To wonder who will look after us in old age?

[malificent7]

I am curently a care assitant temp until my permanent job in healthcare is sorted. It is very rewarding but hard, dirty work for little money.
They are understaffed and many are leaving due to bad pay. As we are an aging population aibu to think this is going to get worse? How can we get carers to stay,?

Disclaimer...there is no way i want dd to look after me...not fair on her...i'd rather go to a home.

@stairway

Maverickess I think some kind of AI will definitely be used in the future, birth rates are plummeting and we are living longer. No one is that keen to send their relatives to a dignitas institution. I don’t know how robots would cope with dementia patients so maybe the robots would just keep them sedated. When I was a student nurse we had cushions that talked to the patient, so if the patient stood up it would say please sit down Mrs Jones and the funny things is they worked!

I'd love to have cushions like that - I seem to spend a lot of my time saying that! And to not much avail tbh! The point is though, with the complex nature of dementia and how it affects everyone differently, it'd be hard to manage without human interaction. Plus, if care providers and the government don't want to pay decent wages to humans, can you really see massive investment in state of the art technology and the costs associated with running and maintenance of that? 😉

Totally agree @Maverickess.
It’s embedded in our society.

Somehow we have managed to believe that death isn’t ok and should never happen despite the fact the very act of being born means we will also die.
I also think that we are still all hooked onto the 1980 promise that science and medicine will solve all problems in the close future so death is only ‘allowed’ old age on a graceful way. Anything else should be fought against (see also all the talk around cancer and being a fighter)

I just don't get why everyone is going on about assisted dying, that's usually an option reserved (where it is legal) for people in the last six months of life, terminally ill or with intolerable living conditions. Most older people aren't in that position at all, they might have 10, even 20 years with increasing care needs but lots of positive experiences of life, family, food, and so on.

I am a complete supporter of assisted dying, by the way, but it isn't a solution to the care crisis.

Even more, people say they are into assisted dying, but actually very very few people genuinely take any steps towards that when they are old, because these things creep up on you. All this 'I'll be off to Dignitas' stuff is a way of not discussing the reality of old age, and the lack of carers, because we aren't going to kill off several million people who require care, or indeed are they all going to top themselves, my experience is people talk about it but rarely do anything about it, which may be a good thing or not.

The care crisis and assisted dying are not the same thing; the vast majority of people who need care would not be eligible or even want assisted dying, they want care to be helped to live with dignity and enjoyment and that's where we are failing.

@MareofBeasttown

I think there will be visas for foreign care workers before AI.

Yep.

And the issue isn’t just carer. It’s who will pay taxes to pay for the pensions too etc….

I'm not sure how the state of the care industry will be when I am old. However, I am in the process of getting an advanced directive/living will set up - I am also hoping that there will be a legal option for people to take re: assisted dying, in the future. I'm a nurse and there is no way that I want to go through what some of my poor patients (and their families) go through.

My culture says that we should look after family who are ill/infirm, and sure that is an ideal...however my family is savvy enough to realise that isn't always practical. I was able to look after my parents (not that they needed much help at all), but they were both always very clear (having helped to look after grandparents) that they did not want any treatments that would prolong life, if their quality of life/outcome was poor. For both of them though, they were both pretty fit, independent and well up to the points they died. I miss them terribly everyday, but I'm also very thankful that they didn't suffer long or lingered, unable to do anything for themselves. They would have hated that and would not have wanted to live for years bedridden, and unable to do anything for themselves.

I worry about the care industry at the moment. Staff are exhausted, shifts are always short staffed. The care staff are often working in awful conditions, under huge pressures and are terribly underpaid. I work on an acute ward and that is hard enough.

@Maverickess

Thing is though, *@TravelLost*, the 'refusal' to accept death has come from society and filtered into healthcare by way of treatment and directives of what people should be offered and how. I work on a dementia unit, we have people who have lost the ability and the drive to eat, we supplement them with fortified drinks to keep them going, some laid in bed 24/7 with (especially during covid) next to no human interaction, unable to talk, unable to do anything for themselves. Why? Because we have to. Because medical science has advanced, and there's an expectation that it's used to increase life, because no one wants to lose their loved one when it comes down to it and want everything done to stop that happening. Because it's morbid and taboo to talk about it.

As a society we've lost sight of quality over quantity, it's not that HCPs alone have this refusal, it's the demands of society that have led to the policies that are followed.

Do the relatives have no say? We made it quite clear to staff at DM’s care home that past a certain stage of dementia (when she was over 90 anyway) there should be no ‘striving’, and unless absolutely necessary, e.g. in the case of a 2nd broken hip - no hospital, which in any case is a terrible place for anyone with dementia.
And the staff agreed.

With a childless aunt who was also in a care home with fairly advanced dementia, and a very poor quality of life, inc. double incontinence, we were consulted when she developed the umpteenth UTI and was refusing food and drink.

Did we want her taken to hospital for drips, without which she would almost certainly die - or given palliative care where she was?

I could only ask the lovely GP what he’d do if it was his own much loved aunt. He said that since it was only going to happen again, and probably quite soon, he’d leave her where she was, where they’d keep her comfortable.
It was a horrible decision at the time, but I’ve never regretted it. I’m 100% sure it’s what my aunt’s former self would have wanted.

My dad died from cancer in 2019. He physically deteriorated very quickly but didn't seem in pain. He spent a lot of time asleep. I googled what I should do if I found him dead as I felt that was a real possibility.
He wasn't able to come to the consultant appointment but it was decided not in his best interests to have any invasive treatments but they did advise some drugs that would prolong and improve his quality of life. The improvement was very short lived and then he had 2 spells in hospital (which were very traumatic for him) and he died in a care home about 8 weeks later.

It sounds awful but in some ways I wished they hadn't given him the additional medication. While it was horrible seeing him deteriorate, the reality was his days were already numbered and we knew he didn't have long left (He did not really know as he didn't have mental capacity at that stage) The additional time we had with him was not quality time for him or us. (He was in his early 80s)

All very well saying 'assisted dying' but that's assuming you have capacity. Assisted dying will never (thankfully) be an option for those who lack the capacity to make the decision and sadly, by the time lots of elderly people get to the stage where this might be a consideration for them they're past the stage where they could be relied upon to make a legally ok decision.

My GM was fine - frail and elderly, but ok at home - until she got to nearly 80. Then Parkinson's and related dementia took a frighteningly quick hold. My family did our best to keep her at home but it got the the stage very quickly where she needed 24h care, something none of us could provide. We put her in the very best home that we could find for her. 10 years later (when they expected her to live for 6m!) she's still there, their longest serving resident. Tiny, frail, barely able to speak, unable to walk, has to sleep in a bed like a baby's cot at night. If she could see as the GM I knew what she's become she'd be furious. I go to see her and she still asks me now when I'm going to take her home. In the last 10 years her husband, my lovely grandfather, has died (which she frequently forgets and is then very cross with him for not visiting her for ages) and her home has been sold (with everything held in trust for her). There is no 'home' left, and it's heartbreaking.

Would she though, at 80, have picked the assisted dying option? No, because she was fine. Until she wasn't. Which happened so so rapidly.

As for who will look after us? No idea. I'm planning to have enough money by then to pay for my own care because having watched my mother and aunt try so desperately to care for my GM with very little help available I am determined that I will never place that burden on my own children.

@Hopeisallineed

Only in our culture do we feel old people are burdens instead of realising what they can offer and how enriching inter generations living can be.

Have you actually read any of the posts about dementia? You're in cuckoo land.

I’m also in favour of assisted dying. I don’t plan on having kids so I will likely end up old and alone. I hope by then that it is legal and accessible so I can have my plans in place long before I start losing my marbles.

My worry is my own mum who does not have much in way of a pension or capital will not be able to do so if it doesn’t come in time. She has told me for years that if she ever loses it or becomes incontinent etc then she ‘wants a bullet’, and I’m sorry but I would not want to be her carer when it gets to that stage nor does she want me to.

I agree with Babdoc. I also feel that we have fostered a reliance on medical intervention rather than leading healthy lives, fuelled by fresh food and exercise (walking/cycling to the shop or station).

Our mothers are both 85 and have no underlying physical health conditions. MIL is in the early stages of dementia and lives 240 miles away and has only DH in the UK. We are paying for carers to go in and cook lunch for her and to check in early evening.

Prior to the dementia she was adamant that if she developed an illness she just wanted to be pain free and not prolong if her quality of life deteriorated; my mother oth would want everything thrown at cancer or heart disease from a fear of dying. I think DH and I fall into MILS camp.

FIL dropped dead from heart disease at 79, quite literally; my father died at 72, 10 months after AML was diagnosed, again suddenly (brain haemmorhage) just as he left remission. Comparing the two, I'd say it is difficult to die well but I hope we do.

Life and death is a personal risk assessment: for DH FILS side are beleaguered with heart disease and don't live much beyond 80 but MILS side live to 90 with few ailments until their latter years.

On my side, I have no knowledge of father's side. On mother's my g grandparents were 83 and 84 (in the mid 60s), mine 85 and 89 (late 90s).

The only certain thin I will say is that my grandmother developed dementia in her early 70s and went through the entire spectrum of the disease. At the end she couldn't remember how to swallow or chew, was doubly incontinent and under 5stone when she died. The reality of dementia/alzheimers in a person with no underlying conditions is horrific and whilst I think the greatest of care needs to be taken in relation to assisted suicide, in those circumstances I would like the choice and would make it now and in advance.

@Peraltiago

We really need assisted dying...

I think it's cruel keeping people alive past a certain point. My auntie recently died at 90. She lives in a nice home for her last 5-10 years but she had alzheimer's and couldn't reocignise anyone and was morose and depressed the whole time.

I'd want a short, sharp exit.

Yes, @User135644, but there is at least the alternative of not ‘striving to keep alive’ very elderly people with a very poor quality of life.

The default, however, unless relatives voice their concerns (see my pp) seems to be that regardless of quality of life, people must invariably be kept alive as long as it’s at all possible to do so.

I am terrified about that part of my future and really want assisted dying when the time comes and I lose all independence.
It’s so obviously the right thing to do.

I watched my father die last year over a period of weeks and quite frankly it was horrifying.

The problem with dementia (and ageing) is, it gradually robs you of the capacity to make decisions about the manner of your death. People who blithely comment that they’ll be off to Dignitas rather than end up reliant on care are just avoiding thinking about the reality of ageing and are fantasising some kind of decline where they can recognise a (non-existent) sweet spot when they are still capable of choosing death for themselves, are close enough to death that someone might agree to help them, and are not yet overly reliant on others for care.

Handing over the decision to someone else on when is the right time to die is messy and problematic (and somewhat cruel to expect others to decide) - but you will most likely find that when you are mentally capable of making that decision for yourself, nobody will agree to help you. So, the best you can hope for is that they’ll let you slowly kill yourself by not force feeding you, or not treating you for something like cancer. Dying slowly of dementia, though - there is no way of making that dignified and independent.

Due to several good reasons, I can't allow myself to get to the stage of needing care from anybody. I worked in adult care homes my whole adult life and I'd definitely rather die than face the prospect of being in one. I'm hoping assisted dying for other reasons other than terminal illness is legalised, otherwise I'll have to go to Dignitas. If I start to develop dementia or simply can't manage my daily living activities, I'm out of here.

Lots of people on here seem to be confusing making the right to make a decision about when to die with automatically farming you off to the euthanasia clinic when you reach a certain age.

It's not about mass euthanasia, it's about choice, like abortion. Sure, live as long as you want, if you can, and that's your choice. But someone else should equally have the choice to end their life if it has become intolerable to them, or would have been intolerable if their younger, healthier self knew what it would be like.

I personally think the extent that we now go to to keep the elderly alive is truly grotesque. Science has afforded us the ability to keep aged bodies and minds alive, but the ability to keep quality of life in line with actually just being physically alive has not caught up, and that has led to an awful gap between the end of one's enjoyable life, and end of actual life.

It's not just dementia or terminal illness that can rob you of your dignity, and to want to have the choice to keep living, or not, should exist, just like we have the choice not to bring life into the world in the first place. To place value in mere life by dint of still breathing, rather than the person's own sense of fulfilment in that life, is a barbaric, crude and selfish way to think, and to view other people. Having helped care for an elderly family member myself (as the only young female family member, interestingly), I can confirm that both the burden of care and the idea of being in that person's shoes were unbearable. And I don't think admitting that makes me a bad person.

My plan is: look after my health from now (i have done for years) to have as healthy old age as possible
Luckily no one in my family has ever suffered from dementia (but have lived very long) so I may be spared on that front
Lastly if I get to late 80s and get ill with something like cancer, I will not pursue treatment. Get all my ducks in order and off I pop when the time comes. A terminal illness left untreated hopefully shouldn’t take too long!
However I will not go for assisted dying. It is suicide. I liken it to studying and working really hard to get your brilliant degree and then just when you’re about to finish, give all the work up and not graduate.

You sound worried. My nan lived to 101 and lived on her own. After a hospital visit she needed recuperation and as there are no long recuperation hospitals was put in a care home for two weeks. She was then coming to my Mum’s. They forgot to put the bed side up. She fell and fractured her eye socket. She was admitted back into
Hospital and died. My Husband’s mother was put into a care home and had a second lady put in her room and started to hit her at night. After that was resolved her very frail little leg got stuck as she was being pushed in a wheelchair. The burly nurse keep pushing and snapped her leg. Negligent they refused to call a Dr for days. Eventually my FIL and MIL carried her to the car and took her to hospital. She had a fractured femur and died. So I will not be putting my mother into a home if she gets to the point of needing care. We sold our houses about 7 years ago bought a house with some land and had an annexe/bungalow built, where my mum lives. Separate from us, she looks after us more than the other way round! My sister who lives 500 miles away had a loft extension in her bungalow which is a suite of rooms for if she needs to look after her too. It may be that your children would rather support you than loose their mother to a care home or euthanise.

@kateluvscats, too true.

There’s always someone who piously says how uniquely callous the U.K. is, in putting their old people into care homes (and in any case the idea that it happens nowhere else is laughable.)

You can almost guarantee that such a person will have little or no experience of dementia, and fondly imagines that it’s just a case of a nice old thing gently getting more forgetful.

If only!

But I will freely admit that dh and I were blithely clueless when we took FiL with dementia to live with us.

Talk about learning the hard way! We’d had absolutely no idea of what it was going to mean.

Might add that I don’t know anyone who has finally taken the care home decision without a great deal of heart-searching first, and frequently only when they’re on their knees with stress and exhaustion.

See PP - my GM was being kept alive when she wanted to die. She had outlived all her brothers and sisters, two husbands, her son and a grandson. When she was readmitted back into
Hospital she would hide the tablets in her cheek and dispose of them after the nurse had left. It took two weeks without antibiotics to die! However, had she gone to my Mum’s and not the care home she would have been afforded the chance to die peacefully at home in a loving ig environment. We haven’t experienced dementia in any of my maternal family’s deaths and they have died peacefully and with loved ones. I did watch my step-father die from a very aggressive dementia and it was awful. He wasn’t capable from the very early stages of making a decision on assisted death.

@Babdoc

Several PPs say that they will keep healthy so they do not need care when elderly, or mention relatives still active in their nineties. As a doctor, I can assure them that the vast majority of healthy old people do not stay fit to the last minute, then conveniently die of a quick heart attack! At some point, they will begin to deteriorate. If they have good genes and kept fit, the process may start later than average, but it will still happen. They will just be 98 and needing care, rather than 88 and needing care. Secondly, some PPs say that we can all sell our homes to fund care. Great, but that solves nothing if nobody wants to work in the care sector! How will you staff your care home? There are currently nearly a million job vacancies in the UK, and most are in much more congenial jobs than having to wipe elderly bottoms for minimum wage. Modern medicine has created a monster. We artificially prolong life well beyond its normal expiry date, and now we are struggling to deal with the consequences. I remember a debate in the BMJ over 20 years ago, asking whether, by treating hypertension etc, we have simply converted a quick clean death from heart disease at 70, into a lingering ghastly death from cancer and/or dementia at 80. I think we are now seeing the answer.

I'd absolutely agree with this.

@GETTINGLIKEMYMOTHER

Yes, they do have input if they want it, but, a lot don't understand the implications of the treatment being offered, and it must be offered, and it can also offer symptomatic treatment. And there's also a fear that when people stop eating and drinking they are being starved to death, or dying of thirst, because something can be done about that, whether it's in the patients best interests or not.
Stopping eating and drinking is a natural progression of many conditions, it's a symptom, and will lead to death. Support in these areas keeps people alive, but it doesn't stop the progressive nature of age or associated conditions that have led to the inability to eat or drink or the refusal. I don't agree with withdrawal of this type of support, but I do question replacing meals with fortified drinks, I think offer, but that's all, if it's declined then don't go any further.
So many people are not happy with that approach though.
More invasive treatment is often declined by individuals or family, but the non invasive treatments can be just as effective at prolonging life as the invasive ones.

@Namechangedforthethousandthtim

Assisted dying is not an option to many people for religious and moral reasons. I certainly wouldn't do it for religious reasons. That CAN'T be the fall back plan, surely 😳 Making assisted dying the norm is, in my opinion, one step away from mass involuntary extermination - if it becomes the norm, people will feel forced or morally obliged to do it. The young and healthy who, in previous generations would have cared for the elderly and infirm, will over time begin to think "Why should we care for X? Everyone else is euthanising themselves - if X won't do it too, it's reallg not my problem." To me, assisted dying becoming the norm is really, really dark.

I don't have religious beliefs against it but I do agree with you otherwise