Richard Smith: What do you want your care home to be like?

Richard Smith At a conference I attended recently we were all asked to think about what kind of care home we would like. This was a truly shocking question. It was a conference on death and dying, and I’d thought a lot about a good death. For me the thought of being in a care home was more terrifying than the idea of being dead. It’s the same for my mother, who may be only months away from a care home. After discussion with the people at my table—all women and mostly nurses—I came up with my answer. I wanted to be in a care home where I could smoke, take illegal drugs, have sex with people I’d just met, and keep a pet python. I don’t actually do any of these things, but I like the idea that I could. And I imagine that in a care home I wouldn’t be able to do so.

Viewed from 56, a care home looks like a prison to me—a total institution where the staff will monitor what I eat, how often my bowels move, and whether I read unsuitable books. This is perhaps unfair, but the care homes I’ve visited usually feel grim—whereas hospices are jolly. As Liam Farrell described so clearly, we cope well with rapid death but badly with slow death.

There are currently over a million people in care homes in England, 10 times as many as are in prison. Without dramatic social or technological change (or a flu pandemic)  then the ageing of the population means that the  number will steadily climb. The Mick Jaggers of this world, the rock and rolling baby boomers, are heading steadily towards care homes. It’s hard to imagine the homes being quite the same when the old rockers check in.

Technology could help keep us out. Our every move will be watched in our smart homes, and robots will bring us red wine and make sure we don’t leave the gas on. The Department of Health has predicted that optimal telecare could mean 1.1m in care homes by 2014 rather than 1.2m.

Euthanasia may also save us from care homes. I’ve long believed that euthanasia will come, and instead of the day when you’re carted to the care home will be the day when friends gather, talk, drink, play music, eat a last supper and say farewell to you as you are put to death. 

A GP friend learnt from her mother that everybody in her care home “has a stash” for when things become unbearable. (My friend worries about the effectiveness of the stash and wonders what the GMC would say about her offering advice on the optimal stash.) I heard as well recently of an ex-colleague who disappeared from a care home never to be found. I imagine him making a break for freedom.

Anthony Trollope, one of my favourite writers, explored “care homes” and euthanasia in his futuristic novel, The Fixed Period, one of his few novels no longer in print. Some young people created a new colony not far from New Zealand and decided that as old age was a bad thing for everybody people would be euthanased at 67.

First, they would spend a year in an upmarket “care home”—a college, indeed—reflecting on their life. The novel describes the time when the first of the colonists enters the care home. Suddenly euthanasia doesn’t seem like such a good idea.

And perhaps when my time comes a care home won’t seem so dreadful—and possibly by then they will allow pythons. Or maybe—in true 19th century style—I can persuade my daughter to keep me in a corner somewhere. Right now, however, euthanasia looks the best option.

Competing interests: I have no competing interest, but buying shares in care homes could be a good investment.