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On a home visit the other week, the door was opened to me by a frail old man; gasping for breath he had tottered to the door, his catheter trailing behind him. He had metastatic disease and sats of 74 per cent, he lived alone. His wife had died several years earlier, and he had two children. He was estranged from one, and the other, though doing her utmost to support him, did so from a distance of several thousand miles.
His home told the story of a full, and I hope happy life, littered with photographs and correspondence; full of memories. My patient died shortly after, in hospital, and whilst I cannot know for sure, it is not unlikely that he died alone. I don’t know the intimate details of this old man’s relationship with his family, and I certainly don’t want to apportion blame, but his sad case got me thinking.
As a teenager I saw my parents and grandfather struggle to care for my elderly grandmother as her dementia progressed; unfortunately there came a point when we were no longer able to provide the care that she needed and she moved to one of the local nursing homes, where she was provided with excellent nursing care until she died.
Around that time, I promised my mother, at her request, that I would not turn my life upside-down to care for her as she had my Nan, but would simply ‘put her in a home’ when the time came. I still don’t know what my decision will be when my parents reach that age, and I certainly do not envy others the anguish of the decision.
The health secretary recently said that ‘delivering integrated care is the central challenge that defines modern healthcare’. And I think, he may prove to be right on this one; but it begs the question what do we mean by integrated care?
A few days ago the news was telling of a new law in china called ‘The Elderly Rights Law’, it is designed to encourage ‘filial piety’; a sense of responsibility and duty to ones elders, and particularly parents. This seems a rather heavy-handed approach, but it raises an interesting challenge: what role should we as individuals, not as doctors, play in the provision of integrated care for our loved ones and ageing relatives, or parents; what are our responsibilities of care within society.
No-one would question the duty of care that a parent has for their young child, should that same duty and responsibility lie with older children for their even older parents? Is integrated care purely the role of the healthcare system and social services, or is it in fact far wider than that?
In the few short months I have spent working in the community I have seen and heard of some remarkable individuals, who, for the sake of providing their loved ones with the level of love and care they feel that only they can provide, have faced huge personal sacrifice.
Sacrificing their financial security, their lifestyle and friendships, and in some cases even their health. I have equally heard some shocking stories of vulnerable elderly people whose choice has been forced, and who have had the life and home that they have spent their lives building torn away from them by their own children.
It is time that society, and not just modern health care, recognises the defining challenge of delivering integrated care. We have learnt that the birth of a child can be anticipated and their care needs planned and prepared for; can we do the same when it comes to caring for our ageing loved ones? Can we take responsibility and prepare for this challenge; as a society, and as individuals, or are we simply going to wait for this dilemma to arrive one day on our own front doorstep, as though it were perhaps delivered by a stork?
Zoe Greaves is a South Tees foundation year 2 and a member of the BMA junior doctors committee
I don't believe there should be a legal obligation on children to look after their elderly parents as there are often very good reasons that the elderly who have adult children are 'abandoned'. For instance, I think more often than is recognised, parents can be child abusers and get away with it. Just because they then get old shouldn't mean they should be pitied and have the right to insist on care from the very people they have harmed.
I do, however, think there is a much stronger case to say that a parent's duty to their children should legally be extended to include a lifetime duty of care and provision if that child has a long term disability.
No need to impose any legal rules. What you give will come back to you one day. Treat your parents failry and you will be treated well by your kin. That's nature law, some call it law of karma. No escaping from that I'm afraid..
In some cultures it is regarded to be the norm to look after parents. The eldest son has the responsibility of the parents but they invariably inherit the house their parents own if they are not already living with them. Of course in British law children have a right over the estate of parents so why not make that so they have a legal obligation to parents. I believe and regularly witness the abandoned elderly with the expectation that the nhs and social care will look after the elderly but the nhs and social care has not hot the means to continue with this given the increase in the aching population so lets make it legal maybe as part of a will last wishes look after parents get their worldly goods!
when I was working I noted many very elderly children trying to look after their 90-105 year old parents. sadly as our society ages so do the "children " age making theml less physically able to cope.This is a fact of life in our society in addtition to the mobile population
I have always said to my children that they are under no obligation to us, their parents. Their duty will be to their children. I once read a fascinating article about human biology, dscribing the last days of one of our ancestors. Western Europeans can be divided up into 6 or 7 families by mitochondrial DNA, which came to us from only 6 or 7 different women. Eve, our distant ancestor lived in the stone age, and there she was, living out her last days alone in a cave. The tribe had moved on without her as she could no longer walk, and carrying her would have put the whole tribe at risk. Her food was running out, as was the kindling to keep the fire going to keep the bears away, and winter was coming. The Holy Book says 'honour thy father and thy mother'.
You have not mentioned that perhaps we / our parents carry some responsibility for planning ahead to make sure our / their care needs are met ? I have no intention of being a burden on my children and will ensure that I have both the plans and the funds in place before they are needed.
Debates like this rely either on stereotyping or the stupid, wrong, assumption that everyone is the same. Manifestly there are myriad differences in personal circumstances. However we are responsible for our children until they reach independent adulthood because we brought them into the world, and are, as adults, responsible for the consequences of our actions. Equally we all have a duty to secure proper provision for our old age. If this means forgoing pleasure in middle life to save for a proper pension, or make other provisions then that is what we must do. It is no use, as far too many wishful thinkers and idealists do, expecting either the state or the next generation to pick up the pieces. That is gross selfishness masquerading as duty. Far too many commentators get off on that pseudo moralistic stance. No child should sacrifice their personal or financial future for the previous generation. It is also manifestly unjust to make children responsible for people they no longer have any meaningful connection with. As for quoting the scriptures; they are only outdated tracts of social control written by the elite to keep the masses in servitude.
I think the rule of what you give governs what you get back applies slightly differently.
If parents have been loving and selfless and brought up their children to a good level of independence the children will often put in the same level of effort to care for them.
However given the current situation many people look after their grandchildren in order that their children can go out to work then when just ready to retire and have some time to themselves they can end up trapped doing the caring for everyone until they become old enough to need care themselves.
I have also had a patient, who worked as a carer ,who was expected by social services to provide personal care to the father who had sexually abused her as a child. She was willing to do shopping, housework etc but not bathing and intimate care.
One needs to know much more than one point of view before judging the situation.
It is remarkable that a topic which should be about expressions of caring within what is hoped to be a warm relationship has aroused comments reminding us of the anger or indifference some people feel about their parents. The responses remind us of the substantial variation in individual experiences that shape beliefs about caring for parents, as well as an important role of cultural values. Statistics are not easily come by but I hope it is not too bold to suggest that abuse and neglect of children is not the norm on which policy or practice should be based, but something which should not be ignored either.
State provision is obviously necessary to ensure that care and protection of the elderly is not wholly dependent on family resources. The ideal that each person should make provision for their future is valid, and maybe even more prevalent in today's world of uncertain pension rights, but the reality remains that low earnings and varied misfortunes make such planning bound to leave large gaps.
Whilst the support of children by parents is explicitly and pervasively maintained by law and social structures, there is very little recognition of the reverse process. In fact valid wishes to protect autonomy and inhertitance tax laws often hinder the process.
I would suggest that much can be done at the cultural and social level to care for elderly and incapacitated relatives by family members more valued. Fetching the kids is presently infinitely more acceptable for missing an after-hours meeting than going to assist grandad would be. The law and the social services could definitely make more strides in recognizing supportive roles outside of the privileged one of parent supprting (under age) child.
We need perhaps to understand the reasons that the nuclear family model took such precedence over models with more flexible and extended responsibilities and ties. Maybe the forces are shifting a little. Perhaps 21st century demography will provide an impetus to develop new attitudes and structures.
None of us knows what is around the corner. Sometimes the challenges life throws at us are difficult to come to terms with, such as caring for an handicapped child, having looked forward to all the anticipated joys of a "normal" family life. In my experience, however, most of the parents of these children are wonderful people who are committed to providing the best possible life experience for their offspring, even though their original dreams of a regular family life are shattered.
And so it can happen with parents, who, if they live long enough, will almost inevitably develop infirmities of various kinds, and need increasing input. In a great number of of cases, the burden of care then devolves to one of the children - often a daughter - whose own life aspirations have to be shelved in order to nurture the elderly parent. Almost inevitably there will be times when the loss of personal freedom for both parties will be difficult to deal with. In many cases the elderly relative will live for a considerably longer time when nurtured, by which time the carer will be elderly!
In countries where ageing relatives are respected, extended families share the "burden of care". It is admirable that the elderly can then remain integrated closely within the family. In our western society, however, families are often fragmented and the burden of care devolves to either one family member or to the state.
Many of the better respite facilities are privately run, therefore expensive, and others are "unattractive", for elderly people who are compos mentis and enjoy interaction with younger vital people.
Old age per se is not necessarily a goal to which one should aspire. But maintaining good health and faculties makes all the difference.
Old Age is not for wimps!
What frustrates me is that we're only having these conversations now. Whether it's the retirement age, pensions, health care or social care, for some reason it has only started to matter now. The way the generation who fought a war then built up the welfare state were treated was an absolute disgrace and now their ungrateful children are starting to make society more 'caring' just at the point that it's their turn to retire! Not only that, but the conversations about how to pay for it will conveniently coincide with them no longer being responsible for paying for it!
The trouble with the generation retiring now is that at a public level, they have not been very nice to anyone outside their peer group. Huge numbers of the older generation spent their old age in poverty whilst their children have been burdened first with qualification creep, then when a degree became essential for a good job, tuition fees. Younger generations don't feel very charitable at a public level.
So, absolutely, this retiring generation will have to depend on their families because politicians will struggle to sell higher pensions or a social care service (and the elderly will have less clout than is thought, as in a FPTP system the majority of constituencies will not have a strong grey vote if they continue their migrations to the seaside). On a personal level, that generation have done well for their own children and that will be reciprocated. But the 'socialism for me, capitalism for you' attitude will not garner similar results from politicians.
Elderly parents can be selfish and manipulative, it is for each family to discuss, plan and be at peace with themselves. In my experience you tend to reap what you sow, there is nothing worse than care that is forced through guilt and not genuine concern and love.
In my opinion it is the parents who have brought the child into this world, it is them who taught him everything, so its upto them what to teach and what not.
If the parents have taught him to love and take care of others around him,if they have always loved him and brought him up as a good child then i think he will surly take care of his parents too. But if the parents are ignoring, abusing, unnecessarily transferring their stress on their children and expecting too much from him the child is surely to become a rebel and in that case the child will not at all care for his parents.
I mean the child doesn't learn anything from the mothers womb and comes. What you do in front of him today is what he will do in front of you tomorrow, as the first thing a child does after coming into this world in imitating. If he hasn't received any love and care then he won't give it back also.
So there are no laws to ensure anything if your upbringing is right.