IIt was visiting hours at the hospital, and the halls were crowded with dutiful middle-aged sons and daughters. The woman who held the door to the ward for me was balancing a massive stack of Tupperware boxes: home-cooked food in case the nurses were too busy to make sure her old father had something to eat. Why hadn’t I thought of that? But there’s always something you probably should do; always a ball you might have dropped.
Much of caring for aging parents reminds me of my early years as a mother, that old balancing act that, looking back, almost seems like a rehearsal. Hello again, my old friend, the nagging guilt. And hello again, that feeling of having to be in two places at once – only now it’s three, if you’re so insanely ambitious about wanting a job, kids and having kids. And Parents.
The frantic tag-teaming is back, too, but this time with my sister, not my husband: if you can get her to this hospital appointment, I’ll take the next one. And then there are the evenings with friends, which inevitably start with the exchange of war stories because everyone my age seems to be battling some form of the same problem. They sit in the emergency room for 36 hours waiting for an 80-year-old to get a bed, or chase hospital messages that inevitably get lost, or spend evenings (like one friend) opening all the letters her mother no longer seems to understand, wondering if it’s time to apply for power of attorney.
Since not so long ago it was our mothers racing down the motorway to rescue us all from some care emergency or other, it seems only logical that my generation would race in the other direction now that our toddlers have become burly teenagers. But the risk of a shrunken state relying on families to fill the aching gaps in health and social care is that for a growing number of older people, that kind of family – the kind that currently provides 92% of all unpaid care in the UK – – simply won’t exist.
Already one in ten people over 60 have no children, and among those over 50, this figure rises to around one in five. For some, this is a happy decision; for others, it is the painful consequence of infertility or loss, divorce or never having found the right person. Or they were born gay at a time when adoption or fertility treatment were not an option.
By 2032, the number of childless older people with disabilities living alone is expected to have increased by 80 per cent compared with 2007. That’s a lot of people without close family to support them – either in a social care system so poor that every bit of it is a struggle, or in overstretched hospitals where the focus often seems to be on patching people up just enough to be discharged rather than getting to the root of the problem. And by 2045, the number of childless octogenarians in England and Wales is expected to triple, according to estimates by the Office for National Statistics.
These figures have serious human consequences, not only for those affected but also for taxpayers: older people without children to care for them are 25% more likely to have to go into a nursing home. said campaign group Ageing Without Children. And even for those who do have children, the demographic trend towards smaller families means there are fewer siblings to share the load – assuming they live close enough or get on well enough to try.
We live in the age of the “beanpole family,” where falling birth rates and longer life expectancies combine to produce long, spindly family trees with more generations living at the same time than before, but fewer people in each generation. And yet social services seem to be built around an imaginary 1950s extended family, with everyone living around the corner from each other and centered around a full-time housewife who can come by every lunchtime and happily do laundry.
The last thing I want to accomplish with this issue is to stoke a small-minded moral panic about the “childless cat ladies” that Donald Trump’s new right-hand man JD Vance so disparagingly called. It is cruel and pointless to make people feel guilty – or worse, afraid – for not having the children they so desperately wanted but couldn’t. Because for the average elderly person in need of care, it is about 30 years too late to regret it. What we need instead are services tailored to today’s families, not the ones that advocates of smaller government would like.
Almost 27 years after Tony Blair set up his first royal commission into long-term care, there is talk that the new Labour government may set up another commission. Not because it hasn’t found a solution yet, but because none of them are easy. Last month, Chancellor of the Exchequer Rachel Reeves scrapped the previous government’s increasingly fictitious plan to cap the cost of social care in England from October 2025, accusing her predecessor, Jeremy Hunt, of not providing enough money to make the plan a reality.
While successive Conservative governments have been busy putting off this issue since economist Andrew Dilnot recommended to then-Prime Minister David Cameron over a decade ago that he should cap welfare, Labour has only been half-hearted about the idea. Keir Starmer’s manifesto was artfully vague on this point, and his new government has only committed to a much broader package of reforms aimed at creating a national care service. So the government will probably have to start from scratch again.
If the social care cavalry doesn’t come over the hill any time soon, in the meantime we should at least expect a far more reliable NHS that doesn’t rely on families to hold it all together. That means coming to terms with GPs – whose work-to-rule is a particularly frightening prospect for older people in England – and doing everything we can to reduce the brutally long waiting times, but also improving the often chaotic bureaucracy and poor communication that make it so difficult for frail or confused older patients to navigate services alone.
But the trade-off for delaying comprehensive reforms again must be that the final package actually reflects the changes in family life. Let’s just hope that this time they don’t put off all the really difficult decisions until the sons and daughters currently waiting for visiting hours are themselves in hospital beds.
