Our own research tells us that extra care housing can prevent the need for residential care for older people in 50% of cases.
We have carried out case audits with the councils’ own care managers. This is a very simple but effective device which enables practitioners to reflect on what could be done differently if other services were available.
We take a sample of cases where the council has recently commissioned residential care and enable care mangers to review care plans and answer two important of questions:
- What were the main factors that resulted in a requirement for residential care?
- Would extra care housing have been a suitable option if it had been available at the time?
The findings of these audits are remarkably consistent. Care managers’ own professional judgements confirm that in approximately 50% of cases extra care housing would have been a suitable alternative to residential care. This does not necessarily mean that bad decisions were made at the time – simply that extra care housing was not available or that it was not specified or organised to meet more complex needs. Care managers tell us that building design, availability of meals, focus on dementia, and personalised technology are essential if extra care housing is to be an effective alternative to residential care.
So why isn’t extra care housing already a well-established cornerstone of social care provision?
In exploring answers to this question I am indebted to Richard Humphries’ inspiring and instructive Ending the Social Care Crisis – A New Road to Reform (Policy Press, 2022). He tells us that “…too many aspects of social care have been left untouched by four decades of apparent change. For someone with substantial care needs today, the kind of service they are likely to be offered has changed little since the 1950s. The offer remains home care, day care or residential care and different approaches and innovations remain small scale.”
This flies in the face of the one guiding principle that has underpinned policy for thirty years or more: the right to a life not a service.
Richard Humphries explains that – notwithstanding a professional consensus that things should be different – adherence to traditional models is a consequence of inter alia political indecision, prioritisation of health services above social care, regular policy shifts and extreme financial constraints. Notwithstanding these obstacles change must happen. So why is change essential rather than simply desirable? Put plainly many people will continue to receive a service rather than the support they need to lead the life they choose.
As Richard Humphries explains:
“Over-reliance on residential and nursing homes is unsustainable because of rising demand and costs of services, and it flies in the face of what most people want. Consequently, the most common and long standing policy ambition across the developed world is to shift the balance of services away from hospitals and long-term care settings towards care based in people’s own home and communities.”
So what can we do about it?
The simple answer is to do something now that is affordable and achievable and creates new and different opportunities for people who otherwise would be reliant on traditional services. Hard-pressed and cash-strapped councils can do this by enabling private investment and independent expertise to help them do things differently. In this way real change can happen with relatively little demand on councils’ time and resources.
It is already the case that 90% of adult social care services are delivered by private and voluntary organisations. It is logical, therefore, to allow private capital – backed by the expertise of developers and architects – to help change the way in which services are delivered.
If councils are concerned that this approach requires them to relinquish control of service development, they can be reassured that our approach gives them a real say in what is developed, where it is developed, and how it is specified and designed. This is particularly important in the social care market where, as Richard Humphries argues, it is too often the case that “…private money can produce both worse outcomes and higher costs”.
This should not be the case in a genuinely collaborative approach to the development of extra care housing. Firstly, social care commissioners can trust developers to produce better outcomes because they are committed to building schemes which will be valued over time both by councils and by tenants and their families. Secondly, commissioners should expect the developer to work on an ‘open book’ basis exposing all costs – land, construction, fees – to scrutiny.
