Service Users Perspective Critically
In this essay I want to carefully examine a broad range of issues concerning elderly people in contemporary British society today. In particular I will want to focus on Residential homes and Older People in Community Care services. I will define residential homes and explain how they have become established from the Poor Law workhouses until present day. I will also discuss relevant government legislation with the viewpoints of older people’s pressure groups and the service users who use residential homes.
I will try and suggest changes that could be made in social policy that could help advantage retired and elderly people in this the twenty-first century. There are two types of homes for older people in contemporary society, residential homes and nursing homes. Residential care is highly an important source of accommodation for old people, who even with domiciliary support cannot manage to live in their own homes, but who still do need intensive nursing care. Grundy and Arie (in Tinker 1992:161) have suggested that residential care is needed for those who need round-the-clock support and live alone.
Current provisions which stem from the 1948 National Assistance Act require local authorities to provide: ‘residential accommodation for persons who by reason of age, infirmity or any other circumstances are in need of care which is not otherwise available to them’ (CPA, 1996). Residential care: consist of respite care, short stay and full time residential care. A residential home is expected to provide both personal care and accommodation. A residential home is a means of providing extra support to people who are not able to cope with their illness or disabilities, even after the support from home care services (O’Kell, 1995).
An estimated three million people live in homes, a figure that is likely to rise by more than 180 per cent in the next 50 years as the average age of the population rises. Local authority, private and the voluntary sector provide homes; however there has been a dramatic shift towards private provision, but the proportion of elderly people in residential care has remained constant. In the last fifty years the development of the major voluntary agencies: Centre for Policy on Aging (1997), Age Concern (1997), Helped the Aged (1962), The National Corporation of the Care of Old People (1947) have made significant ontributions to elderly care service (Tossell and Webb 1994). On the other hand, nursing homes provide the latter along with registered nurses for older people who need care for medical purposes. Even though homes provide support and care for older people, they are often criticised as being institutions that are a form of social exclusion and social control. However, provisions for older people have moved on dramatically from the days of the workhouse where older people who could who could not support themselves were placed. (Peace et al, 1997). Under the 1834 Poor Law Amendment Act, workhouses were established.
This was to ensure that people who experienced extreme poverty, for example, the disabled, sick people, children and old people had indoor relief and were required to work in order to be accommodated. Even though the workhouse provided people with shelter, they were stigmatised as harsh, strict and degrading places that incurred individuals to be segregated from the rest of the society. This policy was arguably a form of social control and social exclusion as the rest of society did not want to see these people on the streets due to the Victorian snobbery of the era.
In response, the government decided it was best to isolate the poor from the rest of the society by placing them in workhouses. (Peace et al, 1997). The birth rate is the number of live births born in England per 1000 per year. The number of live births in 2002 was 669 thousand. It has decreased in the last 100 years because 100 years ago, parents had many children, family sizes of 8 and 9. This was important in them days, as the parents would rely on their children to look after them, when they got older and for the children to go out to work.
Nowadays family sizes are smaller, averaging couples, having babies later on in life, as women are wanting careers, also having children later on in life, therefore limiting how long they have got to conceive. Attitudes have changed over the years also; it is the ‘norm’ to have fewer children than 100 years ago. According to statistics of the 1909 Royal Commissions of the Poor Laws report showed that 150, 000 older people were residing in workhouses due to extreme poverty and need for financial support. This resulted in half of the workhouse population of this period due to decreasing mortality rates and increasing rate of life expectancy.
This eventually influenced and lead to the 1908 Old Age Pensions Act. However, older people remained in poverty as the state pension was very low and it could be argued that this was an inadequate provision for older people. (Means et al. 2008). After the Second World War, there were critical inequalities in the society such as the rich and the poor divide. The Labour government then came into power in 1945 and created their policies, they were influenced by the 1942 Beveridge report, which stated that a system should be created called ‘cradle to grave’ so that an equal society can be created and eliminate the suffering caused by poverty.
Their aim was to make society better and fairer for people with disadvantages such as vulnerable groups, young children and older people etc, (Blakemore 2003, p. 54). Many may argue that the workhouse is a disadvantage to older people. This can be reinforced by the Nuffield survey, a report created in 1947 on institutions. It reflected on the sufferings of older people in the environment and restrictive regime of the workhouse. The Minister of that time then introduced 1947 National Assistance Bill.
The workhouses were then closed down and the residential homes were established, as residential homes could meet the needs of older people in a better way and it was more beneficial for them. (Peace et al 1997). Care homes should provide a quality of service meeting the needs of the residents as in a normal setting. However, the institutionalised nature of the care has many negative impacts on the residents’ as they perceive it is as negative form of care and a service denying independence, autonomy, privacy, power and other principle of human rights.
Elderly are abused and neglected in some care homes while large proportions of staff caring for them are untrained and incompetent in caring. Funding for elderly care is major issue, on one extreme elderly are being forced to pay for care and on the other local authorities struggle to manage service within their budget. # A good definition of community care can be found in the 1989 White Paper on community care, Caring for People, which stated that “community care means providing the right level of intervention and support to enable people to achieve maximum independence and control over their own lives.
For this aim to become a reality, the development of a wide range of services provided in a variety of settings is essential. These services form part of a spectrum of care, ranging from domiciliary support provided to people in their own homes, strengthened by the availability of respite care and day care for those with more intensive care needs, through sheltered housing, group homes and hostels where increasing levels of care are available, to residential care and nursing homes and long-stay hospitals for those for whom other forms of care are no longer enough” (Department of Health, 1989, p. ). The White Paper suggests the key components of community care are services which respond sensitively and flexibly to the needs of individuals and their carers, allow a range of options for consumers, do not intervene more than is necessary and concentrate upon those with the greater needs. The White Paper proposed seven key changes. Many of these changes involved more responsibility being put on the local authorities. They would now be responsible, firstly, for assessing individual needs and securing their delivery within available resources.
Secondly, they would be expected to produce and publish clear plans for the development of community care services and will also be expected to show that they are making maximum use of the independent sector. Local authorities are also responsible for financial support of people in private and voluntary homes. Furthermore, local authorities are to encourage independent sector care homes. The local authority pays more from its own funds for people cared in its own homes. Moreover, the responsibility for inspecting all residential homes rests with the local authority.
Finally, local authorities were given a special grant to promote the development of social care for seriously ill mental people. This is especially important for older people with senile dementia, as social services expenditure for people with mental health problems was often only a very small part of a local authorities budget. # These reforms involved making some legal changes, and thus the National Health Service and Community Care Act 1990 was passed. Included in this act were objectives to be achieved by community care as well as by organisational arrangements by which these could be achieved.