Health and Social Care Committee

Inquiry into residential care for older people

 

RC65 – Cymorth Cymru

 

Cymorth Cymru Evidence to: Health and Social Care Committee

 

Inquiry into residential care for older people

 

 

12/12/2011

 

Background

 

Cymorth Cymru is the representative body for providers of housing-related support, homelessness and supported living services in Wales. We have over 120 organisational members who all work to assist people who are vulnerable, isolated or experiencing housing crisis, including:

 

·         people who are homeless, or at risk of homelessness

·         families fleeing domestic abuse

·         people dealing with mental or physical health problems, or learning disabilities

·         people with alcohol or drug problems

·         refugees and people seeking asylum

·         care leavers and other vulnerable young people, and

·         older people in need of support

 

This list isn't exhaustive, and individuals may often face a range of challenges that make it difficult for them to find or maintain a stable home and build the sort of lives we all aspire to.

 

Cymorth Cymru's members help people address these issues, supporting them in finding both emergency accommodation and long-term, secure homes, where they may fulfil their potential and build happy and fulfilling lives.

 

We have three overarching objectives:

 

·         To improve the links between policy and practice by ensuring that those working in frontline service delivery understand and are influenced by the wider policy context, and those working in policy development understand and are influenced by the experiences and knowledge of those working on the ground.

·         To ensure that the sector maximises its contribution to the lives of citizens and the communities in which they live by helping to build and develop the sector’s capacity and professionalism.

·         To increase public understanding and support for the sector and the work it does in helping people build the lives they aspire to within the community.

 

Acronyms used in this response: 

HWC – Housing with care

BASW – British Association of Social Workers

RSL – Registered Social Landlord

CSSIW – Care and Social Services Inspectorate Wales 

LD – learning disabilities

LGB&T – Lesbian, Gay, Bisexual & Transgender

 

Overview of evidence

 

It is understandable that reviews or inquiries into residential care tend to focus on issues relevant to mainstream care provision. Cymorth Cymru is particularly grateful to the Committee for not limiting its remit in this way and for giving us the opportunity to highlight issues regarding the care needs of more marginalised older people and also to draw attention to alternative models of housing with care (HWC) provision that exist which can help meet the future care needs of older people in Wales.

 

In drafting this response we are grateful to our members working within housing associations, third sector organisations and local authorities for their input. 

 

We have also liaised with partner organisations and would like to take this opportunity to endorse the evidence provided by Community Housing Cymru.

 

Our evidence is presented in the following format:

·         General comments

·         Responses to the Inquiry’s specific points 

·         Summary of our key points

 

General comments

 

Cymorth Cymru’s vision is that all people in Wales are able to build and maintain happy, successful lives that maximise their independence within welcoming and supportive communities.  With an ageing population, many of our members who work with older people are seeing and anticipating further increases in demand for services.  Some members are specialists working in housing, support and care for older people, and others specialise in particular services that we are seeing increasing numbers of older people accessing such as those responding to homelessness, drug and alcohol issues, domestic abuse, learning disabilities/autistic spectrum disorders, mental ill-health and services working with people with a history of offending/prison leavers. 

 

As well as outlining the issues faced by older people in relation to residential care, our evidence will pay particular attention to the experiences of marginalised older people and the future provision of residential care to meet the changing needs of older people in Wales.

 

Our main points are:

 

·         We need to see a move away from care provision that is driven by profit in favour of ethically run, mutual based models.  Although we recognise the advantages of some private sector providers, third sector organisations have proved to be a new and emerging model of care provision and can aid in meeting the future needs of the ageing population and, as such, should be further developed.

 

·         More choice and control is needed so that individuals can access the right type of housing with care that best meets their needs.  Provision such as Extra Care schemes and care at home needs to be a real option for individuals.  Better use should be made of assistive technology to help people meet their health and care needs without having to move or lose their home.

 

·         A characteristic of more marginalised older people is that they have difficulties in engaging with statutory services. This is often due to both a lack of appropriate services and a lack of willingness of health and social care professionals to work with people with complex needs.  Service provision needs to take account of the needs of more marginalise older people and services need to be tailored appropriately. 

 

Responses to the Inquiry’s specific terms of reference

 

Terms of reference 1 - The process by which older people enter residential care and the availability and accessibility of alternative community-based services, including reablement services and domiciliary care.  

 

Feedback from our members indicates that there is great disparity around the range of provision offered to an individual.  Access to different types of provision is largely determined by the local knowledge of the social worker or person advising as to the range of services that are offered.  As a result, the offer of provision within a locality can differ vastly.  

 

As a direct result of the lack of knowledge of different types of provision available, many individuals have found themselves entering residential care settings when more independent forms of housing with care would have been more suited to their needs and helped them to maximise their independence for longer.  We are aware of a number of instances where individuals have been inappropriately placed in a residential care setting due to their social worker not being aware of other more suitable options.  In the current economic climate, this issue is even more pertinent now as we do not know how many other people are living in inappropriate situations which are both expensive for the public purse and limit the individual’s independence unnecessarily.

 

Evidence shows that supporting a person to remain independent has an important role to play in the health and wellbeing of an individual – this reduces the burden and cost to other areas of spending such as the Welsh NHS.  There needs to be further work into determining how many people in Wales have been inappropriately placed and we suggest that the Welsh Government (WG) commission research into the range of options that individuals are made aware of in order to fully maximise the return on public spend. 

 

We would also endorse the recent study carried out by the Care Council for Wales around person centred planning which resulted in guidance to the sector. This guidance points to the positive outcomes of taking a structured person centred approach in terms of choice and wider information to inform better care and support. The guidance is available at: http://www.ccwales.org.uk/development-and-innovation/adult-workforce/older-people-workforce.

 

 

Terms of reference 2 – The capacity of the residential care sector to meet the demand for services from older people in terms of staffing resources, including the skills mix of staff and their access to  training, and the number of places and facilities, and resource level.

 

In light of the recent Winterbourne View case, there are serious concerns around staffing skills and levels within residential care.  The use of poorly paid and under-qualified care staff is an ongoing cause for concern as highlighted by a recent BASW survey in which 81% of social workers stated having come across abuse within adult residential care homes across the UK.[1]

 

Poor levels of pay for frontline workers in older persons services, in comparison to equivalent positions in adult services, does not allow care services to attract and retain ambitious staff.  As a result, the skill mix of staff tends to focus on delivering a task focussed rather than an outcome focussed service. This results in staff doing things for, rather than with, the client.

 

One of the barriers often faced by organisations in relation to staff training can be ensuring that there is a comprehensive training plan in place for all of their staff when places on approved training courses are limited.  In some instances, local authorities insist on providing their own training courses of which usually only 2 places are allowed on a quarterly basis.  This can make it difficult for provider organisation to meet their statutory requirements as they are unable to gain access to enough local authority provided training courses and therefore struggle to adequately train the whole of their workforce.

 

 

Terms of reference 3 – The quality of residential care services and the experiences of service users and their families; the effectiveness of services at meeting the diversity of need amongst older people; and the management of care home closures.

 

Residential care services vary widely across Wales in the level of the quality of the service that they provide.  We support the intention of the Care and Social Services Inspectorate Wales (CSSIW) to place more focus on the experiences of service users and their families.  Other initiatives such as CareChecker in Wales ( www.carechecker.co.uk) are playing a crucial role in raising the standards of care provision through training volunteers – made by of people receiving care, their relatives, visiting professionals, or local community members – to make judgements about the quality of the service being provided.  Central to their approach is judging how committed a service is to person centred working.

 

Care home closures cause much distress, especially for vulnerable people and we strongly feel that a more robust oversight of finances would prevent closures from happening as a surprise and would therefore limit the distress caused.

 

For more marginalised older people who often experience greater discrimination and isolation and that sometimes don’t enjoy the support or understanding of the general public (such as people with offending behaviour and/or drug/alcohol issues, those requiring gender specific care, LGB&T people,  or ethnic minority groups), mainstream residential care services are often unsuitable for a variety of reasons.  For older people with alcohol dependency issues, residential care is can be an unattractive option due to the financial implications accompanying it – for example, some individuals may not want to give up drinking but would not be able to afford to continue if they