To combat negative perceptions of care homes, a new vision and name is needed
The last few weeks have seemed like open season for attacks on care homes, with health secretary Jeremy Hunt and NHS England chief executive Simon Stevens criticising the model of residential care and the quality of services. Clearly there should be no place for services that fall short of accepted standards and quality needs to improve. But the perception that residential homes equate to institutional care is so pervasive that this negative image has become firmly rooted in the public consciousness.
This strengthens prejudice against residential care as a service of last resort rather than a positive choice. It seems as though this prejudice has become institutionalised in policy directives and as a consequence the potential contribution to community care services has been devalued. And yet care for older people and other adults remains a significant service option.
Despite evidence from regulators that standards in residential care have been steadily improving in recent years, this negative image has proved remarkably resistant to change. As the traditional boundaries of care for older people shift, with services responding to increasingly complex needs, the purpose of residential care has become more difficult to define. Clarifying this purpose for the public is essential to creating a more positive perception.
To bring about this vision, there needs to be an informed public debate. The future of residential care (and supported living) affects some half a million people in England, with potentially many more who may wish to consider it at some time in their lives.
The commission on the future of residential care, established by thinktank Demos and chaired by Paul Burstow, is due to publish its report and recommendations in early September. The commission has reflected on the reputation and image of residential care services – the decline in the social acceptability of such care was one of the reasons it was established. This piece, however, represents my own views.
The reputation of residential care will only improve when there is a modern vision focused on outcomes for people using these services and improvements to their quality of life. Care homes need this new standing to enhance the status of residents and staff and to rebuild public confidence. Innovative forms of support, including residential care options consistent with person-centred ways of working, should be the norm rather than an ideal. Much outdated provision that could not meet future needs and standards has already left the market, but more remains to be phased out. There may be issues around de-commissioning and how we manage the transition that will need to be considered further.
Since most people choose to remain in their own home for as long as possible, it is perhaps inevitable that those moving to residential care settings will tend to have the most complex needs. Care homes have become a more specialised service in this way, especially for people living with dementia or those at the end of life. Residential care can offer enormous strength and positive support, providing care 24 hours a day, 365 days of the year. The best residential care services are clearly visible as a local resource integrated in the community. You don't have to create links or networks as they exist already.
As the boundaries between types of services become more blurred, traditional ways of providing services will be replaced by new models of working. Housing with care services, localised and integrated with the community, could easily become locations for multi-disciplinary, multi-agency support. Care and support staff could work with other professions to deliver integrated assessment, prevention and early intervention.
Perhaps all this can only be achieved by consigning the term "residential care" (and even "care home") to history, as was done with the workhouse and all the connotations associated with it. But what should it be called? If we changed the name to "housing with care", or something similar, would it be a more accurate description and would it alter the attitudes towards this model of care? Or would it be seen as simply changing the label without addressing the problems?
The role of a rebranded housing with care service in offering choice, promoting independence and supporting early intervention and intermediate care – along with meeting the needs of those requiring specialist services – is yet to be seen as part of mainstream provision. Redefining residential care as a positive choice is necessary to harnessing its potential. You can't graft good solutions on to old models. Housing with care services would need to be seen to be contributing to a spectrum of provision for adults and older people. And they would have to be able to deliver the vision outlined, with a high and consistent level of quality.