WE’VE COME A LONG WAY
One of the strongpoints seized by the 1916 rebels – and the scene of bitter fighting – was the South Dublin Union, the major Workhouse for South Dublin, housing some 3000 people. With the abolition of workhouses by the new Irish state, the surviving Union buildings morphed into what is today part of St. James’s Hospital.
The Workhouse was a crude and early attempt to alleviate absolute poverty by offering accommodation and employment to those unable to support themselves. Its heyday was in Britain in the nineteenth century, where the first evolving industrial society had to cope with the side effects of industrialisation – the expansion in population, the growth of towns and periodic bouts of unemployment as bust followed boom. At least 160 workhouses were set up in Ireland, catering for hundreds of thousands of indigent poor.
The very name “Workhouse” generates feelings of revulsion today, with images of the poor and destitute being herded into unsanitary buildings and compounds where they were forced to labour (including children) for bread and a bed, with families being broken up under a system deliberately designed to be harsh, to deter the able bodied poor from living off it. The proceeds from the work inmates performed were intended to defray the workhouse costs, which would otherwise fall on the local ratepayers. The comprehensive Wikipedia article on Workhouses makes for a fascinating read.
A dreadful system, designed, to address not Poverty, but Pauperism. But it was a dreadful time, when someone born poor had few prospects, social mobility was limited and life expectancy short. There was not even a rudimentary welfare state, no old age pension, no health system. And the workhouse era was not too long ago. In the 1890s Charlie Chaplin spent time as a child in a workhouse; George Orwell wrote of his time in one in the 1920s. They continued to exist, in one form or another until the British Welfare State was brought into being after 1945.
One aspect of particular dread to the elderly was the prospect of separation, when necessity forced old people to resort to the workhouse. “My Old Dutch,” one of the Music Hall songs of the 1890s, many of which dealt with the life and tribulations of the urban poor, if slightly maudlin, captures poignantly the moment of no return at the workhouse entrance. The singer/narrator, is an old man – for the time, life expectancy was far lower – unable to work and reduced, therefore, to the workhouse to house himself and his wife of forty years. They enter, without hope of ever getting out, and are separated. He sings – maudlin but highly charged all the same:
“We’ve been together now for forty years, An’ it don’t seem a day too much, There ain’t a lady livin’ in the land As I’d swop for my dear old Dutch.” (Dutch being abbreviated Cockney rhyming slang for “Duchess of Fife” = Wife.)
We’ve come a long way since then, but I was reminded of the song, almost serendipitously, by what happened to the Devereux family from Wexford in late June. How the elderly are treated in any country is a good measure of that society and thus far Ireland is probably due a few brownie points in this regard. The state old age pension is reasonable and is supplemented by a number of additional supports including free travel (a much prized benefit) and assistance with the cost of electricity and TV license, all of which survived unscathed during the recent era of cutbacks. Most of the elderly are in receipt of medical cards providing for free care and treatment, with free doctor’s visits for those over seventy who don’t qualify.
Money apart, the main thrust of state support for the elderly is through the Home Care Package administered by Ireland’s Health Service Executive (HSE). The aim of the package is to provide service and support to enable the elderly to stay for as long as possible in their own homes, rather than be obliged to move into a nursing home, either one publicly owned ( of which there are too few) or privately run (which are ruinously expensive). The package is not perfect, not comprehensive and suffered severe cutbacks during the Recession, the mantra that everyone should take a cut being applied callously to the old and infirm, who were for obvious reasons least likely to complain. However there is a structure there, cuts can be restored, it can be built on, it is what most old people want and it is far more economical to the state and the individual than nursing home care. It is also not means tested, an important consideration.
Nevertheless there comes a time when the elderly can no longer cope. 90 year old Michael Devereux and his wife, Kathleen, who is 86, and who have been married for 63 years, applied in March for participation in the Government’s “Fair Deal” scheme to cover the cost of long term residential care in a nursing home. The scheme involves a person (or a couple) surrendering most of her or his income, and up to 22.5% of the equity realised on selling the home after death. There are obvious flaws with the scheme but it represents an attempt to grapple with an issue that is likely to increase in importance as the number of elderly infirm people living longer seems set to rise. Either the state builds a lot more nursing homes or devises a formula to assist those entering private nursing homes by splitting the ruinous cost.
The problem in the Devereux’ case was that, initially Michael was awarded a nursing home place but the assessment of Kathleen was that she was healthy enough to continue to live on her own. The couple were thus to be separated with Kathleen expected to continue to live at home. When their son appealed, a review panel determined she was capable of living independently. The story broke on RTE Radio’s LiveLine on June 26, with an emotional interview with Michael Devereux, complaining that after sixty three years together he and Kathleen were to be separated. Once the piece was aired, an “Operation Stable Door” was mounted by the HSE, which ran for cover. After critical comments by Health Minister Harris and the Taoiseach, the HSE acted. The case was resolved in a day and Kathleen is to join Michael in the home.
To an outsider it might appear that, from the start, a dose of common sense would have prevented the issue ever arising. The HSE practice is to assess first on the basis of suitability for Home Care, and clearly with limited resources and residential care costing so much this is the wise approach – but there are always individual cases where there is need for some flexibility and a common sense approach. This was lacking – shades of the fiasco over withdrawing discretionary medical cards from chronically sick children several years ago.
Still, all’s well that ends well and we have certainly advanced from the Workhouse era. But with the numbers of elderly set to rise sharply in the coming years, the pressures on the system – and its financing – look likely to mount.