The reality is simple enough; our prospects, our lifespan, are finite. We either die prematurely or live to something like an average age, which today stands at just under 80 for men and a little beyond that for women.
A minority of us lucky enough to live four score years, maybe even longer, will not be able to live independent lives.
Age and time will, in their unforgiving way, erode capacity physical or mental. Sometimes both. In that eventuality, options are also limited. Relatives or state carers may help a person stay in their home for a period.
Others may have to seek out the kindness of strangers, usually in nursing homes. Already, around 25,000 people have done that in one of 460 or so nursing homes.
As life expectancy, up two and a half years since 2006, increases, that 25,000 figure will soar. Demographers predict an increase that will be socially transformative.
The number aged 65 or over is set to double to about 1.2m by 2038, the year this summer’s newborn might sit the Leaving Cert.
In terms of public planning and changing culture, that is almost the week after next. That prospect may be exacerbated by a pension crisis, one the unfolding economic crisis may well deliver. Let’s not, this once, mention climate change.
Though that over-65s figure was known this time last year, the ravages of the pandemic has given it, and the way we discharge responsibilities to older people, an entirely new and altogether more pressing meaning.
Nursing homes are the epicentre of the pandemic. What were supposed to be places of ease and warmth, of security and reassurance, have become more akin to jails where visitors who might hold a hand or whisper a last, parting affection, cannot enter and residents cannot leave.
Those same residents are put at greater risk because staff, trying their best in the most trying of circumstances, can work in several homes and often live with others who work in other nursing homes. In those circumstances it is impossible to contain the pandemic.
According to Department of Health figures published earlier this week, figures that will have changed marginally in the interim, more than 62% of coronavirus deaths in Ireland occurred in nursing homes. That figure is out of kilter with EU norms where around half of coronavirus deaths are attributed to nursing homes.
When the pandemic inquiries eventually sit, they will discuss protective clothing, staff shortages, and maybe the communal accommodation used by workers staffing some homes. Those hearings will seem plausible like all of their predecessors but will miss, or more likely avoid, the definitive, central point entirely.
Chaos washed over some nursing homes because they exist to generate profit. Their primary objective, especially for those carrying bank debt, is commercial, not humane or social. As virtually every sphere of human activity confirms, that is an unequal relationship when hard choices arrive.
Despite that, the Department of Health has for years, under Mary Harney, Micheál Martin, Leo Varadkar, James Reilly, or Simon Harris, encouraged the privatisation of nursing homes, a market-first policy driven by favourable tax arrangements for investors.
Today’s chaos — 62% of Covid-19 deaths — is, like it or not, at least partially their ‘the market-knows-best’ legacy.
Profit, as champions of capitalism assert, is not a dirty word, but that does not mean it is always an appropriate purpose. Our housing crisis and two-tier health system, to greater or lesser degrees, support that analysis.
But what to do? One of the ways we’ve coped with Covid-19 is to consider opportunities for positive change.
Suggestions we have moved towards a universal health service is one, even if that seems remote as there are so many actors — each with a specific agenda. Nursing homes are less complicated and a perfect setting to show a caring society at its supportive best.
The pandemic has exposed the flaws of for-profit nursing homes and that, when calamity calls, some are terribly vulnerable. Like stressed banks, they are reliant on state support. The same charge can be laid at some public homes.
The pandemic has put bigger government back on the agenda, which suggests that a new system of public nursing homes, properly resourced and regulated, should be part of any post-pandemic rejuvenation.
Such an ambition would have many benefits and potentially many winners. It would offer us all, when the time comes, the prospect of appropriate care in a setting solely dedicated to that objective.
It should mean more than minimum pay. It would also give the public service an opportunity to disprove those who suggest the sector is incapable of persistent efficiency and delivery.
If universal health care is a noble objective, then universal nursing homes seem a plausible first step in that evolution.
There is an urgency about all of this as, before very long, many of us will be residents of nursing homes rather than onlookers.