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