Recently I attended one of our regional workshops which was looking at the Primary and Community Services Review. Whilst there I was introduced, or more accurately, re-introduced, to the concept of “custodial care” in order to describe Society’s use of residential and nursing home care for older people.

I accept that many would consider this to be an extreme description of these services but the term did have a resonance with the audience, especially those of us working within social care. This is probably because residential and nursing care is our equivalent to acute care and its use or misuse should be as important as unscheduled care and delayed transfers of care are to Health colleagues. Indeed our collective enthusiasm to address the latter two issues could be argued as having the unintended consequence of misusing the former two.

In this blog I will present a number of challenges from my own personal experience which I hope will re-light the debate about our continued reliance upon residential care for older people.

I have worked within social care for almost three decades and during this time I have only met one older person who actively had it within their “life plan” to live in a residential care home when they reached a certain age. In fairness I have met many who once in a home are happy that they are there.

During 1999 as part of a Best Value Review of our residential provision two of us undertook a piece of research which looked at the views and expectations of residential care of potential customers. One of the interesting findings was that the vast majority of respondents did not want to enter residential care but recognised that there may come a time when they would because they did not wish to become a burden on their families. When asked who they thought would make the final decision the overwhelming response was family or G.P.

If you link this finding with the statistics concerning the route into residential care from hospital combined with the infrequency of admission due to real homelessness one has to ask the question who or what really benefits from the provision of the service.

Personally, I am always interested to listen to families and professionals who argue against moving people once they are established in a home because of the fear that it will be too disruptive and may shorten their lives. These are often the same people who previously actively promoted the initial move from the person’s home into the residential setting.

Finally, one of the main arguments made by Sir Roy Griffiths was that the resource used to support people in residential and nursing homes could and should be used more creatively to support the same people in their own homes by promoting their independence and dignity.

This is not an attack on the sector or a lack of recognition of the real progress that has been made since 1993. It is a call for us to be as challenging of and focused upon our use of this resource as we are of other, potentially less liberty inhibiting, issues that confront us all.

Written by Jon Skone, WIHSC Asscoiate