Care doesn't cure

We've had some positive news from the medics and physios over the last couple of days: Viv has recovered well from her latest op and things look bright.

Our physio explained why this might be: Viv has been off her legs since February 2017 but she has been doing regular rehab exercises almost daily. The latest op has, for want of a better way of putting it, fixed a few things in her brain; her brain is once again able to tell her legs what to do, and her legs are able to respond.

The rehab regime Viv has followed has been possible because she has been at home, in my care. If she had been in a care home that wouldn't have been the case; the physio said she would probably have been left, to be bed bound, for the rest of her days.

There is this view that patients leave hospital to go into care - that is actually what was proposed for Viv three weeks ago until I got my Power of Attorney out. Care doesn't cure, though; a home environment, with the right support, is a far better place for someone to get well.

For many patients it may be that the home environment is not suitable for their rehab; but shouldn't efforts be made to change that, and to get people thinking about their likely needs in older age, to keep them out of care?

Also, shouldn't social services be a little less risk averse, and let people live at home if it is at all possible, rather than placing them in care homes where they are just kept in bed all day 'for their own good, for they might fall'?

Retirement

There was a program on TV this morning about retirement, and how wonderful it is ... lots of time for hobbies, meeting people, and all of that. One thing that was missing was any sort of discussion over what the purpose of retirement is. Surely it is to prepare for, and provide, care for ourselves and our loved ones as we grow old.

I wondered how many of the wealthy retirees enjoying their pilates sessions had sorted out powers of attorney, or knew whether their pensions would allow them to enjoy their lifestyle for ever? (Also, why were people talking about maintaining their lifestyle from working into retirement - I used to get up at 5.30 and catch the 6.47 to London every day, I don't want to do that now! I also used to spend £1200 a month on the mortgage, and £500 on a season ticket... why would I want to maintain that?)

I was just seventeen months into retirement (and had not actually started to draw my pension) when Viv was taken ill. I wasn't prepared at all for dealing with carers, district nurses, doctors, social workers and the rest. Shouldn't that be what we should be doing in retirement, one way or another, rather than just frittering our time away on our social lives - even if that does keep you healthier?

'Death of early retirement'

Today's Daily Mail has the above headline on page 2. Apparently, in seventeen years time no-one will retire before the age of 65.
It's all due to pension changes, and the fact we're living longer.

So, what will happen if someone aged around 60 needs their partner (similar age) to care for them? If all their savings are tied up in pensions they'll need state-funded carers to help, because the partner won't be able to afford to give up work to do the caring.

I've mentioned before that the fundamental problem with pensions is that you need to save into them when you're young - under 25 if you want to draw them at 60-65! What we're seeing with the care / pension funding crisis is, in fact, a consequence of the various policies aimed at keeping younsters off the jobless registers - which also kept them out of work: things like keeping them at school to 18, 50% going to university, no dole for students, etc.

We need more people working, not lounging around supposedly studying for pointless degrees.

Appointments not available

Viv left hospital last night, and we have to make an appointment with the GP who has been involved in her case to update him and to discuss ongoing aspects of her treatment.

I phoned the surgery now; they said there are no appointments available for that particular doctor. We'd have to queue outside the door at 8am on one of the days he's in.

I enquired further; apparently they are not taking any appointments for April yet. That's just two weeks away! We aren't going to join the Soviet-style morning queue so I'll phone back next week and see if they have any appointments available for the right doctor then.

No wonder A&E is deluged if it's this difficult to get a GP appointment! In my working days I often used to set up meetings a month or so in advance; we've also got dental appointments in April. If the dentists can manage this, why can't the doctors?

Lesson from History

Saturday's Daily Telegraph contained a story that the government are proposing to increase the tax burden on the elderly to fund the NHS.

The TV was on when I read it; a program on Yesterday, titled 'The Nazis - a warning from history.'

The elderly, or baby boomers, seem to be being blamed for an awful lot nowadays - lack of funds for social care, the queues in the NHS, the housing crisis, etc. I'm not sure that's all terribly fair (youngsters have been discouraged from working in their teens for the last couple of decades, to keep the jopbless figures down.... so there's less tax income, for instance, perhaps?)

The worrying thing is that 'the old' are being blamed for things by those who should know better. One parliamentarian has even suggested their votes should be ignored! How far is that from the way the Nazis started out with the Jews?

There's a desire among 'the elite' to appeal to youngsters nowadays; does that really have to mean disenfranchising those over fifty?

Where it all seems to go askew is that many baby boomers are funding their own social care (as Viv is),  aren't staying in a job that a younger person could do, and aren't living in a huge house blocking youngsters from getting on the housing ladder (our 900 sq ft property is just right for the two of us). The problems being blamed on baby boomers caused by much more complex issues, that perhaps the politicians don't want to admit to.

Pensions and care funding

There's an article in The Guardian today (https://www.theguardian.com/commentisfree/2018/mar/16/death-retirement-striking-lecturers-pensions) that has a very one-sided, 'elite' view of the pension reforms that have taken place since the 1980s. It complains about the death of defined benefit pensions and how defined contribution pensions aren't as good.

A key point that the author misses is that what is 'good' is subjective; he also fails to mention that, with DC schemes, there is much more of a need for the individual to understand how pensions work.

You may pay into a defined benefit pension for 50 years (yes, some of us started work at 15 - not something many of today's snowflake generation would seemingly consider!), pay in a hundred thousand or so in your own contributions, get a supposedly generous pension of £8K or so per annum, and die after two years. You don't get your money back.

What's more, you can't dip into a defined benefit pension to fund short term emergencies - like care.  Viv has had carers for a year or so, the costs have varied but have at times been as much as £2500 per month.  We've been able to fund that by drawdown from our defined contribution pension pot.

If Viv and I had only defined benefit pensions we'd have been dependent upon council funding for her care. This has two disadvantages: 1) it adds to the council adult social care bill and 2) if your care is funded you have much less flexibility about what you can get your carers to do for you - you have to do what Social Services say. For instance, we've had carers helping with rehab, which would not be funded by social services.

I don't know about everyone, but the last thing we want is some busy body from the council coming in and telling us what we can and can't do. Our pensions are our money, we're spending them sensibly (yes, we have enough to see us beyond 80, and have consulted a Financial Advisor) and we want care that suits us. The pensions reforms of recent years have helped us achieve this.

Surely using personal pension funds to fund care is better than the state having to pick up the tab? Is it not just another case of 'the elite' telling us plebs we can't be trusted and don't understand what we're doing (as with Brexit) when in fact we know perfectly well and have things wholly under control.

My own view as to the problem with pensions is that people aren't paying in enough when they're young - you need 40 years at least to build up a pension, and many today don't seem to realise the importance of that. I learnt it at University - oddly enough, the same university at which the author of the above article is a lecturer. I wonder if they still explain the effects of compound growth to their students?

Would you eat in a restaurant where only half of the staff wash their hands?

A few months ago, in the late autumn, I took Viv to Bedford Hospital for an appointment. There was a big poster near the canteen charting how many staff had had a flu jab: it was about half of the total. Beneath it was a slogan encouraging staff to have a free jab.

'I don't understand', I remember saying to Viv, 'why aren't all staff required to have a flu jab? Every year the NHS complains about being busy, partly because of flu; if staff aren't having a jab, they could be passing it on! It's crazy!' We'd already had ours, because of her condition Viv gets a free one, as do I as her carer.

Viv's now in Addenbrooke's, it's March, and there are similar posters up around the wards and corridors, although not quite so visible as the one at Bedford; they became a little more relevant yesterday when her bed bay had to be subject to 'barrier nursing' because one of the patients is suspected to have flu. So, all staff and visitors have to put on aprons, masks and gloves before entering, and take them off when leaving. This slows down the entry and exit of staff from the area and, yes, does impact the quality of care.

I accept that you can't always prevent infection outbreaks in hospitals, but they could take 'reasonable precautions' to prevent them. It's like restaurant staff washing their hands, surely - a precaution that the employer can require staff to take to ensure that all those (employees, customers, patients) for whom he has a duty of care are indeed exposed to as little risk as possible. Indeed, shouldn't the hospital require all on site (visitors as well as staff) to have had a flu jab?

Perhaps someone claims 'human rights' or something as an excuse for no such rules being in place.  I don't know about you, if I found out a restaurant owner respected his staff's right to not wash their hands, I'd boycott the place.

Ah, but we don't have the choice with hospitals, do we....?