The pursuit of ‘happiness’ From care home to my home DEMOS Commission on the future of residential care Paul Burstow MP

Research programme We have undertaken the following research:  1 x literature review  1 x Public opinion survey  4 x focus groups  4 x best practice case studies in the UK  18 x expert interviews  2 x calls for evidence (one invited and one general)  3 x international visits (US, Denmark, Holland)

Perceptions and reality 1

Perceptions and reality 2 We asked all those who said they would not move into a care home in later life why that was. – Because I would lose my independence (69%) – Because I would be at risk of neglect or abuse (54%) – Because it would not be like home (48%) – Because I would not want to be surrounded by people who are also old or disabled (42%) – Because the care would not be good quality (42%) – Because I would have to sell my house to pay for it (33%) – Because I would lose contact with friends, family and community (31%)

A damaged & confused brand? Polling, focus groups point to negative associations with care home and residential care/care home used interchangeably. Cannot deliver on the things people said they wanted in later life – social networks, range of activity, personalised environment. Other forms of residential care are ill defined and the public and commissioners don’t always understand what these “housing with care” options mean Innovations spin off to new labels – ever increasing new terms

Perception and reality 3 Those who know people living in care homes, and who work or know someone who works in a care home, were more likely to say they would choose a care home for themselves if they were older. Would choose Would not choose

What we have seen Lots of examples of care homes bucking this negative perception, but we cannot build all from scratch – squaring the circle of physical constraints with traditional spaces, and innovative/personalised care Care homes work very well as learning environments – eg. Boston – to bring activity and the outside community into the home. The idea of a porous home – one which is part of the wider community in both directions – is something we’ve seen in pioneering care homes. The future of the care home may well be “Hub” care homes – collocating services (including therapies, day centre, specialisms).

What we have seen 2 Linked to that, CORC also sees promise in collocating a care home into a campus of other residential care offers, meeting a range of needs on a spectrum but with a cohering staff culture and approach. Even within a single home, “homes within homes” can help meet a diverse range of needs and improve personalisation. Extensive use of volunteers to support staff and add value.

Developing our proposals Thinking ambitiously about the residential care offer and the terminology used to describe this. Sector is struggling with a shifting client base – older, with more complex needs. This has implications for staff skills, culture, processes, but also the infrastructure of care homes; and the difference between nursing and residential care is becoming less meaningful. “Care home” has become a negative and loaded term, and that ‘residential care’ is being conflated with ‘care home’, damaging this more general term by association.

Developing our proposals 2 Considering whether “accommodation” and “care” should be more consciously separated, and whether the traditional care home setting is still required even though we agree the type of care is. People want to maintain independence, activity, relationships and community life outside of the care home. They want to continue to undertake “normal” activities as they would in their own home, and not indulge in hotel living. People doubt whether care homes care deliver this – expecting to be rendered dependent and infantilised. Care villages, extra care, retirement villages – all evoke a more positive image of social life and independent living.

Next steps for CORC We will be reporting at the end of the summer. Our final report will: Tackle the ‘big questions’ – Does the traditional ‘care home’ still have a place in a model care system? If not, what replaces it? And what do we call it? In turn, we will be considering the implications of the answers to these questions on the care workforce, the regulator/inspector, and commissioners. We will also be presenting our thoughts on what ‘good’ looks like for providers of residential care, so that they are delivering on the expectations of the next generation of residents, and how culture, operations and governance need to be aligned to this.