Community care for older people is dead. Community care has been dead for sometime but its death has yet to be publicly acknowledged. The signs that all meaningful life had drained out of the concept have been there for all to see. There were the persistent complaints from the NHS about bed blocking in hospitals due to cut backs in social services, media campaigns against the closure of day centres and the removal of grants from voluntary organisation. Community Care for older people no longer exists in any meaningful sense of the phrase it has been replaced by cheap care.
Community care was about replacing institutional care which robbed people of their privacy, dignity and independence. Long stay geriatric wards were closed to be replaced by smaller homely nursing homes for those who required nursing care. Very sheltered housing was to replace residential care homes, the idea was that people would remain in their own home or in sheltered housing and the help would come to them. If people had their own front door then the thinking was that they would retain their privacy. If the right levels of care and support were provided people would retain their independence and if people were seen as individuals they would be more likely to be treated with respect and more likely to retain their dignity. If people need help to wash, dress, go to the toilet, get into and out of bed it could be provided even if this involved three or four visits a day seven days a week.
In the past institutional care was characterised by care routines that operated to suit the convenience of staff such as staff deterring when people got up, went to bed, had a bath, what they wore and what they ate. Patients/residents deprived of choices and control over their own lives became passive, accepting and lethargic this behaviour came to be described as institutionalised.
People preferred to continue to live at home with help. The growth in the number of people over 80 put pressure on services and budgets. The budget pressure was relieved by buying care from the private sector rather than providing through staff employed by social services. The private sector was cheaper so the same amount of money could buy help for more people. Despite the growing number of providers of home care it was logistical very difficult to get customers into and out of bed when they wanted. The problem was that a home care had a list of people to be visited someone had to be first and someone had to be last. So someone would be put to bed at six in the evening, someone would receive their lunch at eleven am someone else would gets theirs at 3 pm. Right from the beginning there were complaints from customers about high turnover of staff meaning that frequently a stranger turned up to provide very personal care of young and inexperienced staff and of staff whose English was poor. The private sector could not attract or retain experienced staff on the wages it paid. Employers were reluctant to invest in staff training when staff went as soon as a better paid job came up. Costs were kept down by keeping overheads low which meant few managers and minim supervision of staff. As social services budgets were squeezed they forced down or didn’t update contract prices. As the number of people being referrer for support increased they “reviewed and re assessed” to reduced the number of visits and they reduced the length of a visit. Initially contacts were based on a visit being an hour as demand grow the typical visit was reduces to 45 minutes and they “pop ins” were introduced of just 15 minutes!
Care in the community for older people had become care on the cheap. The report by the Equality and Human rights commission simply confirmed what cares and customers had been saying that this so called community care robbed them of their dignity, privacy and self respect that it often left them to lie in their own mess, cold, hungry and confused causing them to feel ashamed, lonely and frightened.
So clearly community care in any meaningful sense is dead.
Blair McPherson former Director of Community services in a large local authority and author of books on management development and equal opportunities. www.blairmcpherson.co.uk