Opinion: Ageism still the real enemy of better care

The study published by the Alzheimer’s Society last week has, for the first time, estimated the true cost of dementia. It puts the figure at £17bn a year, a sum that includes the cost of NHS and social services and carers’ lost incomes and taxes. The personal heartache, exhaustion and ruined lives are impossible to quantify.

The report also estimates that, within 20 years, the number of those with dementia will have risen from 700,000 to more than a million. By then, carers may be scarce. Women are delaying parenthood; higher mortgages are requiring two wages and family ties are fraying, so the obligation to care may also be diluted.

Dementia is, of course, only one aspect of ageing. The present and future needs of older people have been rising rapidly up the political agenda partly because of their demographic strength and the attraction for politicians that this is the group most likely to turn out to vote.

For the first time, this year, there will be more pensioners than babies in the UK. In fewer than 20 years, half the population will be over fifty. Another factor is the growing mountain of evidence, including the dementia study, that indicates heavily burdened individuals and families will not have the ability and inclination to shoulder the burden of care.

What’s encouraging is that a new vision of services for older people is in the making – far less paternalistic, more flexible and less bureaucratic. At the Empowering Older People conference last week organised by the charity Counsel and Care, senior figures in social care and the civil service painted a very different picture of what services could be like for the elderly.

It’s a picture that acknowledges that “old age” is already a far lengthier period than ever before, one that may include several stages of active life. In 1960, for instance, the average 65-year-old could expect to live for 11 more years. Now, their life expectancy is 22 years and rising. As many in social care know, services are often duplicated, clumsy and sometimes provide what the individual doesn’t want because nobody has asked him or her in the first place.

At the conference, the case of a carer who had had 64 meetings to obtain help for his wife – and still wasn’t given what he sought – caused consternation A range of pilots, including LinkAge Plus and individual budgets, is testing a different approach, emphasising independence and choice.

Simplified pensions and benefits, help through one-stop shops, budgets controlled by individuals and far more participation and scrutiny of services by older people are already producing surprising results. Anne Williams, soon to be the first president of the new Association of Directors of Adult Social Services, explained how consulting older people in Salford on what they would like in terms of support put a toe-clipping service at the top of the list. “Something none of us could ever have predicted.”

Better participation and consultation, improved advocacy and greater efforts to support the independence of older people in their own homes make financial sense. The Social Exclusion Unit estimated that reducing institutionalisation by just 1 per cent could save £3.8bn. More than that, in terms of citizenship, equality and fairness, older people have a right to shape their own future and control the services they receive in their final years. And yet at the same conference, delegates were in despair that even minimal services – like home helps and meals on wheels – were being savagely cut as councils try to balance their books. Why do older people get clobbered? Because in a society in which production is all that counts and youth is deified, they are deemed of little worth.

We have the beginnings of a modern service for older people: the fear is that the traditional curse of ageism will throttle the life out of it at birth.

Yvonne Roberts is a writer and journalist