‘In 2013, do we still need residential care for older people?’

In this provocative piece, columnist Alicia Wood argues that residential care denies older people the rights most of us take for granted and that it should be replaced by supported living.

May 15, 2013 in Care Work, Residential care, Social care leaders

The number of care home businesses declared insolvent rose by 12% from 2011-12, with 67 going bust last year, according to figures from accountancy firm Wilkins Kennedy.

Clearly a major reason for this is the fact that councils are freezing fees, making it unsustainable for providers to deliver, but I think that we need to dig deeper to fully understand why residential providers are going out of business; and I don’t think it is just about the money. Being really concerned about the impact of the cuts on social care I hesitate to present an argument that in any way dilutes the argument against cuts; but we do need to consider whether the model of residential care is fit for the future.

‘I know I wouldn’t want to live in a care home’

Ask yourself this question: would you choose to go into residential care if you ever became in need of care and support? I know that I wouldn’t ever want to live in a residential care home and I don’t know anyone else that does.

For those of us working with people with learning disabilities, we have been talking about this issue for some time. Residential care as a model, even if it is good quality, places restrictions on people’s lives that many people don’t want; having control over who you live with and who cares for you are pretty important things in our lives that most of us take for granted. Being able to keep your home if your care needs change or you want another care provider, instead of being moved around at the behest of commissioners and providers is another fundamental right that we cannot continue to ignore.

We have made a major shift in how we view these fundamental rights for people with learning disabilities – though the majority of people with learning disabilities not living in the family home, still live in residential care – and people with physical and sensory disabilities have long chosen to live more independently and avoid residential care. But what about older people? Ermintrude2, the wonderful social work tweeter, asked some important questions about the rights of older people in care when the care organisation collapses, recently:

‘No security of accommodation for older people in care homes’

“They are at the mercy of care providers. Why do we deny older people and some vulnerable people security of accommodation? …The concept of ‘home for life’ and security of accommodation is non-existent for older people who need residential or nursing care.”

So I want to ask, is there any reason that we can’t have supported living models for older people? Does it have to only be a choice between staying in your own home, extra care or residential and nursing care? Housing and care models where people share or live as part of a network, that give people security in their accommodation and enable people to have control over their lives exist and can work well. People who have the most complex care needs are doing it successfully so this is not only about those with ability or capacity.

Finding ways that we can keep older people in their communities and close to families and friends has to be the way forward. Supported living networks like KeyRing, where support is local and attention is paid to connecting people together, peer support and communities, could also work for older people. Thinking about recruiting and developing care staff based in communities has to be more cost effective and sustainable.

Having small-scale, shared housing models, where people have real housing rights can be just as cost effective, if not more so than residential and nursing care. It is 2013 and this notion of placing people in wherever the available beds are in care homes should not be any more acceptable just because people are coming towards the end of their lives. It will be you or me with this dilemma in the future and we need to think radically about how we create that future.

Alicia Wood is chief executive of the Housing and Support Alliance

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