“Residential Care Dilemma” 4

I have already forecast that we are heading for a financial meltdown in the residential care market – see “Residential Care Dilemma” dated 12 October 2010 and “Houses Built on Sand” dated 16 January 2011 (both can be found by clicking on the   TOPIC        ‘Residential Care’)

I have never been keen on residential care as a model for looking after older people in later life.  Like everyone else, I would not move into a residential home if I had an alternative.

Almost 30 years ago, it was the next step up from sheltered housing.   Not a step you willingly took because the image was one of old ladies sitting around the edge of a lounge all day, with the TV on to comfort the staff into thinking that the residents had something to do.   Beyond the image was the smell   😦  😦        – never talked about – stale urine told you all you needed to know about the attractiveness of getting old.

There were other things you gave up too  –  your mobility first .  There were few electric wheelchairs and no scooters – they were prohibitely expensive and in most places there were steps and narrow corridors which rendered them useless.  So sitting in a chair all day and rarely going outside becomes the norm.  It’s an existance but not a life  😦

Nor did you have the privacy of your own toilet and shower – you shared with about 10 new-found friends.   The communal bathroom was down the corridor, or maybe you needed the plastic commode in your room.   Little dignity left after this everyday experience 😦

Even more intrusive was the fact that many people had to share a bedroom with a stranger.   A right often justified by owners because “people like company”   😦    A lot has changed for the better in the last 30 years – though not everywhere.

I am still uncomfortable with the residential care model because it builds on dependency rather than promoting independence.  There is a place for companionship and interaction, particularly amongst the frailest and  mentally-impaired residents, who benefit from the stimulation of people around them.  But that does not mean that these most vulnerable of residents should have to suffer the indignities of residential care.

It is these issues that make it so important that we re-think the future role of residential care. 

 Sadly all the current discussion is focussed on the imperative of financial viability.  Qualityhas taken a back seat.  The two issues are inextricably linked.   Neither can be or will be resolved without the other.   It is a classic catch 22 situation.   Without more money you will not improve quality but without better quality you will not get more money !

                                         SO WHO WILL TAKE THE FIRST STEP ?

                                   WE NEED TO TURN GRUMBLES INTO SMILES.

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3 Responses to “Residential Care Dilemma” 4

  1. david freeman says:

    I can se the point as you so strikingly make here that care homes as you describe are impersonal, institutionalised, and clinically unclean but they serve their masters point?
    We do need money in investment in older peoples care and welfare: However looking around in my own family positions of encompasing old age, We have various levels of care and attention.
    What you are asking is maybe a footprint of design and layout of provision for the older person. It is a very emotive subject, and you state care is one up from warden control housing, and I assumme you wish a footprint for all, not just the those desirous to have money solve their problems?

    Residential Home
    1 A residential home as defined under current legislation with each resident having a room or suite of rooms with living, sleeping and toileting/washing facilities.
    2 Communial lounges with comfortable seating areas and communial dinning facilities
    3 Safe and secure entry to and from the residency, but not a restriction on the individual residents ability to gain entry or exit.
    4 Laundry services of a general and private nature to be provided for each resident.
    Nursing Home
    Here one has 24 hour nursing care and individual rooms for each patient, with private toilet facilities. Unresticted access for family and friends, and for meals/feeding and general eating drinking arrangements, possibly served form a central point, and to each residents private quarters. Laundry services for genral and personal use to be provided, for each resident.

    These I would suggest are minimum requirements for as I understand the Regulation Care and Nursing Home
    The Alternatives: Are there any?
    The elderly sociecty in the UK are now coming to realise that old age and infirmaty for the few is not a reality? It is for us all, however rich, poor or age profile. Here the picture is one of choice, and education? mainly self education.
    While one has mobility and health regardless of age I think one has a tendancy to bury ones head in the sand, especially while ones spouse/partner is alive. Then you at that age stage in life face a dilemma, do you down size move in with the family, accept senility and go into a nuring home/residential home or what.
    After one has reached 55 One has to look to the future and think? Stone Macarthy type appartment, a care home of some sort, independance as Hanover housing provide, or does one embrace a new concept in social and financial living such a Richmond Housing, or the Extracare Villages. I cannot make your mind up for you? you have to look and decide what you wish out of old age.
    My model would be the Extracare Model, mixed social classes, your own apartment with a suite of rooms, Communial areas wher one can interact with ones fellow residential villagers and friends of the village for such occassions as social functions and activities of all types, and volunteering to help the well being of the village and its residents in general, and well being facilities, while yet knowing that care ‘In the home’ is available at the push of a help button.
    And when one discusses with ones spouse/partner and the greater family one realises life must go on, and it is your own gereration, who have the most understanding and tolerance to your own individual way of life?
    I do not know any of the answers but independence and freedom to think for ones self is a great comfort: But you must do it earlier than you think? especially before life bites you on the bum.

  2. david freeman says:

    Addenda to my comments above are those below.
    One of the attributes I appreciate in a typically designed Extracare Charitable Trust Village is the use of spacial awareness. The Public communal areas, the galleria’s, winter gardens with their apartments, and the streets, avenues, corridors leading to each zone of apartments have the awareness of space. I.e. Two buggies/scooters of maximum size, electric wheelchairs and hand operated wheel chairs have the space to pass one and other anywhere within a village environment, and maybe parked and charged outside one private apartment, without invading the space within an individual apartment. This all adds to the effect of time and well being design. One is not confined to a permanently built edifice where space is at a premium, and little thought has been given to people. Families and friends with the villagers can stop and pass the time of day in any part of the village complex that they wish to without having to make a special journey to the communal areas or being confined to the individual private quarters.
    When one considers some of the other suppliers of residential apartments for the elderly, they have their own selling points, but it is the combination of ideas that draw me close to the designs of the actual villages of the Extracare Charitable Trust.

    • John Graham says:

      There are some very good comments in these last two posts. Ultimately I believe it’s adopting an holistic approach to retirement that makes the ExtraCare Charitable Trust model unique. It’s not just the bricks and mortar which are good, it’s also the opportunities and support services that are essential to the retirement lifestyle. Giving residents an active and meaningful role in managing and volunteering in their community is a key element in the functioning of ExtraCare schemes. Subsequent imitations have copied the bricks and mortar but failed to understand this vital ingrediant.

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