A grandfather with a pipe, a grandmother in a scarf surrounded by grandchildren, a romantic image of old age, right? Now let’s see what reality looks like. Higher life expectancy means an increase in dementia, retirement homes and nursing homes are overcrowded, social services are overburdened and families are desperate.
Take mommy away
I’ll start with my own story. My mom is 87 years old. She was diagnosed with Alzheimer’s disease this year. At first it was just minor memory lapses, nothing that couldn’t be excused by fatigue or age. And yet I had a gnawing suspicion that I couldn’t admit. How to face the truth that mom, my mom, could have dementia? You resist it. You are belittling. Because to voice a fear out loud is to admit that the thing we fear the most may be coming.
But after a few months it was clear that something was wrong. The tests, one after the other, confirmed what I didn’t want to hear.
Mom refused to admit she had a problem. However, I knew that it was only a matter of time before he would not be able to take care of himself. And it came sooner than I expected. Sudden deterioration, collapse, hallucinations, transfer to acute neurology. If before she was still able to function with occasional help, now there was a slump, after which it was no longer possible. What now?
They had a social worker at the hospital. “If I were you, I would put my mother on the waiting list for a nursing home. In Prague, the wait is up to three years,” she tells me. And I think to myself that mom might not even live to see it.
I am in a situation that is unsolvable. I am a single mother. I don’t have the capacity to take care of my mom 24 hours a day. I support myself and my daughter and I need to work.
So I’m calling a private device. “We have time off, we can see mom in a few weeks,” he says. Relief. But only for a moment. Here comes the other side of the coin, finance. A monthly stay costs 44,000. The care allowance is added separately. And this is an even “cheaper” device. The more luxurious ones can easily cost 80,000 per month.
Suddenly I am in a situation that is unsolvable. I am a single mother. I don’t have the capacity to take care of my mom 24 hours a day. Experts, social workers and child psychologists even warn me against it. “It would be devastating for your child. Don’t do it,” they say. And even if I wanted to do it, financially it is unrealistic. I support myself and my daughter and I need to work.
I cross out the option of nursing home and home care. And then they call from the hospital, they release mom, they can’t keep her there any longer, the beds are overcrowded. “We have to release mom, take her. But she’s going to need help,” she says from the phone. So shopping, hygiene, medication, incontinence solutions, overall supervision.
I don’t want to put her on LDN. I take unpaid leave and go see her every day. I take care of her. At the expense of her own daughter, who is home alone until late at night. I call social services, charities, anything possible with care. I hear the same thing everywhere, we can put you on the waiting list, the waiting time in Prague is half a year or a year.
Finally, a private organization that has a free capacity of caregivers. It is more expensive, 350 crowns per hour, but it is still a fraction of the monthly cost of a stay at the Alzheimer’s Center. And so I ask myself, if a person can fall through the system so easily, what about the people who can’t afford either private carers or a home with a special regime? What do they do?
Old people stay alone
Modern medicine can do almost miracles, what it can’t yet do is prevent the increase of typical old age diseases such as dementia. Tax for higher life expectancy. The forecast is that in 2050 there will be more than 300,000 people over the age of 60 in the Czech Republic with some form of dementia. And most likely these people will need some form of help.
We are getting to the point where the public sector is overburdened and the private sector is only for the rich. Caring for the elderly becomes a question of class affiliation.
Society has changed, families generally no longer live together. Aging parents stay alone in their apartments or houses in the village, the offspring move to big cities or even abroad for work. The traditional intergenerational model, where seniors remained part of the extended family, has disintegrated as a result of urbanization, mobility and lifestyle changes.
So the question arises, who will take care of aging parents, who often live to a respectable age, but many of them are no longer capable of self-care? The reality of the current state of social and care services in the Czech Republic points to the long-term overload of the system and the insufficient capacity of available care.
Care only for the rich?
My case describes well the structural problem of contemporary society where there are “atomized households”. Caring for an aging family member is significantly more complicated if there are only one or two people in the household. While in the past caring for the elderly was a naturally shared task of the extended family or community circle, today this responsibility shifts to an individual, most often to a woman who is simultaneously a mother, daughter and working person.
This is not a loss of empathy or moral commitment towards parents, but a systemic failure to support families who want to care for their loved ones. It is practically impossible to manage the long-term care of an elderly person in a “one-on-one” model if the network of public assistance is almost unavailable. According to surveys, family caregivers of people with disabilities and the elderly often struggle with chronic fatigue, loss of motivation and psychological stress that can lead to burnout.
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The social system is now teetering on the edge of collapse and it is the second problem besides nuclear families. The quality of old age is governed by market logic. Those with the means can pay for quality private facilities with individual access. Those who don’t have them have to hope that loved ones will take care of them, and hopefully one day they’ll be able to move up the waiting list. So we are getting to the point where the public sector is overburdened and the private sector is only for the rich. Caring for the elderly becomes a question of class affiliation.
Between individualism and solidarity
In the Czech Republic, there is a noticeable effort to keep the elderly in their home environment for as long as possible, which is commendable. But as with institutionalized care, there is also a lack of human capacity. The number of caregivers is low.
And so far, no adequate strategy has been agreed upon, such as increasing wages, better working conditions or a higher status for the caregiving profession. It is interesting to look at other countries where they are solving the same problem with population aging as here. We can take two opposites.
The Scandinavian model of long-term care is based on the belief that old age is a normal part of life, not a problem to be isolated. In practice, the emphasis is therefore on “aging in place” – the principle that older people should live as long as possible in their natural environment, not in an institution. This approach is supported by an extensive network of home and community services. So it’s a model that we’re still working on at a theoretical level, with the difference that it’s already been working in practice for a long time in Scandinavia.
And in contrast to the USA, where old age is perceived as a “private project”, something that a person has to provide for himself financially and organizationally. Care transformed into an economic service that can be bought. This creates a market in which human relations are transformed into contractual relations between the client and the provider. Access to care varies greatly by income, race, and place of residence. This creates significant social inequalities in access to services.
And so here we stand between two worlds. One where “old people” were a self-evident part of the family, and the other, which is crumbling under our hands and in which old age becomes a logistical and economic horror. But somewhere in between, a real human story takes place. The story of sons and daughters trying to stand up in their roles, and their parents, already deserves a dignified end of life experience.
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