Randall Smith

The Quality of Care

Thus far, we have considered some of the features of continuity and change in the surviving homes and in the everyday lives of those living and working in them. A question that is frequently asked, however, is whether the homes today are better than they were in the past. In this chapter, therefore, we present our findings about the quality of care in the surviving homes then and now. The quality of care in the homes together with policy and practice regarding the registration and inspection of homes was one of Townsend’s key concerns. In the late 1950s, homes owned by the local authority were not subject to registration and inspection procedures. Voluntary and private homes, however, were required to be registered with, and inspected by, the local authority. However, Townsend found that for a variety of reasons some of the voluntary and private homes he visited were exempt; others had not been inspected for at least a year and some for more than five years. The quality of inspection was also mixed. Given some of the conditions found by Townsend, this situation was of considerable concern to him.

Identity in the fourth age: perseverance, adaptation and maintaining dignity

ABSTRACT The fourth age remains a poorly understood phenomenon and there is a lack of understanding of the perceptions of those who might be considered to be living in it. This article draws on findings from a study of dignity in later life which examined the day-to-day experiences of participants who were in need of support and care because of failing health. It discusses their accounts of the changes to their sense of self and their identity that came about as a result of their ageing and health problems and looks also at the ways in which the support and care they received helped to shape their adjustment to those changes. The accounts given by participants reveal a great deal about the physical, mental and emotional effort entailed in maintaining a sense of self and highlight the essential role played by social relationships in the maintenance of identity. These findings are analysed by reference to emerging theories of the fourth age.

From community care to market care? The development of welfare services for older people

Means was lead applicant for this ESRC study which covered the development of welfare services for older people in England and Wales from the introduction of social services departments in 1971 through to the implementation of the community care changes in 1993. Professor John Baldock chose it as his 2002 book of the year for SPA News because of how its detailed analysis challenged the assumptions of community care commentators from both the left and the right.

Geographical patterns of genetic variation in two species of Stylosanthes Sw. using amplified fragment length polymorphism

Understanding the extent and distribution of genetic diversity within a species is essential for the development of effective conservation strategies. The objective of this study was to assess genetic variation using amplified fragment length polymorphisms (AFLP) in two species of the tropical legume genus Stylosanthes Sw. Annual, S. humilis (2n = 20) and perennial, S. viscosa (2n = 20) are found throughout tropical America, and are sympatric for much of their range of distribution. One hundred and eleven accessions, covering a wide geographical range, were selected for AFLP analysis. Binary data matrices derived from DNA banding patterns were analysed using the software programs ntsys‐pc and arlequin. Several accessions were found to be misidentified. Of the S. humilis accessions, the overall average similarity value was (0.72) slightly higher than the value obtained for S. viscosa (0.67). Cluster analysis and principal coordinate analysis grouped accessions from both species by geographical origin, with a few exceptions. Analysis of molecular variance (amova) in S. humilis revealed 59.4% of the variation among groups formed from the cluster analysis. This was highly significant (P < 0.001). For S. viscosaamova also revealed more variation among than within groups (66.5%). This was also highly significant (P < 0.001). The majority of accessions of both species conserved ex situ are of Brazilian and Venezuelan origin. This study has identified areas in Central America and Mexico for which novel genetic variation may be found and where conservation activities should be focused.

From poor law to community care. The development of welfare services for elderly people 1939 - 1971

Recent community care changes have raised fundamental issues about the changing role of the public, voluntary and informal sectors in the provision of social care to frail elderly people. They have also raised issues about the health and social care interface, how to ration services and the respective roles of residential care and care at home. The purpose of this book is to set these debates in the context of the historical growth of welfare services from the outbreak of the Second World War through to the establishment of social services departments in April 1971. Based upon extensive research on primary services such as the Public Records Office and interviews with key actors, separate chapters look at the impact of the Second World War; the 1948 National Assistance Act; issues in residential care; issues in domiciliary care; and the creation of social services departments.

Uncovering History: Private Sector Care Homes for Older People in England

In conducting his research for The Last Refuge (1962), Peter Townsend visited 173 public, voluntary and private residential care homes for older people in England and Wales. Drawing on his data, now archived at the University of Essex, we traced the subsequent history of these homes and revisited a sample that were still functioning as care homes in 2006. In this article, we focus on the 42 private homes he visited, some of which remain open and were revisited by us in 2005–06. The pre-1980 history of private sector residential care provision for older people is an elusive and poorly charted topic. Drawing on the two data sets for then and now, this article contributes new insights into this area of UK policy and practice.

From public assistance institutions to "Sunshine Hotels"

This article traces the development of residential care for elderly people in the period 1939 to 1948. It begins by looking at the nature of such institutions in the period just prior to the Second World War and then discusses the complex impact of war upon such provision. Particular attention is paid to how evacuation hostels, run by local authorities and voluntary organisations, changed notions about the role of the State in the care of elderly people. The paper concludes by looking at how such changed notions were incorporated into the 1948 National Assistance Act.

Creating the asset base - a review of literature and policy on housing with care

Purpose – Appropriate housing for the growing population of older adults is becoming an international concern. The purpose of this paper is to report on a review of UK and international literature carried out as part of a project exploring the commissioning and delivery of social care in housing with care settings. The paper also considers housing with care in the context of UK policy and practice. Design/methodology/approach – The peer literature review process used a range of academic databases as well as government and third sector web sites, drawing on relevant material in English published from 1990 to 2012. Findings – Findings are presented within three main themes: how care and support is provided; the role of the built environment; and the benefits for resident well-being. The review found a paucity of literature focusing specifically on care and support in housing with care settings, particularly in terms of how social care is delivered, but the evidence base suggests that housing with care is in a strong position to deliver on most if not all UK government aspirations. Practical implications – Despite a growing literature both in the UK and internationally exploring the characteristics and benefits of housing with care for older people, substantial gaps remain in the research evidence. Originality/value – This paper presents an up to date review of the housing with care literature in the context of current UK policy.

The Living Environment

In this chapter we address the question of what kind of living environments the 20 homes provided in the early 2000s and how they compare with the past. Forty years ago, Pincus adopted the term the ‘institutional environment’ which he defined as the psycho-social milieu in which the residents live as expressed through and/or generated by (a) physical aspects of the setting, including design, location, furnishing and equipment; (b) rules, regulations and program which govern daily life; and (c) staff behavior with residents.

A community hub approach to older people’s housing

Purpose. This paper explores the potential of housing with care schemes to act as community hubs. The analysis highlights a range of benefits, barriers and facilitators. Design/methodology/approach. Data is presented from the ASSET project (Adult Social Services Environments and Settings) which used a mixed methods approach including a review of the literature, surveys and in-depth case study interviews. Findings. Most housing with care schemes have a restaurant or cafe, communal lounge, garden, hairdresser, activity room and laundrette, while many also have a library, gym, computer access and a shop. Many of these facilities are open not just to residents but also to the wider community, reflecting a more integrated approach to community health and adult social care, by sharing access to primary health care and social services between people living in the scheme and those living nearby. Potential benefits of this approach include the integration of older people’s housing, reduced isolation and increased cost effectiveness of local services through economies of scale and by maximising preventative approaches to health and wellbeing. Successful implementation of the model depends on a range of criteria including being located within or close to a residential area and having on-site facilities that are accessible to the public. Originality and Value. This paper is part of a very new literature on community hub models of housing with care in the UK. In the light of new requirements under the Care Act to better coordinate community services, it provides insights into how this approach can work and offers an analysis of the benefits and challenges that will be of interest to commissioners and providers as well as planners. This was a small scale research project based on four case studies. Caution should be taken when considering the findings in different settings.