These two chaps are not exceptional. There are people like them in every
street, in every block of flats, above every parade of shops, in every
dripping-laurel cul-de-sac, up communal stairs and down muddy lanes. The old
sit in mushroom chairs, never further than two feet from a radiator, a phone
and the TV. They don’t go out much because out is frightening, panicky,
hostile for the old. Outside is a country they don’t belong to any more,
where they’re no longer included. Just think how few old people you notice,
how relatively few there are among us, bustling and dodging in the streets,
shops and restaurants. You will see none after dark. The old live like
Transylvanians, terrified of the young, the swift and supple, loud and late,
irritable young. Even when they do venture out among us we don’t look at
them, we don’t see them; they cling to the wall, curl up like dead leaves in
bus shelters, press themselves into corners.
I have become haunted by the absence of the old. Ever since the death of my
father three years ago, I have got into the habit of asking middle-aged
friends about their parents. There is a common narrative to their answers.
They list the deficiencies, the problems, the conditions, the failings, the
diminutions, usually with a tired fondness and a growing hum of
exasperation. I sat next to a woman at dinner recently who told me how
wonderful her father was because he’d died so well, so quietly and quickly,
ne’er a fuss. And then with a sigh, “Now my mother, she’s always
complaining, miserable, I think she’s scared of letting go.” It wasn’t said
carelessly or without a decorous dab of concern, but mostly it was with
annoyance.
You hear it too among the professionals who care for the old, reciting
illnesses and shortages. You hear it in the media, where old age is a
collection of problems. The old are slow and cold, brittle and cancerous,
breathless, toothless, sexless, forgetful. And, most newsworthily, they’re
victims — of bugs, of councillors and chancellors, or welfare and weather.
They’re also the victims of grief and pity and comedians. To be old is to be
stalked by taxes and frost, flights of stairs, and finally God. To be old is
to vanish behind the sum of incurable, piteous conditions.
For many, the final furlong of a life is spent immobile in a chair, in a
bright room in what’s euphemistically called a “home”. It isn’t a home, just
as Battersea Dogs Home isn’t a home. It’s a hospice for those who’ve been
put out of a home. These villas standing back from the road in the outskirts
of provincial towns, discreet as brothels, hidden behind leylandii, with
bland, forgettable names, are run by opaque, care-dispensing com-panies that
are the shallow end of healthcare.
It is estimated that a quarter of all nursing homes fall below care
guidelines, which are themselves set disgustingly close to the earth. If you
walk up the steps of an old people’s home, holding the rail to steady
yourself through the swinging doors into the little reception area with its
pot plants and notice boards pinned with safety warnings and activity
sheets, be under no illusion. If you ever leave, it will be in an ambulance
or a hearse. You are here until you decide to let go, and the sooner and the
quieter and the neater you can manage that, the better. Residential people’s
homes get less care and attention than prisons. They don’t have to
rehabilitate anyone. Every inmate is on a life sentence. These bright,
wipe-down, neon-lit, disinfected rooms, smelling of fish, piss and Cif, are
death row for the blameless.
I’m sent to be shown round a residential home in Putney. This is top of the
range — they’re proud of this one. Very nice, very busy and efficient. The
directors and the PRs and the housekeepers who come to meet me all have the
gimlet, spearmint keenness of folk on a no-nonsense, long-distance goodness
mission. The walls are collaged with old record sleeves, Perry Como and the
Carpenters, Jimmy Shand and Cliff. The doors and lifts work with security
swipe cards; the rooms are full of inmates, “guests”, who sit for the most
part in a ruminative stasis. A circle of old men sit together, none
acknowledging the presence of the others. Their rheumy eyes swim, tufts of
missed stubble prickle whitely. Only their fingers are restless, worrying a
hem or blindly searching for something lost and forgotten. One holds a large
teddy bear with a blue-knuckled hand, like a prize from a long-decamped
funfair.
In another room three hunched old ladies watch Oklahoma! “I’m just a girl who
can’t say no.” In another, there’s a church service. We sing Praise My Soul
the King of Heaven. In another room there is painting-by-numbers. The place
is a hamster wheel of activity, singsongs and seated exercise, all
purposeless. There is nothing left to learn, nothing to be fit for, nobody
to give the paintings to, no more skills needed, no new tunes and no new
verses. This is merely collective time-whittling.
Visitors often comment how similar old people’s homes are to infant schools.
There is a sort of neatness, a return full circle to the innocence of
toddlers. It’s a comfort to believe that the destination of life is to end
up where you started — in nappies, being fed mush, drinking from a sippy cup
with a matey, loud kindness that excludes dignity or respect. It’s rarely
mentioned though, because it’s a sensitive subject, that almost all the
staff in care homes are imported from nations that have a far greater
veneration for age than our own. As one Filipino cleaner said to me, “You
don’t want to live with your old, and you’re too guilty to even feed them.”
These homes are the final resort. When you fail at basic one-room, single-bar
life, this is where you come. The government will make you sell everything
you own to get here. Nearly all “guests” have some form of dementia. This is
the great unspeakable plague of our medically privileged times: dying from
the inside out. Outside hospital, dementia isn’t even classed as a medical
problem: it’s a concern of social workers. If it were medical, local
authorities would have a statutory obligation to treat it.
In an acute old people’s ward in a central London teaching hospital, almost
all the beds are taken up with Alzheimer’s patients being treated for their
related conditions: the broken limbs, the burns, the cancers, the failing
organs of tired, forgetful bodies. I ask their consultant, who specialises
in geriatric medicine, if the treatment patients get is relative to the
amount of outside support they have from their families. She grips her
clipboard protectively and stares hard into my face, looking for reassurance
or a reason to answer. Finally she says: “Yes, of course. If a frail old
person, probably with multiple conditions and a limited prognosis, is
brought in, we think about where they’re going to go after we’ve treated the
most chronic condition. Who is going to look after them if they go back to
live on their own? Yes, the quality of life is…” she searches for a word,
“If there’s not much quality, we may well not do procedures that demand a
lot of aftercare. We’ll just make them comfortable. We’re not talking about
killing people, or even letting them die, just not prolonging unhappy,
lonely lives.”
Now that thoughtful reply won’t come as a surprise to anyone working with
geriatrics or in the health service, but it might come as a bit of a shock
to anyone whose granny is on a ward that’s just too far away to conveniently
visit. As a society we run old people’s care like a donkey sanctuary.
Perhaps that’s okay — we’re very nice to donkeys.
I ask the consultant if she’d leave her parents to the state. “No,” she said
without hesitation. “They came from a very tight community — they didn’t put
the old out on the ice floes. I’d go home and take care of them.” And would
you be happy to be treated in a NHS home yourself? “No. It’s not that I
think they’re bad — I think staff do their best. But it’s not something
you’d look forward to.”
