Coronavirus has revealed what’s wrong with our approach to ageing | Sonia Sodha | Opinion

“Have a badge.” The latest initiative of the health secretary, Matt Hancock, to boost the status of care workers has been widely mocked, not because it’s an innately bad idea – care workers report being turned away from shopping slots reserved for health and emergency staff – but because it seems like such an utterly incremental gesture. This is a world where carers are going to work without protective equipment, the government has only just announced widespread testing for care home residents, and care home deaths in England are not even included in the official count.

Some of the hardest-to-hear stories of this pandemic are emerging from the care sector. There’s been so much coverage of the awful decisions that doctors may have to face in rationing scarce intensive care beds. But over in social care, managers and staff have been grappling with impossible moral dilemmas for weeks with scant guidance. How do you prevent coronavirus spreading to those whom it’s most likely to kill when you are sending staff without protective equipment from home to home to assist more than a dozen people a day with intimate tasks such as washing and eating? Do you allow relatives into a care home to say goodbye to their loved one or is the risk to other residents too great? What do you tell those at the local hospital who want to discharge patients into your care who haven’t been tested, potentially jeopardising the lives of the people who already live there?

It is a welcome development to see the care sector thrust into the spotlight for once, dominating the recent Downing Street press conferences. Here’s hoping that it leads to decades-old calls for social care to be properly funded and integrated into the NHS finally getting some traction. But rather than pretending this is just a case of an urgently needed policy fix unaccountably languishing at the bottom of to-do lists, we need to confront that it is a symptom of something deeply wrong with the way we think about ageing.

This pandemic is lifting the carpet on some hard societal truths long swept out of sight. One of the most brilliant scientific advances of the last century has been the stretching of human lifespans; one of the least edifying aspects of collective human behaviour has been our failure to adapt to its downside: people contending with longer spells of physical and mental decline in the last years of their lives.

Just because you have dementia does not mean you cannot feel joy and love; just because you need help to wash and dress does not make you incapable of richly stimulating conversation. But the way we talk about, think about and organise older care has become utterly dominated by the management of decline. As soon as someone needs help to live, the expectation of what it means for them to live a good life drops dramatically. We adopt a primitive baseline against which to judge whether we are meeting our societal obligation to our elders, and then we fail even at that: an estimated 1.5 million older people are doing without the help they need with everyday tasks such as washing and dressing.

I don’t want to grow old in a world where it’s considered to be enough if I’m free from physical harm in my last few years. But this cultural more will be stubborn to shift because it is a function of the pervasive ageism that runs through society. Like all prejudice, ageism is inculcated from a young age. But what distinguishes ageism from other prejudices is that what we seem to recoil at, what we ultimately are all fearful of, is what we will all one day – if we’re lucky – become.

Its consequences are ruinous: partly because there is growing evidence that as we take our own ageism with us into older age, it becomes a self-fulfilling prophecy; researchers believe older people who themselves buy into negative stereotypes about ageing are more likely to suffer ill health, for example. But also because that fear and prejudice runs through every aspect of how we care for older people. Caring is mischaracterised as low-skilled work – a misnomer, as anyone who has ever observed a carer at work will know – partly because it is feminised labour. But also because it is so often conceived of as a series of physical tasks rather than the emotionally tough but potentially incredibly rewarding job it is.

The psychoanalyst Isabel Menzies Lyth observed in the 1950s that hospitals organised nursing the sick and dying as a series of fragmented physical tasks, the same task repetitively performed for many patients, each patient cared for by several different nurses, in order to protect the nurses from the emotional stress of death and loss. In other words, patients were objectified and dehumanised to conform with what was thought to be a tolerable psychological strain for carers. Too much of this ill-conceived approach lingers in how we conceive of care 70 years later. In a world where pitifully paid care workers are expected to zip in and out of homes in short slots that force them to choose between washing and feeding, it is a miracle that they have not evolved into an army of emotionally dead robots in the interests of self-preservation.

That’s the tragedy of the badge. It gently hints at a cultural revolution we so desperately need: to see care work as enabling people to live a life filled with joy and love, and to compensate and value that work accordingly. But the badge is so completely and utterly unequal to that task. That’s not really Matt Hancock’s fault. It’s on each and every one of us.

Sonia Sodha is chief leader writer at the Observer and a columnist for the Guardian and the Observer

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