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Care in the Community policies are designed to save the government money at the expense of women's lives, says Fiona Foster

Who cares?

'When I look back, I suppose my obsession with incontinence pads and rubber sheets just didn't turn him on.' Doreen was explaining how her husband left her three years after her ailing mother came to live with them.

Doreen was 32 and had three children when her mother had a severe stroke. 'I found out very quickly that mum wasn't ill enough, and we weren't poor enough to get her into a home - so we had no choice, she moved in.' Doreen's mum has just died, but eight years of caring for her full time have taken a high toll. 'I lost my job, my husband and very nearly my sanity.'

As her mother grew more and more dependent, needing to be washed, dressed and taken to the toilet, Doreen had to give up her job as a radiographer at a local hospital. 'My mother was brain damaged after the stroke and couldn't speak properly. It was like eight years of caring for a 15-stone baby, but without any of the nice bits.' The first time Doreen was offered any help was when she threatened to take a knife to her mother's throat. 'My youngest ran next door screaming. The social workers came running quick enough then.' The social services offered to take Doreen's mum into care for a fortnight to allow the family to take a holiday. It was her first holiday in two years and all she did was worry about how her mother was being treated, and dread going home.

Doreen is 40 now, and feels anxious about 'starting again'. She says she can't imagine 'normal life for other people. Normal life for me was looking after mum and talking about looking after mum.'

In fact Doreen's life is horrifyingly normal and is becoming more so. There are estimated to be almost seven million carers in Britain, over half of whom gave up jobs to care for relatives full time. The National Association of Carers claims that 80 per cent of these are women, the typical carer being the daughter or daughter-in-law. Two thirds of those who do more than 20 hours a week caring get absolutely no help, financial or otherwise, from the state. In surveys conducted by care organisations, nearly half of carers say they are at breaking point, 13 per cent admit that they have felt like being violent towards their relatives, and a small proportion claim to have considered suicide.

Hospitals are reporting a small but growing incidence of what has been dubbed 'granny-dumping'. Carers, pushed to the limits of their endurance, abandon their charge in the accident and emergency department of a hospital in the hope that the hospital will simply have to take them in. There is also a rising incidence of assaults against the elderly - not by teenage sadists, but by women like Doreen pushed to the point where they lash out.

Brenda can understand how it happens. She's 37 with two children and a 56-year old husband who has suffered from Alzheimer's disease for four years. He has degenerated quickly and now needs to be fed, washed, dressed and kept under Brenda's eye 24 hours a day to prevent a repeat of the time he went out with no clothes on, or the time he tried to put his arm in the fire.

Brenda says she's aged 20 years in the last four. She is tired and worn and hates her life but can see no way out. 'My marriage is dead. I feel as though my husband is dead but there has been no funeral and I'm not allowed to mourn. There are times when I've been a split second away from bashing him.' Like Doreen, she had to give up working to care, 'not that it was any great shakes, cleaning offices, but we had a laugh, you know, the girls'.

Now, as the government seeks to slash public spending under the pressure of the slump, its reforms of the NHS and social services will force even more women to live like Doreen and Brenda.

Over the next two years 'community care' is set to replace most of the state-run long-stay institutions for the elderly or mentally infirm. It sounds a progressive move. Nobody likes the idea of institutionalising the elderly. Old people's wards conjure up visions of bleak institutions full of threadbare furniture and neglected people. Institutions sound horrific, community care sounds great. In practice it's a disaster.

When Kenneth Clarke first floated the proposals three years ago he insisted that 'the reason for developing care in the community and reducing dependence on institutional care for so many patients is the welfare of the patients'. Clarke's successor as health secretary, Virginia Bottomley, has kept up the claim that the reforms will be of benefit to the elderly.

But community care is not about improving the quality of care or putting the old and infirm back in touch with life. It is about cutting costs, at a time when the state can no longer afford even the miserly levels of care which it previously provided.

There are two aspects to the savings plan. One is the transfer of responsibility for the elderly infirm from the NHS to local authorities. The other is the transfer of responsibility from the state to the family.

From April, responsibility for the elderly infirm will be transferred from the NHS to the local authorities, which will have to put contracts out to buy places in nursing homes from the private sector. It is obvious that when putting services out to tender in this way, councils will be looking for services to fit their budgets rather than the needs of the elderly. Some money will also be clawed back from the elderly themselves. As long-stay geriatric wards are closed, the elderly infirm will be means-tested, and those with savings will have to pay for their care.

At the same time, families are being encouraged to take direct responsibility for elderly relatives. When challenged, the Department of Health has insisted that nobody is suggesting that families must care, that the transfer of responsibility has been made from the NHS to the local authority, not to the family. But in practice families - and that means women - are under pressure to pick up the pieces.

Rhona Barnett's mother and husband have spent seven and five years respectively in a Dudley hospital. Her mother at 91 is very frail, her husband's Alzheimer's disease has reached the stage where he doesn't know who she is. But when she was informed that the hospital was to be reorganised, she wasn't even told that there was the possibility of further state care. 'I was simply told I would have to make other arrangements. I honestly thought that I was going to have to have them here with me. I was beside myself', she says. 'I couldn't have coped with one of them, let alone both. If my daughter hadn't stepped in and said there was no way either of them were coming home I don't know what would have happened. I feel that guilty, but I just couldn't have managed.'

Why should she have to? The reorganisation has been a cynical way of saving money, legitimised by undermining the idea that the state should take on responsibility for the sick and elderly.

In principle there is nothing wrong with the concept of state institutions. The diabolical state of many old people's homes and long-stay wards is a consequence of years of underfunding and poor standards of care. With adequate funding it's quite possible to see how old people's homes could be pleasant enough places.

There is everything wrong with making the family the focus of care. Even if the government extended further benefits to carers or provided them with more support, as Labour's health team constantly demands, 'caring' would still be a diabolical life.

Even if you are paid for it, caring for someone at home isn't like a normal job. If you are a secretary, a teacher or a nurse, however much you hate your job, you've still got your home to come back to. When you shut the door you can cook a meal, watch the TV, go out for a drink. It's your own time, your life. Women carers are more like slaves than workers. There's no clocking on or clocking off, and no escape - the responsibility is yours, 24 hours a day.

The intended goal of the switch to community care for the elderly and infirm is to cut billions off the social security bill. Each old person looked after by their family represents a saving of £4000 to the state. That is the sort of reform the government really cares about. If it gets away with it, the cost to women's lives will be immeasurable.
Reproduced from Living Marxism issue 54, April 1993

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