Debate on care homes

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