The norm today is the nuclear family in which there is little cushioning. There are few hands to begin with; and no person has much time to spare, given that all adults are generally engaged in income-earning work while the young must struggle to prepare for life in a competitive world.

The less a person can do for oneself, the more one needs a carer. Those who can do nothing for themselves need full-time carers. In a middle-class household, the carer is generally someone employed for the purpose; for no member of the family can afford to do anything but care for the aged person. A parallel is the ayah employed to look after an infant. The difference is that infants are not chronically ill or enfeebled; and their condition does not deteriorate.

Unless the person so employed is a trained nurse or is at any rate literate, at least one responsible member of the family must devote time to the care of the old person. In addition, because the person employed cannot usually be counted upon to deal even with minor emergencies, one responsible member of the family is tied down.

We are already in a world in which people in their late fifties or older can do little productive work because they must care for an elderly parent. The economic costs of these realities can be staggering when we consider their spread and magnitude. One aged person contributes nothing; another person, of necessity able-bodied, is occupied by little more than the care of the first; and a third person is physically tied down and left with little time and space for productive work. The older a person gets, the more expensive it becomes to keep alive.