We have nationalized the elderly, as we are too busy to care for them

My grandmother would hobble across deserts for me if I was in trouble, yet I am too selfish to look after her now she is old

By Johann Hari

The Independent, February 21, 2003

Across the Arab world, people are fond of recounting a popular horror story about the West. A few years ago, I overheard a middle-aged man in a Syrian souq tell his children: "When Westerners get old and can't look after themselves, their families send them off to live in big buildings. They visit them once a week, if that, and let nurses do the rest. Sometimes, they forget them all together, and old people die alone and crying for their families."

He could have added – if he had read a survey released this week – that we drug them into catatonia if they begin to rebel against their abandonment. The journal Age and Ageing has found that almost a quarter of people in nursing homes are being given powerful psychiatric medicines – and of those, a chilling 80 per cent were prescribed either for the wrong reason, without proper monitoring of the effects, or without any thought as to whether the patient's condition still required it. This is even more scandalous than many front-page child-abuse shocks because it is much more widespread and systematised. Yet it was reported, if at all, only on the inside pages of our newspapers.

A friend of mine has recently switched from working in an old people's home (and by no means a bad one) to working with children who have cerebral palsy. She was startled by the difference in standards of care. "When I started working with the elderly, I was given three days' training – two of which consisted just of watching the other care workers doing their job. That was it," she explains.

"But before I could do anything with the kids I work with now, I had a week of detailed training courses, and I'll be on probation – where I'm very carefully monitored – for another 26 weeks," she continued. "It's only when I got the training in my new job that I realised how unprepared I was before. I didn't know really basic things about how to lift people without harming them or causing them distress. Why are the elderly worth so much less than disabled kids?" The truth is that old people aren't sexy. We don't like to think about all that sagging flesh and those failing bladders; much easier to sympathise with doe-eyed children.

Numbers, numbers, numbers – if politicians bothered to make up soundbites about care of the elderly, this would be it. The number of care workers is not nearly high enough. Disabled children have, at most, a child-to-care-worker ration of two to one. It is a sign of how little we care about the old that, as Polly Toynbee's new book Hard Work: Life in Low-Pay Britain explains, nobody even bothers to compile national statistics about the ratio of care workers to the elderly. It seems anecdotally to be around six to one. Quality care is impossible in this situation; instead, we end up with factory-farming of the old. They are fed, washed and clothed, but there is no time to treat them as individuals.

The mass drugging stems from the numbers problem. If you have no time to talk to a distressed old person, it's much easier to give them a pill. New Labour took several steps forward last year when they introduced much higher care regulations, mandating, for example, that all old people are entitled to a room and toilet of their own. Yet, dismayingly, the Government retracted many of these commitments this week – and the numbers problem festers on.

Yet even if we had extremely high-quality, well-funded homes (a distant dream), we would still have high numbers of old people on drugs, especially anti-depressants, because of a simple fact: being left in even the best care home in the world is appallingly depressing.

Nobody could deserve it less than the generation now left in this situation. My grandmother, who is in an excellent state home, is of an age group who have shown a level of altruism and self-sacrifice that beggars belief. Four years ago, my grandmother was on her way to post some money to my sister, a broke single mum. As she crossed the road, some fool driving at 70mph smacked into her, and she was thrown into the air and hit the road at the other side of the car. When the paramedics arrived, as she lay bleeding into the road, the first thing she said was, "Excuse me, but would you mind putting this envelope into the post-box? My granddaughter's really desperate for the money." Six months later, she was back on her feet and back to health.

How do we repay people like her? My grandmother would hobble across deserts for me if I was in trouble; yet I am too selfish to look after her now she is old and in need of help. I called her yesterday, and she cried, saying simply, "You won't ever forget about me, will you?"

Our growing individualism, where we value our own space and freedom from constraint above all else, claims the old as victims. We cannot be bothered to look after the people who brought us up. The collapse of extended families, who in cultures such as India's look after the elderly as automatically as they look after their children, has had some liberating effects. Yet it reaches its dark apotheosis in care homes. Their conditions should shame us into reintegrating the elderly into our everyday lives. Or, as the population grays, will we simply build more and more homes until a third of the population ends up in one?

The real alternative to the ongoing misery of care homes is radical. We must shift care of the elderly from depersonalised care homes back on to the extended family. In Britain today we have nationalised our old people, handing them over to the Government so we can get on with our terribly busy lives. But the Government does not care for the old any better than it provides for children in care; governments should not be in the business of looking after people directly through institutions, because it always ends in disaster.

At the moment, we hand £279 a week on average to a care home for each elderly person. Wouldn't it be far better spent not by the state but by families caring for their own relatives? My family and I would look after my gran, I suspect, far better than nurses who don't know her – so hand us the money to make it possible and we'll do the job, with the help of a hired nurse. This would reverse the existing ratios: not six elderly people per carer, but rather four or five carers (who happen to be family members) per elderly person. The numbers problem is solved in a flash, for all but the most incapacitated elderly. Those old people without families could be "adopted". This would transform the system without spending an extra penny.