Is the strategy what’s best for the client, what makes us feel better, or what happens to be in fashion?
If an elderly person was to be asked whether they would prefer to live at home or in a care home the answer, would be resoundingly, “at home”.
Those with Learning Difficulties are often however, unable to make that decision for themselves and there is a worrying trend for Social Workers to suggest that community-based care or “care in the community” is always the preferable option. Operators with great LD homes are seeing their occupancy numbers dwindle and are facing closure. Those with small LD homes are changing the model of care and selling the same service as a small home (that the client pays for using housing benefits), with care delivered under separate packages by the original home owner.
The question that needs to be asked, is why is community-based care preferable to home-based care? Ask a number of proponents of community-based care this question and you’ll be bewildered by the variety of responses.
The most common answer however, is that it is far better to provide a setting as close to ‘normality’ as possible, to promote greater independence and to avoid isolation from society as a whole. To argue this is, however, to deny the special needs of those with learning difficulties. I’ll give an analogy…. I think that squash is a marvellous sport that encourages social interaction. It keeps me fit and healthy and gets me involved in an activity outside of home. Lots of people do it. Using the same arguments, I could dress my octogenarian mother in squash kit, shove a racquet in her hand and sit her in a squash court for an hour – I doubt that she’d see the benefits. Similarly, placing an LD client in a modified flat out in the ‘community’ is unlikely to deliver all the benefits that proponents of community-based care suggest.
To begin with, the “community” to which they nostalgically refer and into which they want to ‘re-integrate’ the client to, no longer exists. Few people have the time in their busy lives to take elderly, disabled or otherwise challenged neighbours under their wing. In the majority of neighbourhoods, people speak only rarely to their neighbours, particularly as in most households the adult(s) are at work all day. As a result, the only real contact that the LD client has is with the carers that are paid to call in to deliver paid care, or with other similarly challenged clients during the few hours that the individual spends at day centres.
To get around this problem, often those with learning difficulties are clustered into small households of three or four people.
How much better would it be though if, instead of just two or three other people, there were twenty people or more living together, offering many more opportunities for each to form meaningful relationships, to bond and to take part in activities together, to have 24 hour support and continuity of care, to share in each other’s successes and support, without judgement, each other through their challenges?
The argument about trying to involve those with special needs in normal everyday tasks likewise needs challenging. Why is it important that we actively encourage those with special needs to take part in daily activities? Is it more important to get someone to be able to tie their own shoelaces than it is to provide them with stimulation and ensure that they are happy and well cared for? They might not see tying their own shoelaces as relevant or important.
A final point that I hesitate to raise is one of pure economics. In these straitened times, notwithstanding that there may be a better outcome by placing in care homes rather than community-based flats, isn’t it equally important to seek a cost-effective solution. It is far more economical to offer care in a care home environment than it is to deliver care throughout the community. By choosing a cost-effective solution Local Authorities can offer help to a far greater number of clients thus reducing the number of incidences where care is simply withheld due to a lack of funding.
I make the above points for a number of reasons. The first is because I think it useful to constantly challenge what is seen as ‘accepted wisdom’. Secondly, I see, in the current approach to care of LD clients, a one-size-fits-all solution emerging with very good LD homes being forced to close as they no longer fit with current dogma. In closing these homes, we are at risk of losing a wealth of experience.
Operators are seeing occupancy levels dwindle and this, in conjunction with the pressure to reduce fees is causing some excellent services to close. Even more absurdly, in the case of very small homes, owners are simply looking to change the structure of their funding from a weekly care fee to housing benefit and care packages simply to conform to a trend in thinking. Surely great care is great care and we should worry less about how it’s packaged than whether it makes the clients happy and improves their quality of life?
Tony Stein Chief Executive
Healthcare Management Solutions
