Behind the seafronts of the South Coast, Henry Porter searches for a berth for an ageing relative
The first thing that strikes you about the coast between Hastings Harbour and Eastbourne is how damned dull it is. No rock pools, no spits of sand, no dunes, no wind-bent bushes, no bathing huts, no cliffs; just a beach of shingle and wooden groynes and a sea-front of stuccoed hotels and jaded shopping parades. It is all pretty drab, yet tens of thousands of Britons come to Hastings to spend their final years on Earth, waiting by the grey waters of the Channel for the very last ferryman.
Hastings is a testament to the seaside’s powerful hold on the British imagination. Even now, nearly two centuries after the seaside was invented by the Georgians, there is a superstitious belief that the sea air prolongs life. Before retiring here people imagine that they will spend their days sunning themselves by bright civic borders along the seafront, enjoying the easy society of holiday friendships. Never do they think of Hastings in February or the steepness of the roads that lead away from the sea-front.
It is clear that the seaside plays little part in the life of the inhabitants of this conurbation of geriatric care. Few of the homes overlook the sea and apart from the occasional cackle of a herring-gull one is barely aware of it. Once you are up among the red villas of St Leonards-on-Sea you might as well be in Leamington Spa.
Aunt Phoebe has been dead many years now, but I resurrected her in order to interview the proprietors and managers of retirement homes in St Leonards and Hastings on the sly.
I also wanted to imagine myself about to consign a real person with a demanding personality and tastes to a little pink room with a glimpse of the sea.
Actually, there is no establishment in the Hastings area which could have contained my aunt Phoebe. She slept with a 20-bore shotgun in her bedroom and on one occasion went on a shopping trip to Cheltenham with the gun in a golf bag. When I talked about her I made her sound a good deal more amenable than she was.
The first home that I looked at was the Hurst, a big redbrick house which caters for 29 mentally disordered patients. The Hurst’s brochure contains examples of that awful institutional cheeriness, and it set my teeth on edge: ‘The home is proud of the quality and presentation of a varied diet and fresh home-grown produce is used when available from our allotments, i.e. tomatoes and broad beans.
‘You should see the rush to prepare the fresh vegetables! Most of the staff join in and have a good laugh.’
This would have made my aunt shudder too and I was rather surprised that it was handed to me, not by some trilling matron with a watch on her bosom, but by David Wells, who stood six foot four in his trainers. He wore a Puma sports shirt and there was a denim jacket hanging on his office door. He looked like a site engineer who played vigorous weekend Rugby. Somehow I could not envisage Mr Wells helping his old ladies with the last few pieces of the Princess Di jigsaw puzzle.
Still, he had a gentle manner and answered my questions about the restraint of old people in residential homes directly. That week an organisation called Counsel and Care had produced a disturbing report which described the use of sedation and ropes to control old people who wander and who are abusive.
Reading the report one is struck by the intolerable loss of human rights that old people suffer when they enter one of these homes. Many use subtle methods of control and are not beyond monitoring the residents with video cameras and microphones. If any other group of people suffered such a routine invasion of privacy, such denial of freedom of choice and movement, there would be a constant barrage of complaint in the press. But these people are old and do not merit the fuss that accompanied the revelations about Pin Down in a council home for adolescents. But there is not much difference between Pin Down and what some old people suffer.
Mr Wells assured me that there was little restraint in his home. He said that the sedatives were administered by the community psychiatric nurse and if the problem was serious the hospital took over. He showed me round a little pink room with a view of a brick wall. I remember a bedside lamp made in the shape of a poodle.
Mr Wells passed one or two tests I had set the owners and managers of the residential homes that I visited. He did not react badly when I told him that my aunt Phoebe was a fan of Eric Clapton's music and that she would occasionally want to play it quite loudly in her room. He also said that her small dog would be made welcome.
But Mr Wells failed the nomenclature test. As we crossed through a room full of old people watching day-time television he used the word patient instead of resident. This was important. Once old people are regarded as patients they are done for.
There was also another sentence in the brochure which irritated me: ‘Activities within the house and garden are geared to residents’ needs and interests, within their capabilities and with an emphasis on individuals’ and groups’ achievements.’ He made no better sense when he explained the occupational therapy given to his residents. I decided that if my aunt Phoebe had been alive she would not be going to the Hurst, however gentle Mr Wells seemed.
‘Cucumbers are better than men because they are at least six inches long, they stay firm for over a month and you can always cuke [sic] and eat them.’ The notice in a bulbous green typeface might have been just tolerable in a lavatory, but it was hung on the landing and impossible to ignore. I thought my aunt Phoebe might find its nudging ribaldry rather trying.
And then there was Fred, who seemed to be the retirement home’s ‘character’. Clearly Fred fancied himself as being something of a ladies’ man. There were pictures of Fred at a party in the hallway and on his bedroom door someone had stuck a newspaper headline which read SEXY FRED’S ROOM. I imagined an old chap with grey whiskers sprouting from his shirt collar pursuing my aunt with a toothless leer. Would she not find this a little tiresome too? Probably, but Cerdic House in St Leonards-on-Sea, a suburb of Hastings, was altogether different from the traditional Death’s Door Nursing Home of the South Coast. There was a life about it and that was the first thing that I wanted for my aunt.
A good proportion of the people in the homes in Hastings are paid for by the taxpayer. If an old person’s capital is less than £3,000 the Government will foot up to £165.00 of the cost a week. Their state pension is then replaced with a weekly allowance of £11.40 which is very little if an independent-minded resident wants to take a taxi to go shopping or buy a new cardigan; and it doesn’t take much to drink and smoke £11.40. The inevitable result of this is that residents become more reliant on their home than they should. Instead of deciding to go out on a sunny day to have a meal at a cafe, they have to wait for a member of staff to give them a lift. Their independence is seriously limited.
When a resident has over £8,000 in capital he or she will pay the total cost of board and lodging. In private homes the independently funded resident may get a larger room and a bath because they can pay extra. They can also buy little services, a personal telephone perhaps, or a weekly taxi ride to the hairdresser. These set them apart from the less well-off residents and do not help the complicated social life of the home. Most of the managers and owners that I talked to admitted to spending a great deal of their time on the envies and rivalries that exist between sweet old ladies. A retirement home is a closed society and the peace between different class groups and backgrounds is only preserved with the greatest tact.
At the other end of the scale, you can pay seven or eight times as much. At St George’s Nursing Home in Pimlico, London, a suite costs £90 a day, a room with a bathroom £89, a single room £65 (the cost per year is respectively £32,850, £31,025 and £23,725). But for this one may sit next to fellow inmate Loelia, Duchess of Westminster and Margaret, Duchess of Argyll in the television room. There is also a high ratio of trained staff to residents at all hours, which gives residents a greater sense of freedom. They can order a meal at any time of the night, and arrange for the chauffeur to drive them to the hairdresser or to a gallery. The home has accounts with Harrods, Fortnum and Mason, etc.
In 1993, much of the system will change. Concerning the average old people’s home, local Social Services departments will have a greater hand in deciding who gets funding. This was the subject of a long lecture given to me by Ian Ross, the administrator of the Old Hastings House. Mr Ross, who was in his early forties, was another surprise in his mustard-coloured shirt, dark jeans and soft shoes.
He sat in a small ill-lit office fulminating about the inadequacies of social workers. ‘What will happen is that there will be thousands of new social workers employed at a phenomenal cost and they will all be given cars at a phenomenal cost so that they can visit old people to assess whether they should go into residential care. But then of course they will have spent so much money on the visiting assessors that there won’t be any more money for the funding of old people in care.’ All this, however, will not affect the gentle abuse of human rights in old people’s homes.
The home that Ian Ross runs for the 13th-century Magdalen and Lasher charity was one of the best equipped that I saw. Each floor is decorated in one theme so that the older residents only have to remember the colour of their floor when they get out of the lift. There were several Parker Baths (hydraulically operated) for people who cannot use conventional baths. It was all very clean and impressive but I was left with the overwhelming impression of an institution. The faint smell of cooked cabbage in Old Hastings House reminded me of a boarding school and I felt it would be unacceptable to my aunt. Besides, residents are not allowed to smoke in their rooms, and there are smoke detectors to alert the staff if they do. These are so sensitive that they are sometimes set off by talcum powder.
The next stop was St Peter’s Grange where I was welcomed by a woman called Sister Crichton who had the brisk friendliness of a prep-school matron. She looked at me carefully and enquired more closely than the others about my aunt. How old was she? How mobile? How batty? How independent? How well off? She said that she believed in encouraging her residents to take reasonable risks. By this she meant that she would not want them to sacrifice quality of life for quantity of life. Still, they seem to have long innings at St Peter’s Grange and four residents are within striking distance of the century.
What I liked about St Peter’s Grange was chiefly Barbara Crichton. She even seemed to tolerate smokers and referred to some old gentlemen puffing away in front of a Channel Four racing programme as ‘my little row of chimney pots’. I think my aunt might just have been happy there but she would have done anything to avoid the sing-along sessions round the electric organ in the main sitting room. She might also have disapproved of the uncomplicated cheeriness of Sister Crichton.
As we walked along the pot plant- lined corridors, past the dried flower arrangements, I was reminded of one of Betjeman’s best poems, ‘Death in Leamington Spa’. Here are the last two stanzas:
Nurse looked at the silent bedstead,
at the gray, decaying face
As the calm of Leamington ev’ning drifted into the place.
She moved the tables of bottles
Away from the bed to the wall
and tiptoeing gently over the stairs
turned down the gas in the hall.
Had I been about to consign my dear aunt to limbo in Hastings I would by now have been feeling extremely guilty for not looking after her myself. This is undoubtedly in part the inspiration of the Association of Relatives of Elderly People In Homes which announced its formation last month. One of its important aims is to make home managers more responsive to relatives’ wishes. Another, although unstated, is to watch for the abuses that occasionally occur in old people’s homes.
In Hastings there is something called the Residents’ Charter which is meant to protect residents from exploitative home managers and rough handling by staff. This certainly helps the image of the Hastings homes, but it seems extremely unlikely that many old people are going to find the strength and courage to lodge formal complaints under the charter about the men and women who govern every aspect of their lives. When you enter one of these homes as a resident you exchange to some extent your liberty for security.
But if I had to send my aunt to one of those places in Hastings it would probably have been St Peter’s Grange. It was not the most beautiful building, there was none of the family atmosphere of Cerdic House (where I had found the cucumber notice) and it did not possess the array of Parker Baths that I had seen in the Old Hastings House. But it did seem to treat old people with respect. I liked the way the residents’ names were listed in the hall as if St Peter’s were an apartment block and I felt Sister Crichton was as much interested in dignity as she was in efficiency.
I left Hastings with mixed feelings. On the one hand it was clear that retirement homes necessarily entail a loss of freedom. I also became convinced that even with the most intelligent nursing, the relationship between staff and residents is unequal. On the other hand I was impressed by the dedication with which so many youthful people are caring for the old. Being an attendant in God’s waiting-room is a pretty unrewarding job.