Living In A Care Home

I have been living in this Care home for a while now and have been writing a blog post almost every week since I arrived. In fact the only times I have missed were when I was in hospital. This week one of the Senior carers came to see me and asked if I would consider moving to a different room, down the other end of the building, because when I first arrived in this Care home I was given a choice of rooms, but to get to one of them was impossible for me at that time because it involved going up two small steps. Back then I was only able to walk with the aid of a walking frame, so that meant the going to the other one that was available. So I moved in to room 16, but with some effort my mobility improved and after a year I was able to put aside the walking frame and use a single stick, which pleased me as well as the Care home staff. I think they were happy to see my progress. However, I had a couple of setbacks, diagnosed as strokes, which meant I was in hospital for a short while each time. But I persevered, mainly by setting myself targets as to how many steps per day I managed. Some days were better than others! I learned more about the people staying in this Care home, which is staffed twenty-four hours a day, I saw some of the improvements made to the home like an updated alarm system so if any person needed assistance they could press a button and a carer would attend. The old system had worked, but this one was better as there was even an ‘emergency’ button for urgent assistance if it were needed. With my sense of humour I referred to those of us resident here as ‘inmates’ – mainly because for a while we were virtual prisoners, due to Covid. Even now, if there is any sign of a health issue like a tummy upset affecting a few inmates, we are requested to stay in our rooms, although that isn’t always easy. I have mentioned before that some inmates have dementia in varying stages and sadly at times must be treated a little like young children – politely but firmly. What has also been sad to see is the gentle ‘turnover’ of people, mainly due to the effects of dementia on them though some perhaps pass away through natural ageing and some through the effects of Covid and the relevant medication. I do not know. But I continue with my research and my writing, which I hope you enjoy, though perhaps not always as I do try to vary it a bit! If you read last week’s blog post you will have gathered that I am no great fan of football, but I still found it an interesting subject to research and write about! So I try to do the same with other things, but not politics – I do draw the line at that as it is a subject which can be long and drawn out with many different views. So I have been moved to room 34.

As to Care homes themselves, the history of these in Britain began in 936AD, when the first-known almshouse was built in York. The story goes that King Aethelstan, at that time King of the English, provided funding for it after seeing clergymen of an older incarnation of York Minster using their own money to care for the elderly. ‘Alms’ means to give to others, through virtue or compassion. Also known as bedehouses, from the Anglo-Saxon word for prayer, these houses were funded by wealthy people hoping that their funding would increase their chances of being accepted into Heaven. Almshouses were religious places and their aim was to nurture the soul as well as the body. Residents, known as Bedesmen and Bedeswomen, would have to live under a strict regime of prayer and worship as part of their care. Those who were Ill, disabled or elderly people could also be given residence in monasteries and later the first hospitals. The first hospital known to care for people long-term was St. John’s Hospital in Canterbury, founded around 1087AD. In these hospitals, long-term residents were cared for alongside short-term patients, with leprosy being a common reason for temporary admission. As leprosy rates waned, many smaller hospitals were converted into almshouses while large hospitals were established to care for temporarily ill people and wounded soldiers. In Elizabethan times, the 1601 Act of Relief for the Poor, now known as the Old Poor Law made that every parish in England and Wales’ responsibility to house people who could not work. The ‘impotent poor’ included people who were too ill, disabled or old to maintain employment. Some were sent to almshouses and some to early workhouses. By Victorian times, care for the elderly still fell under the same category as care for the sick and for the poor. Then the 1834 Poor Law Amendment Act, also known as the New Poor Law, put stricter methods in place for helping the poor. It got rid of ‘outdoor relief’, i.e. providing food and clothing to poor people and made the workhouse the main source of aid for anyone unable to work. However, workhouses were grim and designed as a deterrent, making conditions so bad people would do anything to avoid them. Older people would be made to work for 11 hours a day to earn their keep, with elderly women often working as nurses to other inmates, despite having no medical training whatsoever. Then the twentieth century saw significant reforms in care for older people. The 1908 Old Age Pensions Act brought in the first pension for anyone over 70 years old. It was means-tested and deliberately low to encourage people to save privately towards their retirement and included a behavioural test in order to redeem it. The 1925 Widows, Orphans and Old Age Contributory Pensions Act introduced the first contributory-pension, where some of the person’s wages went into their pension pot, as opposed to solely the employer contributing. In 1927, parliament passed the Nursing Homes Registration Act, with Scotland following suit in 1938. At this time, as defined by the latter, a ‘nursing home’ meant a home “providing of nursing for persons suffering from any sickness, injury, or infirmity, and includes a maternity home”. These laws made it compulsory to register nursing homes so they could be inspected, and introduced penalties for those who failed to do so. Homes also now had to keep proper records of every patient.

The Second World War brought a need for a new solution for housing for the elderly. Many were still confined to hospitals, but the huge number of casualties, both of soldiers and citizens during air raids, meant hospitals were crowded. At this time, medical care was still privatised and with men away fighting, affording it was extremely difficult. So shortly after the war the Labour Party came into power and started to lay foundations for the Welfare State. Prime Minister Clement Atlee created National Insurance, and his Minister for Health, Aneurin ‘Nye’ Bevan, formed the NHS in 1948. This was followed by the 1948 National Assistance Act that abolished the Old Poor Law, and this legislation made local authorities responsible for assisting ill, disabled and older people with care. Then a twentieth-century hero of social care named Professor Peter Townsend (not to be confused with Group Captain Peter Townsend, one-time love interest of Princess Margaret) appeared. He was a sociologist who visited 174 care homes in England and Wales in the late 1950s and the resulting book that described his findings, ‘The Last Refuge’, showed the inequality of standards of care between those in private homes and those receiving support. He was alarmed by the treatment of those whose care homes were former workhouses, finding that the old workhouse ways still haunted the homes, such as deaths being kept secret from other residents. His findings led to widespread reform in improving the standard of care for older people who were unable to pay for care privately, including central heating and single-occupancy rooms becoming standard. Then in the 1980s, under the new Conservative Government residential care homes became big business. Prior to this, local authority homes had been the majority, but self-funded care homes increased and the number of places in them tripled over the course of the decade. Whilst some were against privatisation, this did free up more places in local-authority funded homes for those that really needed them. The Registered Homes Act 1984 ensured that all private homes were still regulated. The 1990 NHS and Community Care Act Reform, implemented in 1993, brought in the idea of care cantering on individual needs and the care needs assessment was introduced. In 2000, the Care Standards Act, though not enforced until 2002, replaced the Registered Homes Act and for the first time considered nursing homes to be a form of care homes for the elderly. The legislation also established care councils in England and Wales, regulated the training of care workers and introduced a new set of minimum standards that all forms of care home were legally obliged to comply with. The Health and Social Care Act of 2008 aimed to combine the three existing regulatory bodies into one all-powerful inspectorate. This resulted in the Care Quality Commission (CQC), that inspects medical practices and care homes in England, beginning in 2009. In 2011, Scotland introduced the Care Inspectorate, but both lagged behind Wales, who had had the Care and Social Services Inspectorate Wales (CSSIW) in place since 2002. In 2018, the CCSIW changed its name to Care Inspectorate Wales. But I learn that the landscape for care homes is still changing. According to an IPPR think-tank report, 84% of care home beds occupied by older residents are in for-profit homes, while 13% provided by the voluntary sector with just 3% offered by local councils. In recent years there has been a push from developers for more luxury care homes, with the number of small care homes falling. These large builds offer luxury living with fine dining at every meal, facilities like salons, spas and cinemas and services like chauffeur-driven cars. Some even have built-in high streets to provide a safe community for their residents. There has also been an increase in demand for retirement villages, as people look to find a balance between independence and support. Me, I like what I have here. We shall see. My blog this week is deliberately short, last week’s was quite long and it is Christmas time, so I hope you are having a good time and maybe a bit of a break, as it is meant to be. I wish you all a happy New Year.

This week…a little poem

As we gently look back,
At the days that have passed,
As an old year now finishes,
To the knowledge we’ve gained.

Some doors have closed,
Some doors have opened,
Some lives have ended,
Some lives have begun.

Some chances were taken,
Some mistakes were made,
Some lessons were learned,
Some changes were made.

Now we look to the new year,
Now with peace in our heart,
Now we go with enlightenment,
Now we wake with a smile!

© Andrew D Williams 2018

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