meIt was visiting time at the hospital and the corridors were full of dutiful middle-aged sons and daughters. The woman holding the ward door open for me was balancing a monstrous stack of Tupperware boxes: home-cooked food, in case the nurses were too busy to make sure her elderly father ate. Why hadn’t I thought of that? But there’s always something more you should probably do; always a ball you might have lost.
So much about looking after aging parents reminds me of early motherhood, that old yoga pose that, in retrospect, almost looks like an exercise. Hello again, my old friend nagging guilt. And hello again, that feeling of having to be in two places at once – except now there are three, if you’re insanely ambitious to want to work, children and parents.
The frenzied tag team is also back, though this time it’s with my sister, not my husband: if you can take them to this hospital appointment, I’ll do the next one. And then there are the nights out with friends that inevitably start with swapping war stories, because everyone my age seems to be dealing with some version of the same thing. They sit for 36 hours in the emergency room waiting for an 80-year-old to find a bed, or chase after hospital follow-up letters that keep getting lost, or spend the evening (as one friend does) opening all the letters her mother can no longer make sense of. wondering if it is time to get a power of attorney.
Since not long ago our mothers were the ones running down the freeway to save us all from some childcare emergency, it seems only fair for my generation to run back the other way, now that our toddlers are fabulous teenagers. But the danger of a shrinking state relying on families to fill the painful gaps in health and social care is that for growing numbers of older people, such a family – the kind that now provides 92% of all unpaid care in the UK – just won’t exist.
Already one in 10 people over 60 do not have children, but for those over 50, that number rises to approximately one in five. For some it will have been a happy choice, but for others it is the painful result of infertility or loss, divorce or never finding the right person, or being born gay in a time when adoption or fertility treatment was not an option.
By 2032, the number of childless elderly disabled people living alone is expected to have increased by 80% compared to 2007. There are an awful lot of people who do not have close family to advocate for them, either in a social care system that is so overstretched that you having to fight for every litter, or in busy hospitals where the focus often seems to be on patching people up just enough to discharge them, rather than getting to the root of what’s wrong. And by 2045, Statistics Norway estimates that the number of eight-year-olds with no children in England and Wales will have tripled.
These figures have serious human consequences, not just for those involved but for taxpayers: elderly people who do not have children to care for them are 25% more likely to end up in a nursing home, according to the campaign group Aging Without Children. And even for those who have children, the demographic trend toward smaller families means fewer siblings to share the load—assuming they live close enough, or get along well enough, to try.
We live in an era of “beanstalk families”, where declining fertility and higher life expectancy combine to form long, straight family trees, with more generations alive at one time than before, but fewer at each. Yet a social service built around an imaginary extended family from the 1950s, all of whom live around the corner from each other and have a full-time housewife at their heart, seems free to come in every lunch hour and do the laundry happily.
The last thing I want to do to raise this issue is to add malicious moral panic over what Donald Trump’s new right-hand man, JD Vance, so apologetically called “childless cat ladies.” It’s cruel and pointless to make people feel guilty – or worse, fearful – about not having the children some of them wanted to have but couldn’t, when it’s about 30 years for the average older person to need of care. too late for regrets. Instead, what we need are services that are shaped by the way families are now, not the way smaller government advocates want them to be.
Almost 27 years after Tony Blair launched his first royal commission into long-term care, the new Labor government is said to have launched another, not because it somehow still hasn’t figured out what the options are, but because none of them. are easy. Last month, the chancellor, Rachel Reeves, scrapped the previous government’s increasingly fanciful plan to cap social care costs in England from October 2025, accusing her predecessor, Jeremy Hunt, of not putting enough money aside to make it happen.
While successive Conservative governments have been busy kicking this can down the road since economist Andrew Dilnot recommended a cap to then-prime minister David Cameron more than a decade ago, Labor has been lukewarm to the idea. Keir Starmer’s manifesto was artfully vague on the subject and his new government has only committed to a much wider package of reforms aimed at creating a national care service. Back to the drawing board it is presumably.
If the cavalry isn’t coming over the hill any time soon with social care, the least we can all hope for in the meantime should be a significantly more reliable NHS that doesn’t depend on families to hold it all together. That means coming to terms with GPs – whose work to manage their practices is particularly daunting for older people in England – and throwing everything into cutting brutally long waiting times, while also improving the often chaotic bureaucracy and poor communication that make the service so difficult. for sick or confused elderly patients to navigate alone.
The price for delaying wider reforms once again must be that the final package truly reflects how family life is changing. Let’s just hope that this time they don’t leave all the really hard decisions until the sons and daughters who are currently waiting in line for visiting hours are in hospital beds themselves.
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