Johnson, former Chief Executive of the Social Care Association, social care
practitioner, manager and member of the Residential Forum considers some of the
challenges to the purpose and image of residential care home living.
Many years ago, when trying
to define whether a couple were cohabiting for benefit entitlement, the
criteria were, “common roof, common table and common bed” – simple and clear.
In the case of residential
care, the judgement we made at the Council placements panel was on the need for
care throughout the 24 hours of the day. Anyone who did not need night time
intervention, could be supported at home.
That criteria have become
highly sophisticated with the regulators describing in more detail the
specifics of care and support to begin to narrow further the need for regulated
support which might equate to the need for a residential solution. This has led
to the reduction in residential care bed numbers and the de-registration of
many previously registered care settings because they have been deemed to not
be providing ‘personal care’ – especially in the Disability and Mental Health
In every case, the working
age residential placement is temporary, rehabilitative and anticipates a return
to a more ordinary and inclusive life. For most older people, the move into a
residential home is the last move they will make and carries with it the growing
shadow of death. It is this that might make it so fearful but in fact, the fear
is not that at all but rather the likely experience of being in a residential
setting as perceived from exposes that they and their family have watched on
Generally, we choose where
we live, driven by our income, the demands of our job and the locality of where
we grow up or work. Historically, residential homes would have fulfilled a
continuity to this process with the choice to give up one’s home (often nearly lifelong)
was a choice based on the desirability of being part of a community of people
with support needs but more importantly, social networking needs.
Ironically, all the social
networking needs that enhance our lives, now fall outside regulation. People
living in supported housing may receive a lot of support to shop, access the
community, manage their domestic chores and discuss their options on any
decision, may receive more direct one to one support than a person living in a
care home but the service is outside regulation because no ‘personal’ care is
Most regulation has its
purpose founded principally on ‘protecting the public’ – not first on quality.
The idea that any business setting out to offer support to a group of people
needing their offer should first be tested on their risk of harm to their
customers. And yet, the danger of residential care is far better known to the
public than the excellent care that thousands of people receive in the last
place they live or the place they underwent a recovery package from a trauma or
illness, prior to moving to a new address.
It may be that ‘residential
care’ has become a toxic brand and we need to rename it and re-brand it, just
like city companies do when things have gone wrong and their reputation is
lost. It may be that supported living is a better description and less arduous.
In many of these places that already exist in extra care housing, for example
the amount of care and support received in these unregulated settings is more
than would be delivered in regulated care.
The removal of bureaucratic
boundaries, regulatory lines, and budgetary gates would all help the image and
purpose in choosing to live in community rather than alone at various moments
in our lives.
Any thoughts on steps that
would assist enhance the residential care brand then lets us know at the Residential
or through a response to this blog