Not Dead Yet: A Manifesto for Old Age. Julia Neuberger
3 Don’t take my pride away: end begging for entitlements
Then there is the question of money. The finer points of pensions are too abstruse and obscure for this kind of book, but what might older people expect as a basic minimum income, what might they be expected to pay for care out of that, and what things should be provided free or cheaper because people are older? Also, what is a reasonable proportion of wealth that should be left to our children?
Old age is not what it used to be. More of us will get there, and it is likely to last longer for most people than it used to. Better health and lower death rates mean that each successive generation is more likely to reach 65. Men now in their forties are nearly 90 per cent likely to collect their state pension, and the likelihood for women is over 90 per cent.
The concept of a long retirement is fairly new. The original state pension was set with a starting age where people were expected to live a few months or years, rather than several decades. This scenario of being retired for decades has many implications for financing old age, and that is where the political debate has tended to be. But it has equally important implications for people making choices about how they want to live, as well as around the support they may require. All over Europe, parents also want to pass their wealth onto their children and the children expect to inherit homes.
There are huge disparities and inequalities in income and wealth for older people. Some of this is sudden, brought about by old age and inadequate pension provision. In other circumstances, we see poor older people who have been poor all their lives, and then the question is whether we should try to redistribute older people’s income to alleviate the worst of the misery in older old age.
Meanwhile, governments around the world, and particularly in Europe, are concerned at the effect the pensions ‘time bomb’ will have upon the wider society, and are using rhetoric that seems to blame older people for staying alive. Older people are becoming angrier about broken promises around financial and other support in old age, although arguably not angry enough, and younger people are beginning to fear what has hitherto always seemed to them to be impossibly far in the future.
4 Don’t trap me at home because there are no loos or seats: reclaim the streets
Then there is the question of access to life, like the problem of transport and getting from place to place. Older people fill our buses and use their Freedom Passes with pleasure and abandon. What would an ideal transport system look like for older people when in rural areas many find it difficult to go anywhere if they do not drive, and in cities and towns there are still shortages of accessible transport, despite disability legislation? What would ideal transport look like? Would it be taxis, private car pooling, rental of wheelchairs in busy places, better access to buses, better and safer places to wait and sit at stations and bus stops?
Younger campaigners might find it awkward to talk about, but there is no doubt that the issue of public loos – as well as park benches, park attendants and seats in shops – are absolutely central to the way older people are being excluded from our town centres. Certainly, older people need to feel safe, given that many public spaces in cities feel as if they have been given over or abandoned to the young and disaffected. But unless there are adequate loos there as well, many older people feel they dare not leave their homes and go shopping. But because there seems an element of bathos about even mentioning it, nothing is done.
5 Don’t make me brain dead, let me grow: open access to learning
What would it look like if education and educational activities were geared more to older people? Not only degrees, or the University of the Third Age, but specialist courses such as stone carving, pottery, art programmes and other things which could continue into very old – and possibly very frail – old age. Will university charges for degrees be reduced or waived for the very old, and should they be? Can older people get scholarships?
How can education work when some older people have problems with vision or hearing, and how well-adapted do universities and colleges, and general classes, have to be to help people hear and see all that is going on?
A fully inclusive educational programme might be geared less to future employment and more to the idea of education as fulfilment, as a goal in itself, to enrich one’s life. So the instrumental view of education policy in many education authorities will need to be seen through a different, holistic lens that implies that education could and should be for its own sake.
6 Don’t force me into a care home: real choice in housing
There is the basic question of accommodation, including people’s own homes, sheltered housing, or – if things get rough – nursing homes and care homes, much feared by many older people and often rightly so. Nobody wants to give up their home and go into a ‘home’. Yet questions about why we are still so bad at providing care at home, particularly – and maybe understandably – for older people with Alzheimer’s disease, still need answering.
Fewer than one in twenty people want to spend their final days in a nursing home, yet one in five deaths takes place in those very places. We ought to be asking ourselves whether this is fair or right. Equally, there are questions around fitting homes for people who do become more frail and more disabled: why are architects and designers not putting real energy into designing for age? Why do older people seeking co-housing or mutual solutions find it so hard to make them happen, when they are commonplace in the USA and continental Europe?
7 Don’t treat those who look after me like rubbish: train and reward care assistants properly
Then there is the question of care and support. Many older people need no more care and support as old people than they did when they were younger, but many do. Those with more money tend to buy that care in from private agencies. People with fewer resources are very dependent on local authorities, even though local authorities charge for the care they provide. What should be the quality of care provided in people’s own homes or elsewhere?
How would we make it better, and how can we make sure there are no more stories about care workers coming to put people to bed at 6 p.m. or earlier? How can we teach local authorities that you cannot ask care workers to visit three or four older people in an hour, hour after hour, and carry out important personal tasks like toileting and putting people to bed?
What would care look like, if it were what people wanted, and what care workers often want to give, rather than what they get now? Indeed, what would it look like if those who look after old and frail people in their own homes, in sheltered housing or in care or nursing homes were treated quite differently? Care staff are poorly paid, poorly regarded, and have poor self-esteem. Perhaps the question that we should really ask is: what possesses us to leave our nearest and dearest in their care? And why are we not making a bigger fuss about the fact that care workers are badly paid and poorly regarded when often they do the most important, and often most difficult, of tasks?
8 Don’t treat me like I’m not worth repairing: community beds and hospitals
There are certainly questions around health and healthcare, and how they operate for older people. How are decisions made, and who makes them? Who decides if older people are reasonably fit or not? How seriously are older people’s own views about their state of health listened to? How far is it possible to get good generic care, without seeing too many specialists, as an older person? How easy is it to provide much of the care oneself? Who makes decisions about whether one should go for aggressive treatment or not? And how is it possible that hospital wards are so full of older people, of whom many seem to have no business to be there?
Would an ideal health system for older people look quite different, and have different rules? If so, would it be based on people’s own advance directives and clear views about what they wanted themselves?
9 Don’t treat my death as meaningless: the right to die well
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