prospective closure of her care home where she had lived happily for many years, took a petition to Downing Street and caused some embarrassment-but not enough. By the next week things had moved on, and she was forgotten. Some have gone on hunger strike, and others have been moved-against their will-and have died shortly afterwards. But grey power is coming. As The Economist made clear recently, the overall fall in voter turnout is largely a change in the voting patterns of the young.† The old vote as they always have done. So pensioners, who represent 24 per cent of the voting-age population, accounted for 35 per cent of votes at the last election. At the next one, the figure is more likely to be 40 per cent. So grey power will soon begin to bite.*
Long-term care has been one source of anger amongst older people. Another issue that has caused resentment is abuse.
Abuse
A survey conducted by Age Concern as far back as 1991 estimated that between 5 and 9 per cent of people aged over 65 had been abused-more than half a million people. The incidence of abuse is clearly likely to increase as the population ages: the greater the level of dependency, the greater the risk of abuse. In 2004 Jennie Potter, a district nurse who is a national officer of the Community and District Nursing Association, compiled a report on abuse of older people† that suggested the problem was widespread. The CDNA surveyed just over seven hundred nurses, and found that a staggering 88 per cent of them had encountered elder abuse at work, 12 per cent of them daily, weekly, or monthly. The most common form of abuse was verbal (67 per cent), followed by emotional (51 per cent), physical (49 per cent), financial (34 per cent), and sexual (8 per cent). The most likely perpetrators were partners (45 per cent), followed by sons (32 per cent), daughters or other family members (29 per cent), paid carers (26 per cent), nurses (5 per cent), or other persons (4 per cent).‡
This suggests a huge incidence of abuse, one that until recently we did not take seriously. Though dramatic cases often make the local press, very few are reported in the national papers. The appalling case of 78-year-old Margaret Panting, for instance, who died after receiving huge physical abuse that included cigarette burns and cuts from razor blades is little known. Whilst there is a major inquiry over the death of Victoria Climbié, and over every other child who dies in appalling circumstances, abuse of older people, which may also lead to death, simply does not carry the same weight, or tug at the heart strings as much. Yet there is equally a serious problem here, and some