News

We asked:- Do care homes still have a future?

Here are some of the comments we received.

“This was an interesting article, but appears to have missed the point. Housing with care, is a model of care where older people have the potential to maximize control over their environment.

The success of housing with care will depend on the level of community support provided.

Through my experience as a scheme manager in a purpose built extra care scheme, one of the major factors why the housing association were failing to meet their objectives was because older people were still having to leave their extra care accommodation and enter residential care.

This was because statutory service providers were unable to sustain intensive care packages due to lack of resources.  Local authorities will consider best value options or cost effectiveness when in particular circumstances intensive support packages are required. This often proved more costly than a residential care model. Housing with care is not a low-cost option, it should be viewed as the potential to offer quality person centred and flexible care.”
 
Linda Murphy
Student social worker
Liverpool
 

“Your article "curtains for care homes" made interesting and timely reading.  After 17 years of managing residential care provision (in the voluntary sector) I am walking away at the end of this month.

It has always been a bone of contention that a body who could never manage its own
care provision efficiently(local authority part 3) was given the task (and funding) to contract for private/voluntary residential care services. That this is not working has been effectively highlighted in recent months by the whinging of representative groups over the dangers of increasing the National Minimum Wage. That any care worker is expected to work for the minimum wage is a disgraceful reflection of government policies on care for older people!

Despite the hype around National Minimum Standards, mandatory training requirements, and POVA / CRB checks, the reality is that if there is no political will to improve conditions of employment for care workers, there is no real desire to do any more than pay lip service to the concept of quality care. Give care workers a minimum wage of £7 (£9 in London), recruit and retain workers who actually see it as a career, rather than a stop gap until something better comes along, and we may just find that quality will thrive.

Continue to make the career an unattractive choice and the fact that the sign on the door says "Residential Care Home" or "Extra Care Home" will matter not a jot.”

 P.M
London

“I write from the point of view of a learning disability residential care home manager with regards to this issue because this topic I believe affects all large care homes in general.

My considered view is that residential care homes still have a future and will be in operation for a very long time to come.

What occurs to me however is that most large establishments remaining will over the next few years be replaced by small scale ordinary housing which would turn out to be 'glorified residential homes' under the guise of supported living.

In spite of this trend under the Valuing People White Paper, a good many people with learning disabilities who I have spoken to like the idea of having new homes, but anticipate with apprehension living in smaller units or their own homes. This is partly because on the one hand they have not been enabled by staff in large homes to develop the everyday living skills needed to live as independently as possible in the community (mainly due to staff ratio) and on the other hand they cannot bear the thought of not living with those they have lived with for years in the home, and with whom they have formed lasting social bonds and relationships and consider them as family.

I would wager that if informed choice of people with learning disabilities is to be exercised fully under person centred planning, we will find that depending on their needs and social abilities many will opt to stay where they are.”
 
David Kingsley-Nyinah

“I believe care homes have a future but only if the government puts more funding in place. Care homes are essential to the carers.”
 
 
Stewart Macdiarmid

“I am working for an older person's mental health team, and we find that for some people a care home admission becomes the only

viable option. Once a person becomes a grave risk to themselves and others, or their carers can no longer cope, and the maximum care package is already in place - it would appear that there are no other options available. I am not sure whether extra-care housing would be able to meet the needs of the most vulnerable.

And what about the people who have been assessed as requiring nursing care? Their mobility issues and physical health needs generally require the provision of 24-hour nursing care that can only be provided in a care home setting.”

Margaret Butler

“In the wake of the government's green paper about direct payment to older people so that they can pay for their care and support needs, I believe this will empower older people to choose to remain in their own homes longer.

As a result, the future trend is likely to be more demand for domiciliary care, less need for residential homes, as we now know it and more demand for nursing homes.”

Remi Alaka

“The article by Katie Leason says it all. For some, especially older mentally ill people, a group home with shared responsibilities within their capacity, invariably becomes a family by affinity supported by skilled staff - and -  they do not ALL have to all be 'old'. 

Nevertheless, this requires a sensible approach and not, as in one London borough, where they seek to super-impose people with a dual diagnosis and histories of violence, onto an existing, vulnerable, but happy group.”
 
John Wilder
Psychiatric Rehabilitation Association

“In response to your article on the future of care homes, before we sling the wrecking ball, I’d like to offer a word from the perspective of dementia care and architectural research.

The provision of care is a complex dynamic interaction between the resident, the care and the building, impacted directly by the changing care needs of the individual.

Terminology such as ‘care home’ and ‘extra care’ conjure up a mix of buildings and services, myths and rumours which enable us to prejudge their suitability for our loved ones or ourselves. Add into this mix our disposition to enjoy or complain, to assist or provoke, as well as our social, cultural and spiritual expectations, and it is clearly impossible to know what we will want in 29 years time. It makes as much sense to ask a 60-year-old what they will want in their 80s as it does to ask a teenager what they want to be 40. Once that 60-year-old has lost a spouse, suffered a stroke, fallen and fractured a hip, gone blind, developed dementia or found that the children don’t visit or that their lifelong friends have predeceased them, living communally with care on hand if and when it is needed may seem a blessing.
 

Our quality of life in old age will be about choice and control - the what, when and how of food, sleep, social interaction, hygiene and spending time and money. My research has shown that with people with dementia the essential pleasures of life – music, laughing, nature, concern for others, loving and being loved are what matters to them, and the ability of the building and the care to enable these human needs largely determine their wellbeing. Therefore, labels such as ‘extra-care’ need to be peeled back to examine the life being proposed. Every care setting will be perfect for somebody. Staff and management make or break the environment - even a ‘bad’ building can be compensated for by caring people. Likewise, a new or a ‘good’ building can be a dreadful place to live if poorly run. Hence, the importance of the human in care provision cannot be overstated. Even so, while ‘providing care and support’ is a necessary mandate, especially for frail and cognitively impaired elderly, provision implies a one way street with a giver and a recipient. Care provision disempowers the recipient by providing the rationale to ‘do it for her’ resulting in imposed disability. This affects everything from buttering tea cakes to walking. In communal living, accessible design for those who need it speeds up disability for those who don’t. Instead of rehabilitating and strengthening bodies to meet daily challenges, care provision removes them. Life without steps un-teaches the knees, so they will sooner require life without steps.

 
Partially counteracting these imposed disabilities of communal care, the newer models of care seem to be driven by a perceived need for the individual to remain independent for as long as possible. Being able to do our own shopping will help us feel independent because we don’t have to ask or pay somebody to do it for us. Ironically, our ability to be independent is essentially about our ability to maintain relationships. Consider whether or not you are able to do your own shopping. This involves the concept of one’s ‘life-world’ which is like casting a net of relationships over the extent of your day to day life. If you are able-bodied and imagine for a minute not being able to walk, it is your life-world you feel drastically diminished.  Doing your own shopping is not the goal but the outcome of a web of relationships with shop keepers, buses, weather, pavements, seating and neighbours, in both geographical and emotional proximity to you. To think of accomplishing tasks as a goal of independent living is to miss the rich, satisfying complexity of day to day life.
 
The concern over models of care provision and the buildings in which they occur is essentially about place-making and a day to day life worth living. Will I be happy living there? Can I make a place for myself there? Can I exist and feel whole as a person in relationship to others and to the built environment, and therefore act ‘independent’ of others how and when I choose to do so? Developing housing structures with the goal of independent living is dangerous because if the goal is not met the built form enters the revolving door of fashion. But if a person can re-create their life-world (a place for themselves within a web of human and physical relationships) where enduring human needs for communication, engagement and pleasure as well as choice and control over them becomes our goal, facilitated by the built environment, technology and hands-on care, then independent living has a framework within which to succeed.”

Mr. G E Chalfont, MA ASLA
School of Architecture, University of Sheffield
g.chalfont@sheffield.ac.uk
www.chalfontdesign.com
Research and design of dementia care environments

“I have no vested interest in care homes - as a social worker, quite the opposite! In my view, care homes have a future but the National Care Standards Commission (NCSC) should not - it is a well-resourced, expensive waste of everybody's time that causes more problems than it solves. In my view, the lack of training, experience and common sense of many of its staff members leads to rigid, discriminatory rules being applied.

Moreover, I know of more than one home that has been inspected repeatedly yet shortly afterwards neglect and seriously bad practice has come to light. In my experience, the staff employed by the NCSC are not well-qualified or particularly competent. Unless their working practices have changed very recently, they do not even routinely interview residents and families. I have anecdotal but reliable evidence that some very poor managers are running some of the offices. To mix metaphors, the proof of the pudding is in the eating and the experiences of many people in residential care still leaves a very nasty taste in the mouth. The organisation is ineffective, insufficiently scrutinised and evidently unable to effect real, positive change. The government should give it up as a bad job, disband the commission and try something else.”

Andrew Thomas

“Yes. They do still have a future providing their residents are treated well and with dignity. There must be many out there that are run very well. Sadly it is the few that are not well-run that give the good ones a bad name!”

Angela Johnson

“Definitely. As the population ages, we need more safe havens, not fewer. People do not always lead happy contented lives in their own home. Many older people have cognitive impairment and are desperately isolated. Many are unable to care for themselves. A care home can give them a new lease of life, giving them company and a reasonable standard and quality of life.”

Angela Wolfson

“I believe care homes do have a future as it is clear that not everyone can or wishes to be cared for in the community. There needs to be a menu of care models available such as home care, care homes, extra care/very sheltered housing schemes.

The issue, as always, is one of recruitment and retention and I believe this will be the driving force of how care will be provided in the future.”

Vanessa Baxter

“Yes, I definitely think that care homes still have a future, there is a great need for good care homes in the UK. But what I do think is vitally important and a huge part of the question offered is that we can not forget how crucial it is to ensure that you have the right staff in the home, particularly an experienced and qualified manager.
 
From my experience, our clients (mainly residential home owners) have experienced difficulties in the past with recruiting managers, (some have employed up to three in one year unsuccessfully) some of these managers have not passed the fit person interview laid down by the CSCI therefore leaving the home without a registered manager and being in breach of not meeting the required standards.

We have clients whose homes have been in crisis under bad management in the past and we have placed managers with them who have brought the home up to scratch and up to the CSCI standards, this in turn has earned the homes a good reputation and resulted in full bed capacity, therefore ensuring the home has a future. My theory is... a good manager...a good home.”
 
 
Kate Wheeler- Managing Director
Point Nine Recruitment - Specialist in Care Management recruitment

“It depends on what you mean by 'care homes'.  Do you mean residential children's home or nursing homes?

I have got experience working with service users in the above homes but feel more comfortable discussing the future of children as I presently work with them as a social worker.

I professionally think that care homes that are well regulated and seeking the best interest of children with an aim for family reunion have a future.

There are some children who would be more comfortable living in care homes due to their traumatic past, reoccurring emotional difficulties or just for their own suitability.”

Shola Babatunde
Social worker


“I sincerely hope so as I am a social worker who sends substance misusing clients to residential rehabs for therapeutic treatment. For most who go, their eligibility is so high they are unlikely to make use of treatment in the community. Residential treatment is a must for this group. It literally saves lives. There aren’t enough residential rehabs and local authority funding caps have helped close many over the years which is why there will never be enough bed spaces to accommodate the numbers the government wants to see in treatment.”

Mervyn Bryant
Brighton