There are thousands of Pats

Judging from Twitter, the person who caught most people’s imagination in last nights Panorama on the crisis in social care was Pat. Pat lived alone, her closest friend who was also a neighbour had died and her nearest family which appeared to be a niece lived 200 miles away. After being in hospital for 6 months, she returned home and had 3 visits from a Red Cross volunteer to help her settle, take her shopping and encourage her to do things for herself. Once his visits stopped, she declined rapidly saying

“occasionally I feel I’d like to see somebody but there isn’t anyone who comes”

the film crew were so concerned they contacted social services on Pat’s behalf. Social services carried out an assessment and when we last saw Pat, she was getting 2 visits a day and seemed much better.

Many people on Twitter expressed their sadness and heartbreak at Pat’s situation offering to visit if possible as well as complete bafflement that the volunteer who clearly made such a difference was only allowed to come 3 times. It was so good to see Pat’s story told because she often the stories of the Pat’s of this world aren’t told.

The stark facts are that in the UK there are tens of thousands of Pats. The demographics are clear. The numbers of people over 65 without adult children are set to double from 1.2 million to 2 million by 2030. 50% of people over 75 live alone. Currently 92% of informal care is provided by family and 80% of older people with disabilities are cared for by either their spouse or adult children.  The number of older people with disabilities who live alone and have no child is projected to increase rapidly, rising by nearly 80 per cent between 2007 and 2032. People ageing without children are already 25% more likely to go into a care home and ironically 30% more likely to be carers for their own elderly parents. The increase in the numbers of people ageing without children has also led to the rise of the so called ‘bean pole family’, when a family has more generations with living members but fewer members in each generation. The impact of this is that more people are growing old, not only without children, but also without siblings, nephews or nieces. As well as people who have no children, many thousands of others live far from their children or cannot look to them for support for a variety of reasons. However, despite this, the presumption of family support is baked into our health and social care system

Pats difficulties were not just about being lonely although she clearly was. It was also about a lack of information and advocacy and being disconnected from her local community. Research shows that it is often people’s adult children who find out informant about what is available in a local area; they make phone calls, sort out transport if they can’t provide it themselves, deal with bureaucracy, complete forms etc. People like Pat have no one to do this, if the TV crew had not intervened, it is highly likely Pat would have remained as she was, struggling to cope and eventually been readmitted to hospital.

One of the things we know sadly is that people ageing without children are less likely to have unpaid care support when their health deteriorates

“The absence of children is not clearly associated to a disadvantaged situation when health is good, but when someone becomes frail and loses their independence in carrying out daily living activities, childlessness becomes a problem. The worst situation in terms of the availability of informal support is clearly that of the frail elderly who are both childless and unmarried or widowed, especially if they are men” (1)

Furthermore, it has also been demonstrated that extended family e.g. siblings, nephews/nieces, cousins, friends and neighbours do not make up the care deficit if one does not have a nuclear family. Essentially, the more support a person needs, the less robust their support network is in being able to meet their needs

“Childless people tend to compensate for the absence of exchanges with their own children by more frequently extending their networks to neighbours and friends, and by getting more involved in community activities. They also tend to develop stronger ties with other family members – parents, siblings and, along the generational line, nephews and nieces………However when strong support is needed, these compensatory arrangements work only partially. When getting frail and acquiring limitations in their ability to carry out the activities of daily living, childless people receive much less support than parents, are more likely to enter residential care, and do so at lower levels of dependency” (2)

People ageing without children are often more likely to be involved in their community, have good friendship networks and get on well with wider kin but there comes a point when that is no longer enough.

If we are to help all the Pats out there, we need to be realistic about what we can expect of individuals, neighbours, communities and at what point the right thing to do, is for there to be support from the state for those people who have no one.


  • Childlessness and support networks in later life: a new public welfare demand? Evidence from Italy Marco Albertini Letizia Mencarini 2011
  • What Childless Older People Give: Is the Generational Link Broken? Albertinin M and Kohli M Ageing and Society 29(08):1261 – 1274 · November 2009
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