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84
In stressing the need for the closest co—operation between
housing, health, welfare and voluntary organisations the circular
pointed out the extent of the problem and the role which the general
practitioner would have to play if any appreciable advancement is
to be made in covering the needs of the elderly.
Later in the year the circular was followed by a memorandum
entitled "Services Available to the Aged and Chronic Sick" which
had been prepared by the Standing Medical Advisory Committee.
This memorandum describes the problems of an ageing population
and, in order to help the general practitioner, sets out the kinds of
services provided by the local health and welfare authorities, housing
department and hospitals, etc., that are available to his older
patients. Much of the material contained in this latter publication
has already been discussed at great length in my previous Annual
Reports including possible action which can be taken by the various
authorities mentioned therein.
Notwithstanding all that has been written about the elderly
from a social medicine point of view, fundamentally there are only
two courses of action open for the treatment of their problem, viz.
institutional care or home care.
Not unnaturally, it is generally agreed that old people are
infinitely better off in their own homes especially when infirmity
rather than illness seems to predominate but the usual assumption
that this is also economically sound is rather open to question.
It has been estimated that short—term acute hospital cases
could cost from £25 to £30 per week but that in the long—term stay
so often met with in geriatric wards, the weekly cost may be as
low as £10, a figure which is usually augmented by a contribution
from the patient's pension.
On the other hand, effective home—care demands a high standard
of co—operation at all levels from all the various agencies
concerned with the wellbeing of the aged. In effect, this involves
home nursing, home help services, meals—on—wheels, bathing and
laundry services, pharmaceutical services and National Assistance,
the overall costs of which are likely to outstrip the cost of a place
in a geriatric ward and, moreover, it is doubtful whether such
arrangements make the most economical use of personnel.
However, the salient fact in all these deliberations is not the
cost in terms of money and personnel, important though it may
be, but the happiness of the aged in the twilight of their lives.
Undoubtedly the person most fitted to exercise an overall control