People ageing without children are far more likely than people who are parents to end their life in a care home, 25% more likley. People ageing without children are 25% more likely to enter residential care and at a younger age and lower level of dependency (Wenger 2001). Findings from cross-sectional studies conducted in Germany, The Netherlands and the United Kingdom report an over-representation of childless older adults in residential care homes, particularly among men (Koropeckyj-Cox and Call 2007). Australian census data show that childless women are two times more likely to be in institutions than mothers (Rowland 1998)
The reasons for this are varied but can essentially be boiled down to the following; when people ageing without children are well or need low level support, networks of wider kin, friends and neighbours are willing and able to offer help. As care and support needs increase, these networks fall away. Although people ageing without children are more likely to rely on paid for care, accessing it in the absence of an adult child willing to help them navigate through the system and manage any issues arising from care packages, makes accessing formal domiciliary care more difficult. This combination of factors explains why people ageing without children are therefore more likely to go into residential or nursing care.
The care home sector in the UK was already under huge pressure before the virus with many small providers going out of business, concerns about the standard of care and a workforce shortfall making it very difficult for homes to recruit new staff.
The coronavirus has caused a perfect storm in care homes with several key issues including
- A lack of PPE for staff working in homes
- Care homes being asked to take patients who have tested positive for coronavirus
- The impossibility of self-isolating care home residents with coronavirus
- Care homes being asked to accept new residents from the community who have not been tested for the virus
The upshot of this has been an increasing number of multiple deaths in care homes being reported. Scotland has reported 12 fatalities at one care and 8 at another with several other homes reporting more than one resident with the virus. A care home in Liverpool has had 9 residents die of the virus and in Portsmouth another 4. However, despite this, care home staff and residents are not being tested despite repeated desperate requests. Several care homes staff have also died of the virus.
In addition to this, there are reports that care home residents are being sent letters asking if they have made their wishes about Do Not Resuscitate known and told that if they have Coronavirus going into hospital is “undesirable”. Leading age charities have banded together to point out that
“Any suggestion that treatment decisions can be blanket ones, based on age alone or with a person’s age given undue weight as against other factors, such as their usual state of health and capacity to benefit from treatment, would be completely unacceptable”
I can’t help but think though of the emotional aspect of all this. Care homes are not without televisions, radios and newspapers. It must be incredibly frightening to listen to stories of deaths in residential care and the lack of testing and equipment and know that there is nothing you can do. The advice about DNR is to discuss with your family – but what if you do not have one to discuss it with? Who do you discuss your fears and concerns with?
There is a massive need for advocacy in care homes, but advocacy services were already under funded and overstretched even before the virus, but even more than that there is a need to radically rethink how long term care is provided in the UK. Not everyone can, or wishes to, remain in their homes but equally long term care must not be left to the vagaries of the market.
For people ageing without children who are more likely to spend their last years residing in a care home, this reformation cannot come soon enough. The virus has brought much hardship and sadness but also shown what is possible when people let go of ‘we’ve always done it this way’. We must not let this opportunity to think again pass us by.