Residential Care Transformed

Transcription

1 Residential Care Transformed

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3 Residential Care Transformed Revisiting The Last Refuge Julia Johnson The Open University, UK Sheena Rolph The Open University, UK Randall Smith University of Bristol, UK

4 Julia Johnson, Sheena Rolph and Randall Smith 2010 Softcover reprint of the hardcover 1st edition All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No portion of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, Saffron House, 6 10 Kirby Street, London EC1N 8TS. Any person who does any unauthorized act in relation to this publication may be liable to criminal prosecution and civil claims for damages. The authors have asserted their rights to be identified as the authors of this work in accordance with the Copyright, Designs and Patents Act First published 2010 by PALGRAVE MACMILLAN Palgrave Macmillan in the UK is an imprint of Macmillan Publishers Limited, registered in England, company number , of Houndmills, Basingstoke, Hampshire RG21 6XS. Palgrave Macmillan in the US is a division of St Martin s Press LLC, 175 Fifth Avenue, New York, NY Palgrave Macmillan is the global academic imprint of the above companies and has companies and representatives throughout the world. Palgrave and Macmillan are registered trademarks in the United States, the United Kingdom, Europe and other countries. ISBN ISBN (ebook) DOI / This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. Logging, pulping and manufacturing processes are expected to conform to the environmental regulations of the country of origin. A catalogue record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data Johnson, Julia, 1946 Residential care transformed: Revisiting The last refuge / Julia Johnson, Sheena Rolph, and Randall Smith. p. cm. 1. Old age homes Great Britain History. 2. Townsend, Peter, I. Rolph, Sheena. II. Smith, Randall, 1936 III. Title. HV1481.G72J dc

5 To our parents Netta Huxley ( ) and David Huxley ( ) Muriel Bell ( ) and Thomas Bell ( ) Hilda Smith ( ) and Frank Smith ( )

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7 Contents List of Figures and Photographs List of Tables In Memoriam Acknowledgements List of Abbreviations x xi xii xiii xv Part I The Context 1 Why Revisit The Last Refuge? 3 A work of lasting importance 3 The impact of Townsend s research 9 Revisiting The Last Refuge 11 The plan of the book 14 2 Changing Contexts of Care 17 An ageing population 17 Changes in residential care provision 21 The welfare state: The early years 23 Privatization 27 Modernization 29 Paying for care 32 Personalization and residential care 34 Changing research agendas 35 3 The Study Design and Methods 40 Survivors or non-survivors? 41 The tracing study 44 The follow-up study 49 The context of change 51 Research instruments and methods 53 Access, participation and consent 56 Methodological issues 58 Part II Revisiting The Last Refuge 4 Survivors and Non-Survivors 63 The ex-pais 64 Other local authority homes 66 vii

8 viii Contents The voluntary homes 68 The private homes 71 Accounting for survival 74 Conclusion 83 5 Residents and Staff 85 Residents: Gender, age and ethnicity 86 Residents: Family and social circumstances 88 Residents: Personal assistance and capacity for self-care 90 Residents: Reasons for admission 94 Staff: Numbers and roles 97 Staff: Training and qualifications 103 Managerial responsibilities 105 Conclusion The Living Environment 109 Location and scale 110 Internal spaces 112 External spaces 119 Creating a homely environment 123 Rules, regulations and routines 126 Managerial styles and staff attitudes 133 Conclusion Daily Lives 138 From domestic work to daily living activities 139 Caring and supporting 144 Organized group activities 146 Hobbies and pastimes 150 Friends, cliques and internal communities 153 Getting out and about 155 The role of family and friends 159 Conclusion The Quality of Care 165 Townsend s quality measure 166 The CSCI quality ratings 174 The worst homes 177 The best homes 180 Conclusion 186 Part III Conclusions 9 Revisiting and Reuse 189 Working with volunteer researchers 190

9 Contents ix Reusing data 197 Conclusion Continuity and Change in Residential Care for Older People 207 Stability and change 207 Social care in the twenty-first century 210 De-stigmatizing residential care 216 Appendixes 219 Notes 254 References 261 Index 277

10 List of Figures and Photographs Figures 4.1 Home closures by original tenure, 1959 to The location of the sampled homes, , and the surviving homes, Photographs 1.1 Peter Townsend with Brian Abel Smith at the London School of Economics in the late 1950s Robert Pinker with the matron and warden when visiting The Shrubbery, Walsall, a local authority home which closed in Four former homes now closed An early post-war purpose-built home Matron and staff 1959 and Manager s office in Two entrance halls Sitting on the threshold 1959 and Resident s bed-sitting room 1959 and bedroom The institutional environment Cleaning silver, Recreation in Dayroom 1959 and lounge Reg Paine, x

11 List of Tables 2.1 Long-stay places for older and physically disabled people (000s) by sector, UK, 1970 to Townsend s sample by tenure, Indicators of survival Organizations through which volunteers were recruited Sources of data for the follow-up study, Survival rates by tenure Surviving homes by tenure, and Survival rates by tenure and location The size of the surviving homes in by their size in Proportion of men by home, the follow-up study, and Residents in the follow-up study homes by age and sex, and Residents in the follow-up study homes by marital status, and Residents in the follow-up study homes by family circumstances, and Residents in the follow-up study homes by need for assistance, and Incapacity for self-care scores, and Number of staff at Fairview, by category and sex, Scores using Townsend s quality measure by tenure, and Average scores for and using Townsend s quality measure Percentage of CSCI standards exceeded, met and not met, England, CSCI scores for follow-up study homes, England, xi

12 In Memoriam Peter had agreed to write a Foreword to this book once we had completed our final draft. Very sadly, he died before the text was ready to hand to him. A host of tributes have been published, acknowledging his integrity, his humanity and his seminal writings. This note comprises our reflections of the willing enthusiasm he displayed for our project and the unstinting practical help that he provided. One of the most exciting features of the project was delving into the Townsend collection boxes held in the UK Data Archive at the University of Essex. At times, the material on the homes he and his research team visited presented us with a puzzle. Peter was always happy to help us out. Sometimes, we called upon his memory to test uncertainties in our own minds. At other times we needed practical guidance. For instance, the detail was sometimes lacking about when his research team visited some of the 173 homes in the study, or even where the homes were specifically located. We listed our queries and back came, in that neat handwriting so typical of Peter s meticulousness, the relevant details copied from his personal diaries for the period Apart from this support, Peter gave willingly of his time to respond to a host of topics we wanted to discuss with him. As the research began to produce newsletters, conference papers, book chapters and journal articles, he again was enormously helpful in commenting on early drafts. In early June 2009, we sent him a draft of one of the Appendixes to this book. It acknowledged and celebrated the invaluable work of our volunteer researchers up and down the country, who traced the fate of the 134 homes which had closed in the years following Peter s study. Peter s reply, as ever, was generous in his encouragement and imaginative in suggesting improvements. His was sent late in the morning of Sunday, 7 June That evening he suffered a fatal heart attack. Many thousands of people have benefited directly or indirectly from his commitment to the promotion of social justice and the eradication of poverty. We want to thank him and remember him as a generous colleague who gave time willingly to support a project that could not have been undertaken had it not been for his deep commitment to rigorous research and the preservation of research material. xii Thank you, Peter. RS, JJ and SR

13 Acknowledgements This book is based on research that was funded by the Economic and Social Research Council (RES ). We are grateful to colleagues who read the proposal before it was submitted, to the anonymous referees who endorsed it and to Robin Means, Sheila Peace, Ian White and Annie Stevenson who, as members of our advisory group, wisely guided us in the conduct of our research. The research involved reusing data from the Peter Townsend collection which is stored in the UKDA. Louise Corti, Libby Bishop and John Southall at the UKDA have shown a consistent interest in our project and Nigel Cochrane, librarian at the Albert Sloman Library at the University of Essex, has been tremendously helpful in searching out information for us. Thanks also to Julie Charlesworth, one of the original archivists of the Last Refuge boxes, for the time she gave us and to Robert Pinker who allowed us to interview him about his work as a research officer on Townsend s project. Several of the photographs reproduced in this book, including the one on the front cover, were taken by Peter Townsend in the late 1950s. We would like to thank Jean Corston, who now holds the copyright, for generously allowing us to use them. The other photographs used in this book are also reproduced with the kind permission of the copyright holders who, in addition to ourselves, include Barbara Prynn and Peter Wade. We also thank Sheila Bennett, Eileen Hayden, Ann James, Keith McCoy, Tony Paine, Philip Roberts and Rita Young for giving us permission to include photographs of themselves or their relatives. An enormous number of people helped us trace the history of the 173 residential homes visited by Peter Townsend in the late 1950s. We recruited nearly a hundred volunteer researchers across England and Wales. Without their enthusiasm, curiosity and persistence, this project would not have been possible. Each is named in Appendix 1. In addition, we have extended our thanks to numerous local studies librarians and others who helped us to put together some of the missing pieces. Our success in recruiting so many volunteers was in no small part due to the support and efforts of Keith Richards, Lin Jonas and Daphne Sirett, University of the Third Age, Joan Rapaport, History of Social Work Network, Members of OPRSI (Older People Researching Social Issues), Peter Leather, Department of Continuing Education at the University of Birmingham, xiii

14 xiv Acknowledgements and various local history associations. Particular thanks to William Evans, a local historian, who piloted the tracing study on two homes. We also wish to thank the providers, residents and staff of the surviving homes we researched. In particular, we are grateful for the time given to us by the 20 home managers and 75 residents we interviewed together with the 18 members of staff and residents who kept a diary for us. We hope we have treated their words and deeds fairly. Those who wished their contribution to our research to be acknowledged are also named in Appendix 1. We received help too from staff in various local CSCI offices, particularly Lyn Davis and Sandra Gibson from the Avon Office, who we met in We thank too our respective universities for the support they have afforded us. June Ayres, Kate Fawcett, Penny Wilkinson, Lesley Henderson, Sandra Riekie, Linda Price and Angela Torrington have provided invaluable administrative and secretarial assistance. Linda Johns and Tanya Hames created and maintained our website and Neil Walker, Vicki Fowler and Kate Stothard provided IT assistance. Several academic colleagues and friends from the Centre for Ageing and Biographical Studies at The Open University and the Research Programme on Ageing and the Lifecourse at the School for Policy Studies, Bristol University, have helped us throughout the research and we are particularly grateful to Chris Harris, Ken Blakemore and Moyra Sidell who read earlier drafts of the manuscript. We are deeply indebted to Henry Rolph for his interest and support in the conduct of the research and very special thanks to Bill Bytheway who has spent many hours patiently discussing, advising and helping us with the research and the preparation of this book. Finally, we would like to thank Olivia Middleton and Philippa Grand, our commissioning editors from Palgrave Macmillan, and Manavalan BhuvanaRaj, our project manager, for their patience and support in the production of this book. Some of our chapters draw on papers we have had published elsewhere. Part of Chapter 4 draws on Johnson et al. (2010), published by Cambridge University Press, and parts of Chapters 3 and 9 draw on Johnson et al. (2007) and Rolph et al. (2009), published by The Policy Press and Taylor & Francis respectively. Every attempt has been made to contact copyright holders. If any have inadvertently been overlooked, the author and publishers will be pleased to make the necessary arrangements at the first opportunity.

15 List of Abbreviations BASW British Association of Social Workers CQC Care Quality Commission CRB Criminal Record Bureau CSCI Commission for Social Care Inspection CSIW Care Standards Inspectorate for Wales CSSIW Care and Social Services Inspectorate for Wales DH Department of Health DSS Department of Social Security ESRC Economic and Social Research Council HI Home Interviews (files held at the UKDA) HIMP Health Improvement Programme HR Home Report (written in ) LRR Last Refuge Revisited LSE London School of Economics MI Manager Interview (conducted in ) NCSC National Care Standards Commission NHS National Health Service NSF National Service Framework NVQ National Vocational Qualifications OPRSI Older People Researching Social Issues PAI Public Assistance Institution POVA Protection of Vulnerable Adults PTC Peter Townsend Collection (held at the UKDA) RD Resident Diary (written in ) RI Resident Interview (conducted in ) SEAN State Enrolled Auxiliary Nurses SRN State Registered Nurses SSI Social Services Inspectorate xv

16 xvi List of Abbreviations SWHN U3A UKDA WAG Social Work History Network University of the Third Age UK Data Archive (University of Essex) Welsh Assembly Government