Have faith in care homes

We live in grey times. In Britain, 200 years ago women on
average could expect to live to 50, and men to 48. Today, the
average life expectancy for women is almost 80 and around 75 years
for men. By 2025 there will be five times as many centenarians as
there are now. There will also be more people over the age of 65
than children under 18 years. There are major long-term concerns
about how society will care for the increasing number and
percentage of older people who will require formal care services,
combined with worries that people in the UK are not saving enough
for their retirement pensions. Of much more immediate relevance,
however, is the national shortage of care home beds.

Looking into the future is no longer a luxury, it is crucial for
government and service providers for older people. In this respect
the UK’s Jewish community has important lessons for society as a
whole, and for other ethnic and religious minorities in particular,
because it is ahead of national trends. In terms of life
expectancies, Jewish men live four years longer than the average
for males in the UK, while Jewish women live three years longer
than the average UK females. In terms of the proportion of older
people, 14 per cent of UK Jews are aged 75 or over, compared with 7
per cent nationally. Finally, with regard to socio-economic status,
older UK Jews are more like younger Britons with many more having
managerial or professional occupations. So the organised Jewish
voluntary sector is now facing the demographic and social planning
challenges that the rest of society can expect to deal with in the
coming decades.

The Jewish voluntary sector, which comprises some 2,000
financially independent organisations and has an annual income of
£500m,¹ provides care in a range of settings for
people from across the age spectrum. The largest component of the
annual income of the sector is for social care (£135m), the
lion’s share of which goes into the 36 residential and nursing
homes that provide for some 2,500 older Jewish people.

The care provided within Jewish voluntary sector homes reflects
a long-established tradition and moral commitment by local Jewish
communities to care for their older members. The quality of
services provided within the majority of these homes is extremely
high, but even here the realities of national funding and
recruitment crises are biting hard. Despite some of these
facilities being founded in Victorian times, several are under
considerable financial pressures and are struggling to survive.

Among the many strengths of Jewish voluntary sector care homes
is their ability to provide services that are culturally
appropriate and to do so in a setting that is familiar and
comforting. Some residents need care homes to fulfil obvious
religious requirements, such as providing kosher food and having
facilities that do not contravene the enormously complex
requirements of keeping the Sabbath holy. For others, religious
elements are secondary to cultural factors: traditional Jewish
food, celebrating the Jewish festivals and being surrounded by
people with whom they have much in common. As King’s Fund chief
executive Rabbi Julia Neuberger puts it: “when you are looking
towards the end of your life, you want to be with your
own”.²

Residents often speak of the comfort value of mixing with people
who may have lived in the same close-knit communities. Others like
to be around people who have worked in similar professions and may
have a shared sense of humour. As one says: “It’s like wearing a
shoe that fits well. Why would I want to wear a shoe that doesn’t
fit properly?”

Others have expressed these social and cultural desires even
more strongly. Those who suffered state-sanctioned anti-semitism in
their youth – especially those who were refugees during the Second
World War or were Holocaust survivors – feel a keen desire to be
with other Jews in their latter years. It is worth noting, however,
that this desire to be with people “like us” runs counter to
government encouragement for the mainstreaming of services. The
government would rather avoid care being provided in “segregated”
environments by distinctive ethnic or religious groups. The lesson
from the Jewish community is that this contravenes the wishes of
the majority of care home residents. Why does the government regard
the provision of faith schools as legitimate, but not faith
homes?

The cost of staying in Jewish voluntary sector care homes is
considerably higher than the national average. For example, it
costs an average of £533 per week for private clients staying
in Jewish nursing homes compared with £350 nationally. This
reflects factors including the costs of providing kosher food,
their geographical location (most homes are in north west London
where the costs of land and staff are high), as well as the
expectations of services from a largely middle class clientele.
Nevertheless, despite this increased funding and a long tradition
of charitable financial and volunteer support by the community,
deep-rooted problems remain.

Some Jewish homes provide stimulating activities for their
residents, but in others the stereotypical image of residents
sitting in armchairs saying nothing to each other is all too real.
Even within the best homes there are major problems of
institutionalisation and of the creation of a dependency culture
whereby clients are not empowered to take responsibility and
control over their own lives. Partly this is because of the
increasing age and frailty of clients. However, there is also a
tendency to provide services in a “top-down” manner, thereby
bypassing the specific needs and wants of individual residents.

Moreover, a shortage of local authority funding for clients
needing long-term care, which in turn is driven by a shortfall in
funds provided by government, has forced several homes to reduce
their costs in order to stay financially viable. Having a high
ratio of staff and volunteers to residents is arguably the single
most important element in providing long-term care for older
people, but this is threatened by a shortage of finances and could
have consequences for people’s quality of life.

Nationally, care homes face an uncertain future. In a marked
downturn from the boom years of the 1980s – stimulated by generous
subsidies from the government – thousands of care home beds have
been lost recently. The government is seeking to help people remain
in their own homes for as long as possible and reduce the numbers
entering institutional care. For many people this policy is
appropriate, but any assumption that this is best for everybody
should be challenged. Many residents in Jewish care homes have
benefited from no longer being socially isolated, and instead being
in an environment where their physical, social and spiritual needs
can be catered for. The Jewish voluntary sector shows how care
homes can provide high levels of support that can be appropriate
for large numbers of people. Nevertheless, even in a largely
middle-class community, with a long-established tradition of care
and high levels of communal involvement, there are major financial
difficulties.

For a government seeking to encourage voluntary sector provision
and the involvement of local communities, Jewish care homes show
that much can be achieved. But by the same measure, caring for
large numbers of older people has major cost implications. With an
increasing proportion of older people – who are twice as likely to
vote as those aged between 18 and 24 – the government will have
difficulty ignoring their calls for more money for long-term care
services.

As one social services professional warned: “Elderly people get
such a raw deal. If they were children, then people would be
screaming”.

Dr Oliver Valins is a research fellow at JPR/Institute
for Jewish Policy Research and author of ‘Facing the future: The
provision of long-term care facilities for older Jewish people in
the United Kingdom’ (see

http://www.jpr.org.uk/Reports/PJC%20Reports/no_1_2002/index.htm
)

References

¹ P Halfpenny and M Reid, The Financial
Resources of the UK Jewish Voluntary Sector, Institute for
Jewish Policy Research, 2000 available here:  

http://www.jpr.org.uk/Reports/PJC%20Reports/no_1_2000/index.htm

²
Jewish Chronicle, 31 May 2002,
Page 29