Thursday 7 July 2016

Free the demented

Last year we had the Marriage Equality Referendum and I wrote Free The Gays a facetiously titled piece about how, by plebicite, the Irish people voted to recognise homosexual marriages as having parity of esteem (and tax, inheritance and legal status) with trad marriage.  It was a triumph for the liberal agenda and those on the YES side felt inordinately chuffed about the turnout and the result.  It is not good to bury things about which we feel uncomfortable - they fester and eventually poison the whole system.

With the steady increase in life-expectancy, we are getting to see a lot more diseases and conditions that are naturally late in onset.  Classically Huntington's Disease doesn't manifest until the 40s and many cancers don't appear in the young simply because they take a long time to develop. People with cancer don't, as a rule, wear it on their sleeve: generally they carry on working until they are hospitalised for treatment.  If they return to work, often without hair and less bounce than before, then we know they have been sick.

Dementia otoh is quite in your face. You can't ignore people talking to themselves on a street-corner. Well actually you can, and we do, because it's not clear how we can and should interact with such a person. But we don't often get the chance to ignore the demented because we rarely see them. They are behind closed doors - either in an institutional setting or at home being looked after by their family. A combination of shame and anxiety keeps them off the streets. In Ireland there are 55,000 people with Alzheimer's, of which about 5,000 are banged up behind locked doors in a "Home". It is just wrong to use that word for the Institutions that manage those who are now unmanageable. Homes for the elderly are in many cases homes for the demented: if they had their marbles they'd still be getting up from their own bed and waiting at their own kitchen table for the meals on wheels van. Institutional care is fabulously expensive despite all the workers getting dirt-poor wages and still being under-staffed. The clients are managed to make a difficult workload possible.  If several of the clients need feeding by spoon (which is a long, tedious and mussy business), then it's a blessing if several more don't get up from the bed any more. If one of the inmates is so difficult as to consume a disproportionate amount of staff-time, then there are always anti-psychotic meds to apply.  There is no way that a loving family would countenance such treatments - not least because, hard as the task is, most families only have one demented relative at a time to care for and cope with.

Keeping demented people in their own homes is cheaper and more humane than incarcerating them. But it's damned hard work and a small amount of help can be leveraged to allow this optimal solution to pootle on for a bit longer. Every month that a train-wreck of a mind is kept in the community, rather than being swept under the carpet, saves money, saves heartache and makes several people feel better about and in themselves.

The Alzheimer Society of Ireland ASI is hoping from €67 million to fund their Dementia Care Begins At Home campaign. Funding the infrastructure that allows volunteers to cover their costs in making life brighter for the demented and their families. The Minister of Health has just signed off on a €20m/yr bull for Pembro, so that 140 people can get fabulously expensive treatment for their late-stage melanoma.  Sign up on ASI petition?  Go on, Do!  ASI is pushing this as a right, I'm pushing it as an economic no-brainer. Also there is the empathy argument: having dementia out there is a salutary reminder: Sum quod eris, fui quod sis. I am what you will be; I was what you are.


  1. Well done! Well said and I hope will make a difference.

  2. This has to be one of your best pieces, Andrew. You HAVE to send it to John Crown and get him to explain exactly how society could ever justify
    the Membro costs.