Sunday, August 26, 2012

So much for the Money; what about the Care?

The Government recently published the latest Social Care White Paper; which starts to address the problem of financing the care of elderly people. In outline, there will be a scheme whereby those receiving care will not be forced to sale their homes to pay for that care. Instead, they will be eligible for a council loan, repayable from their estate after death. With implementation postponed until 2014, the detail has yet to be revealed. However, if the recent Health & Social Care Act is an illustration, the ultimate Act stemming from this White Paper will be a hotchpotch of compromise, inadequately thought-through process and a few nasty surprises, which will fall short of appropriately addressing the real issues.

One of the real issues for me is not so much the money, but the quality of care. Having to sell one’s home to pay for care in a residential home may be emotive, but ultimately someone has to pay. After all, money is only a tool to obtain what we desire. When we are elderly and infirm, what we truly need is the security of knowing someone is properly looking after us. Sadly, for many people, that quest is an impossible one; particularly the closer we get to dying.

The physician and author, Dr Brian Livesley, addresses this issue in his book ‘The Dying Keats – A Case for Euthanasia?’. Livesley uses his 50 years of medical experience of caring for the elderly and combines it with a well-researched thesis about the circumstances of the death of the poet John Keats.

Keats, also a doctor, died in 1821 from tuberculosis at the age of 26. Well-aware of the availability of drugs such as opium, it is therefore an irony that he was deprived of medicines to relieve the distress of his final days. So distressing were his symptoms that Keats described the concluding period of his life as ‘this posthumous life of mine’; something Livesley describes as the Keatsian Experience.

Sadly, the Keatsian Experience is still endured. In 2008, 54% of the complaints about hospitals were related to the lack of care at the time of someone’s death. As Livesley states, dying should be a humane experience for us all. That the reality for many is so different is a sad indictment of the so-called ‘caring professions’. At the heart of the matter is the failure to treat dying as a clinical diagnosis requiring action.

The term ‘euthanasia’ is today frequently used as a synonym for assisted-suicide. However, the origin of the word is very different and means ‘a good and comfortable death’.  Keats lacked carers skilled in providing him with a good and comfortable death. Without those skilled carers, all the money in the world is meaningless to those in their twilight days if they are not being appropriately looked after.

So the message to the Government should be that the Keatsian Experience has no place in our time. Of course the problem of funding the provision of care in our final years needs to be sorted. However, the quality of care also needs to be considered. Getting the quality right from the moment we first need care will help ensure our closing days are also right. Without that, the Social Care Act will be yet another 21st century political failing, and one we will all potentially suffer from as a consequence.

(First published in the Scunthorpe Telegraph, Thursday, 19th July 2012.)

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