DEMOS Commission of Residential Care published its report in September 2014. The Commission has spent the last twelve months reviewing the brand of residential care, public perceptions, best practice and identifying the direction in which residential care should go in order to “reinvent” itself. Its aim was to set out the vision of residential care in the twenty-first century and how the existing housing could help to deliver this vision.
The report is welcome and it appears that the “ageing crisis” is finally moving up the political agenda. At present, 10 million people in the UK are over 65 years old. The latest projections from the Government’s Actuary Department estimate a further 5.5 million more elderly people in 20 years time and 19 million by 2050. While one in six people in the UK is currently aged 65 and over, by 2050 this figure will be one in four.
We take a look below at some of the key conclusions and recommendations in the report.
Rebranding residential care to “housing with care”
The report concluded that the brand of residential care is “fatally damaged”. There has been significant negative media coverage revealing mistreatment and abuse in the care system including Panorama’s exposé “Behind Closed Doors: Elderly Care Exposed”. Public perceptions link independence with remaining in one’s own home and residential care with an end to independence.
The report recommends rebranding residential care as “housing with care”. This new terminology is designed to describe the range of care options available from care homes and residential villages to supported living apartments and bring about a shift in perception from residential care as a “last resort” to a spectrum of choice. The report describes the positive impact that housing with care can have for people, in particular the range of activities available and the opportunity to engage in group trips and outings which may be harder to access if living alone.
It remains to be seen if changing the terminology can achieve this outcome given embedded public perceptions. It may help to address the understanding of the range of housing options available so that people feel that they have a real control and a positive choice on how they want to live but it is questionable whether it can go further and change perceptions following some of the shocking abuse scandals. Of course, re-branding the terminology does little to address the actual challenges in the care sector.
Uncoupling the housing from the care package
The new terminology of “housing with care” is also designed to separate the care package from the location in which the care is delivered. The report describes this as putting the “housing option first and foremost, with a care package attached”.
Disability Rights UK have questioned whether re-branding could, in their opinion, be detrimental as it glosses over the real priority of providing support in people’s own homes and legitimises the default option of making people move to where the support is rather than support being delivered to where they choose to live.
Building more housing with care
Demand in the care sector is only going to increase and projections vary on how many care home beds will be required in the short term future. The planning agenda often focuses on first time buyers and affordable housing and less priority is given to considering whether adequate land is being provided for housing with care.
The report recommends that local plans should recognise the need to provide residential care homes, including an assessment in the local plan of the population’s future housing with care needs.
The report also recommends a review of the CIL regime charges in order to establish whether housing with care providers are being “disproportionately disadvantaged” by this regime. Care home developments are more likely to have large amounts of communal space compared to housing developments (where the square footage is mainly made up of private apartments) which leads to higher CIL charges. The CIL charge could then be passed on to the individuals through high service charges and therefore a lower CIL rate or an exemption may be preferable, as currently exists for social housing developments.
The workforce for housing with care
The report makes a number of recommendation in respect of the workforce – recognising the specialised skills set of the workforce but that staff are often not invested in through training or wages.
In respect of wages, it recommends that the care sector should become a “living-wage” sector . At present 78% of the care workforce in the housing with care sector in “direct care” roles earn £6.45 per hour – 14p more than the minimum wage. If this were increased to the living wage (£7.65 per hour outside London), it would cost around £1.1 billion per year. Where would the additional funding come from in order to pay for this increase? The report suggests it would be delivered from central government and administered locally via a fair funding formula or alternatively secured by increasing the personal tax thresholds and national insurance contribution allowance for such workers.
In respect of training, it recommends that “Skills for Care” (a charity which works to set the standards in the adult social care sector) becomes a national professional organisation to represent housing with care staff. Professional registration should not simply be linked to employment in the sector but be given on qualification and training. The report suggests that a dedicated professional body may succeed in promoting excellence and best practice.
Other recent ideas to safeguard training and standards of care have included a “care certificate” which is currently being trialled through Skills for Care. The report is concerned by the lack of independent validation and accreditation of these certificates. The preferred proposal (put forward in the Kingsmill review into working conditions) is that care workers should be awarded a licence to practice. The advantage of this approach is that in the shocking cases of abuse and neglect, the licence could be revoked.
The report is a welcome initiative whilst its recommendations are not new, it helps to bring attention to this important agenda. It remains to be seen whether its recommendations can be converted to action and change in the care sector.