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Family is not always best

21 June 2019

It is often not possible or desirable to rely on relatives for care, says Anne Bennett

BBC/Ismar Badzic/Rogan Productions

Rita McAllister, aged 77 (left), who has Parkinson’s and has been looked after by her daughter, Siobhan Madden, for six years. They featured in Panorama: Crisis in care, broadcast on BBC1 in May

Rita McAllister, aged 77 (left), who has Parkinson’s and has been looked after by her daughter, Siobhan Madden, for six years. They featured in ...

MY FATHER was bone thin in his final illness, wasted and weak, but conscious until his last days. Together with my exhausted mother, my sister and I looked after him, aided by visiting nurses and his excellent GP.

This was my first experience of the shocking intimacy of tending to an adult relative’s personal needs. I was grateful to the professional carer who taught me how to turn him over, where to apply cream, and how to care gently for his mouth, until he died peacefully in his own home with his family around him.

Many people need this type of “social care” for years — some for a lifetime. More people work in social care than in the NHS, and it is by far the biggest part of local-authority spending. Done well, social care is a blessing, and I have met some truly wonderful carers; done badly, it leads at best to a loss of dignity, and, at worst, to life-threatening neglect.

Birth rates have fallen in Europe. In our ageing population, it becomes harder to find care workers. In the UK alone, 100,000 carer posts sit unfilled. Carer pay is low, typically falling under the proposed £30,000 threshold for immigration proposed under Brexit, and causing increasing alarm among policymakers; for one sixth of the care workforce has come from abroad.

A letter from the president of the Association of Directors of Adult Social Services (ADASS), Glen Garrod, to the London Evening Standard, said that we would struggle to wash, dress, and feed vulnerable people, unless there was a guarantee that care workers could come to the UK without hindrance after Brexit.

RATHER than advocate for the widest possible labour market to cope with the ageing population in Europe, some have called for social care to be taken back into the family. Writing on the UnHerd website in February, for example, Canon Giles Fraser argued: “Children have a responsibility to look after their parents. . . Care should be embedded within the context of the wider family and community. This sort of thing is not something to subcontract.”

This sounds virtuous, on first reading, but the reality is that relying primarily on family care is neither possible nor desirable. Long-term care is often not viable, although many people do care for family members. Dispersed families are the norm in any developed economy, and it is not just children who move away. When your parents choose to retire to that nice little place in far-off Cornwall, they implicitly accept that later-life care will be subcontracted.

There are also disturbing assumptions underlying the “family is best” model. Many people shudder at the idea of their children performing intimate tasks for them, and would much prefer professional care. It may be dangerous to move a confused, frail relative into a family home, when thousands of families live in already overcrowded flats and houses. Care is physically demanding: carers repeatedly lift heavy weights in awkward positions, and it cannot be done by everyone. And, while some families are loving, healthy units, others are not. Willingly caring for a beloved family member is one thing; being forced to care for an abusive relative is quite another.

Women shoulder most of the burden of family care: more than 80 per cent of those offering more than 35 hours a week of family care are women. Women offering family care miss out on their careers and suffer financially, losing income, work opportunities, and pension contributions. Some of the worst off are the 1.3 million “sandwich carers” in the UK, who care for both elderly parents and dependent children. The Office for National Statistics says that more than one quarter of these carers with multi-generational responsibilities are depressed or under stress.

THE Church has a part to play. Taking the sacrament to a housebound couple, where one is caring for the other, can bring joy to both. Volunteers, suitably trained and checked, can offer a couple of hours respite for a carer. Dementia cafés, such as the one at St Peter’s, Rochester, offer a space for carers and sufferers to meet, get advice, and break their crushing isolation.

The Church can also be an advocate, ensuring that people receive the help and benefits that they are entitled to. I spent many hours with a young person with a degenerative illness, helping her to navigate the tortuous benefits system. We should advocate, too, for living wages for carers, flexible working patterns, and stronger employment rights.

In the Bible, we read the story of Mary and Martha. Jesus gently chastises Martha for being focused on domestic work, while Mary simply sits at his feet. If society does not share the burden of care, we force family carers — mostly women — to become permanent Marthas. Everyone needs “Mary” time.

Society must not begrudge the economic cost of paying carers a living wage and ensuring that family carers have access to regular respite care. There are no easy answers to the twin challenges of increasing demand for care and decreasing availability of carers — but this is a challenge for the nation, not for families alone. Care work, whether performed by families or professionals, is valuable to all of us.

The Revd Anne Bennett is the Team Vicar of Deptford, in south London.


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