Friday 10 October 2014

The unwell of loneliness

What are we like?

On the way to work in the car at the end of last week I heard Brian Lawlor, who is Conolly Norman Professor of Old Age Psychiatry at TCD.  He has just completed a study on social exclusion among the old. Actually he has designed and carried out an experiment. Having recruited a cohort of pensioners who had been fingered by health and welfare professionals as likely to be lonely, Lawlor's team split the old folks into two groups: one group was visited socially by a volunteer (a nice cup of tea and chat) for one hour a week over three months; while the other lot only had the usual run of home-help, district nurse and the postman (if the grand-children could be bothered to write a letter).  The study claimed "significant" benefits to both visitor and visitee. Loneliness is stressful and stress induces a lot of illnesses in the compromised immune systems of the tired and old. How difficult would it be to drop in to visit with your elderly neighbour one evening a week?  They always have a tin of chocolate biscuits!  Maybe you believe that The State should take care of our retired people, I don't disagree but I also think we have a duty of care towards the actual people whom we meet in the corner shop as well as the statistics who hoover up so much of the exchequer in pension cheques. I've tried before to articulate the voluntariat issues involved.

Ten minutes later, the wireless (Newstalk FM) was on about discretionary Medical Cards. 1.9 million people, something in excess of 40% of the population of Ireland, including ex officio all pensioners, are eligible for a card that secures them free medical care. Medical Cards were introduced in 1970 and cost me-the-taxpayer on average €1200 a year. Yes, that is €2.25 billion in all. The stated criteria for eligibility are very low and based on income.  As a single person for example you must earn less than €184 a week. That excludes, for example, Dau.II who is working full-time for the minimum wage [€8.65] which nets her €300 pw or €15,000 pa. But in a nation run by politicians The Man has created 'discretionary' Medical Cards to be allocated on some pressing and demonstrable need. If you are working for the minimum wage and have M.S., for example, recombinant beta-interferon therapy will set you back the bones of €13,000 a year.  Without a medical card it's food and rent and early death or treatment and sleep in a dumpster. In the last budget a little over a year ago, the Minister of Health announced that his apparatchiks would carry out a probity review to save €110 million. They hoped to identify 100,000 people who held a medical card but who were, through changed circumstances (or fraud) weren't really eligible. The exercise looked good on invoice but a political disaster in practice as the officials wrote hundreds of letters asking people if they still had Down's Syndrome.  How many officials do you think have spent the last year on this exercise piffling at the fringes of the €13.5 billion Health budget?  Might be 100?  Might their wages, employer's pension contribution, office rental costs come to €100,000 each?  Would that €10 million of sprat catch an €8 million mackerel?

One really sound outcome is the leaked report on a committee of 23 (!) stake-holders and independent quango-men which found that it was impossible to decide about Medical Card eligibility on the basis of medical need. Right now, people with Down's syndrome could claim a Medical Card simply by waving a third chromosome 21 at the woman behind the Welfare desk.  It is demonstrably true (and genetically interesting) that Down's predisposes to congenital heart disease (40%), cataracts (15%), chronic ear-infections (50%), epilepsy (50% in adults), early Alzheimer's, leukaemia, hypothyroidism. But 60% of Down's syndromees don't have congenital heart disease, etc. But there are many other congenital diseases which have a similar load of symptoms but a less obvious diagnosis and also less good Press, so they and their families have to fight for help with their medical bills. That's not fair.

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