Book review: Residential Care Transformed: Revisiting The Last Refuge

Residential Care Transformed: Revisiting ‘The Last Refuge’

★★★★

Julia Johnson, Sheena Rolph and Randall Smith

Palgrave Macmillan.

ISBN 9780230202429£55

Peter Townsend’s seminal book, The Last Refuge, exposed care homes in the late 1950s as a poorly resourced final port of call, which should be scrapped and replaced with better domiciliary support for older people or sheltered housing-style schemes, writes John Percival.

In revisiting some of the care homes originally researched by Townsend, the authors of this fascinating new book highlight continuities and changes that have taken place in the care home industry.

The sampled care homes are more homely environments than they were when Townsend visited. More are in private ownership, which, together with the modernisation and personalisation agendas, ostensibly empowers residents as consumers. They also house older, frailer residents, looked after by higher numbers of better trained staff.

Despite these changes, or because of some of them, we also have very large care home institutions, run as investments with clear business cultures. And while there is less gender segregation than in Townsend’s day, the wings designated for those with dementia or chronic physical disability signify a continuing social divide in some care homes. Clearly, it is still difficult to balance ‘home’ with the management of risks in care home settings.

Interestingly, the voluntary sector homes have offered greater regime stability and quality of care, across the 50-year divide. The authors could have detailed the reasons for this more fully, together with why the sharp contrast between good and bad care homes persists. But there is much to reflect on in this book, aided by historic and contemporary photos taken in the homes.

John Percival is research associate at the Open University’s faculty of health and social care

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