A care home is a home

Richard Banks is leading for the Residential Forum on an approach to neighbourhood planning of accommodation and lifestyle options including group
and assisted living.  He writes in the
light of recent exposure of abuses and aware of the consequences of years of
austerity, but finds some ‘reasons to be cheerful’ about residential care. 

Residential
care has a poor and deteriorating image. A stream of reports and TV
documentaries detail abuse and neglect, closures and alleged profiteering in
services for older people, disabled people, young people and children. A system
that appears to be broken emerges with failed regulation, undiscovered cruelty,
absent management and suspect financial arrangements. Some of the worst abuse
has occurred in private hospitals (paid for by the NHS) for people with
learning disabilities just as Winterbourne View was in 2011.  Despite numerous promises that ‘lessons have
been learnt’ there seems no ability to improve or prevent further damage to
people.  

Those of us
working in social care are likely to say that most residential care is better than
reported – frequently good and sometimes outstanding. Whilst true, unfortunately
facts do not alter negative views.  As a result
there is a widening gap between the general public who distrust almost
everything about residential care, and those who are working day and night to
create good care.

Positive
neighbourhood knowledge

People’s view
of residential care is often more positive when they are thinking about
residential homes they know in their own neighbourhood.  They know people who live there or work there
they may visit residents or attend events.  

For those
with a positive local experience the possibility of using residential care is
less abhorrent. Their preference maybe to avoid the need for residential care.
They would be concerned about how the cost could be met. However local
knowledge and experience of care homes is a good foundation for making a
positive choice should the need arise.

Financial
fears

The fear
about the cost of residential care and the inability (with some honourable
exceptions) of residential care providers to initiate improvements is closely
linked to policy shortcomings across the UK.  
In England, for nearing 20 years, social care funding has remained a
murky topic; the subject of reports falling short of clear policy. People in
need of public support to gain access and funding to meet their needs are being
squeezed through tighter and tighter criteria as the state retracts.

Whilst those
with money and houses fear for their inheritance, those without fear for their
very lives. Residential care might eat away a nest egg when families can no
longer cope but it can offer comfort to those with no family and no money. So
long as it is safe and sound.

The vacuum in
government policy about social care funding is inexcusable and made disgraceful
by the effects of austerity.  We have
reached a stage where this lack of responsibility is tantamount to active abuse
of disabled people, older people and anyone who needs care and support.[1]

The
government in England has not even been able to publish a consultative (known
as a Green Paper) document first promised in March 2017. The delays and excuses
are farcical. Without policy there is no guide and no framework for treasurers,
planners or providers at national or local levels, to organise residential care
provision. Nothing for families and people with care support needs to inform
their personal planning of their long terms living arrangements. Extolling the
virtues of three generational households is no platform for ensuring people
have a home – a household, a flat, a care home – where they can be supported
and receive care.

A place
called home

It is sort of
wrong to say that government have made no decisions about residential social
care. Inaction is an action. Cutting funds to local authorities has resulted in
the budgets for children and adult social care shrinking by £7 billion since
2010.   As a result 1.4 million adults who need it are not getting
basic care or support (think of that as about equivalent to the total population
of Essex).[2] That
longevity is falling is no accident. Basic economics tells us that one way to
reduce demand is to cut supply. Services for children are in a similar state.
The cost of specialist residential provision rockets as, for example,
local child and adolescent mental health services fade into a postcode lottery.
In such circumstances, children without families and where fostering and
adoption was not suitable, are denied a place they can regard as home. Instead
they are placed in specialist ‘units’ away from communities at massive cost.
Hidden children, hidden and unnecessary costs.

Attempted
hiding of the effects of austerity includes deliberate attacks on disabled
people and the ‘scrounging sick’. The increase in hate crimes against disabled
people appears to be direct consequence.[3] The
politics of strivers versus skivers again denies a cohort of people a home. If
they don’t live on the street the homeless might secure accommodation in a
hostel or B&B. Some may be shipped to a ‘centre’ or imprisoned.

Reasons to be
cheerful

There are
several reports by independent bodies on the effects of austerity. The government’s
own National Audit Office has reported on the problems for the social care work
force as a result of inaction by the Department for Health and Social Care.

The poor
behaviour of government in England is not a reason to reduce our efforts to
seek better ways to support people, better ways to care. Surely residential
care homes have a positive offer. It need not be as a last resort, but whatever
everyone deserves a home.

That staff
continue to cope with the difficulties and strive to improve care is one of the
reasons to be cheerful.  Ever watchful,
as residential workers, that we do not get drawn, by a desperate and absent government,
into a shift of responsibility onto just families, friends and neighbours –
the community.

Communities can make sure
everyone gets the home they need, that includes group and assisted living, that
includes sharing lives and spaces, both personal and private as well as
collective and communal.  Unequivocally
they must not be left to sort it out alone. Residential support options will
not spring up through some philanthropic volunteer spirit. They need nurturing
and enabling. The state’s minimal role is to facilitate a system where public
money engineers a home for everyone. What we can do, as residential workers and
owners of care homes, is to add local voices and creativity to the planning and
delivery process in ways, which enhance local assets, increase oversight and
improve the experience of group living.

[1]
Adapted from Francis Ryan ‘What kind of country have we become? Ask a disabled
person’ Guardian 10/6/19

[2] https://www.theguardian.com/society/2019/mar/08/not-just-schools-five-public-service-areas-struggling-with-cuts

[3] https://www.independent.co.uk/news/uk/disability-hate-crime-rise-latest-figures-united-response-a8583751.html

Published by Residential Forum

The Residential Forum is to promote the achievement of high standards of care and support for children and adults living in residential care and nursing homes, supported housing, residential schools and colleges, hospices and hostels. It contributes to improving the quality of service to the public. Members of the Forum are people of standing and experience drawn from the public, private and voluntary sectors, as well as some who can speak for service users and carers.

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