Consistency: a pre-requisite for inspecting old people's homes?

Correspondence to Dr Ian Gibbs, Centre for Housing Policy, University of York, Heslington, York YO1 5DD. Summary Inspection of old people's homes, in both local authority andindependent sectors, forms a major component in the work ofthe new ‘arm's length‘ inspection units. The successof these units will depend in part on inspectors' ability tomake consistent judgements based on agreed standards. This articlereports on a study which examined the extent to which inspectorswere able to reach reliable conclusions about the quality ofcare in old people's homes and the possible contribution ofchecklists in this task.     

Dependency and its Relationship to the Assessment of Care Needs of Elderly People

Correspondence to Dr Ian Gibbs, Social Policy Research Unit, Department of Social Policy and Social Work, University of York, Heslington, York, YO1 5DD Summary A number of previous studies of old people in residential homeshave suggested that a substantial minority are not in need ofthat form of care. The rapid growth in the number of peoplein private homes, supported by social security payments andentering without any independent assessment, has led to concernthat many more people enter residential homes without needingto be there. Social workers were employed in four areas to assess the needsof residents newly admitted to homes in the independent sectorand over eighty per cent were found to be in need of residentialcare. It is suggested that the measures of dependency used toindicate need in some previous studies fail to take into accountthe complex factors involved in deciding whether a person needsresidential care.     

Factors Predicting Admission of Elderly People to Local Authority Residential Care

Correspondence to Dr Ian Sinclair, Director of Research, National Institute for Social Work. Mary Ward House, 5–7 Tavistock Place, London WCIH 955 Summary Successful community care may partly depend on identifying thoseat risk of entering residential homes and targeting servicesto them. This article is concerned with how this identificationcan be achieved. It considers a sample of old people livingalone. in touch with home helps or social workers and followedup for between two and four years. The research examined thefactors likely to produce admission, and used discriminant analysisto predict it.     

Private Children's Homes

Summary The paper provides survey and intensive research material onthe private children's homes sector. It is shown that this sectoris currently in decline. Private homes are found to be shelteringchildren with long and complex care histories and to adopt adistinctive residential style. Although private homes providevaluable long term continuity, they are less likely to offerthe same range of community services as do residential settingsmanaged by the local authority and voluntary child care agencies.     

An Attempt to Assess a New Design in Residential Homes for the Elderly

Summary A comparison of the residents of three county council homesfor the elderly is undertaken. The three homes differ both intheir architectural design, and in the role of the staff. Themeasures used are mainly concerned with the residents' dailyactivities, and information is collected both by questionnaireand by personal observation. The results show significant differencesin the three groups and tend to support the authors' predictionsconcerning the residents' behaviour, based on the differencesin the physical design and staff role in the homes     

Foster and Residential Care Practices Compared

Correspondence to Dr Matthew Colton, Department of Social and Administrative Studies, Barnett House, Wellington Square, Oxford OX1 2ER Summary This paper reports what is, remarkably, the first systematic,in-depth, comparative study of foster and residential care practices.The overall research objectives were: (1) to delineate and comparecare practice in special foster homes (i.e., homes accommodatingchildren traditionally considered too old or disturbed for fosterplacement) and Children's Homes for older children in localauthority care; and (2) if possible, ascertain whether the responsesmanifested by children in such settings can be related to thecare practices they experience. The approach adopted was essentially sociological. A lengthyperiod of field-work in two local authorities featured the useof a range of research instruments and included the collectionof data on the following: the management of recurrent–mainlydaily–social events; children's community contacts; theprovision of physical amenities; the controls and sanctionsused by caretakers vis-à-vis children; the roles of caretakersand their behaviour and attitudes towards children; and thecharacteristics of children, their behaviour towards caretakers,perceptions of their social environments and progress duringplacement. Quantitative methods were used in data analysis becausethey provide a useful guide to the import of observed differencesbetween foster homes and Children's Homes. Care practice in the foster homes was, overall, significantlymore child-oriented than in the Children's Homes. Moreover,the responses of residential children appeared to fall shortof offering justification for the ways that the lives of suchchildren seemed to differ from those of foster children.     

The Children's Family Trust: a Unique Approach to Substitute Family Care?

Summary This article outlines the contribution made to child care since1945 by the Children's Family Trust in providing substitutefamily homes. Reference is made to some Trust policies whichhave aroused controversy over the years. Recruitment and supportof the substitute Parents is discussed, and a brief analysismade of the children for whom placement with the Trust may bemost appropriate. Comparisons are drawn between staff turnoverin Trust families and other residential homes, and between successand failure rates of placements with the Trust and in long-termfoster-homes. The final section assesses the role of the Children'sFamily Trust and its philosophy in contemporary child care.     

Social Process, Space Usage: Reflections on Socialisation in Homes for Children

Summary This paper analyses the links between social processes and spaceusage through an examination of socialization and patterns ofspace use in local authority homes for children. Concepts of’family group‘ and ’responsibility‘are discussed using data from a participant observation studyas a basis, drawing attention to the relationship between socialpower and meanings attributed to architectural space.     

The Supply of Foster Families for Children in Care

Correspondence to John Miles, Institute of Social and Applied Psychology, The University, Canterbury, Kent CT2 7LZ. Summary The family circumstances of 2694 foster homes in England arecompared with representative families from the 1985 GeneralHousehold Survey. Foster families typically include a womanin the 31–55 age group, live in homes with three or morebedrooms, are two parent families with one parent working full-timeand the other not, and they have older children only. The incidenceof families with these characteristics is used to develop anestimator of the relative supply position of local authorityareas for foster care, from which a number of conclusions aredrawn. Over the last thirty years some social changes have improvedthe supply, others decreased it, and on balance the nationalsupply position is little changed. Ironically, supply is bestin those areas which have the lowest need for fostering services.Ways in which local authorities can improve their supply positionare considered. The supply estimator reveals that the averageboarding out payments made by authorities show clear signs ofresponsiveness to the local supply position for foster families.     

Short Term Care for the Elderly in Residential Homes: A Research Note

Please address requests for reprints to Dr. D. Boldy, Division of Health Sciences, Centre for Advanced Studies, Western Australian Institute of Technology, Kent Street, Bentley WA 6102, Australia. Summary Short term care for the elderly has expanded rapidly in thelast five years. The study evaluates short stay care in fourresidential homes using interviews with 42 clients, their main‘carers’, officers-in-charge of the homes and socialworkers. Whilst the service worked reasonably smoothly and provideda break for family carers there remains further potential forimproving the quality of service in the context of a full rangeof services for elderly people.     

Aspects of Old Age

Summary The opportunity of growing old has extended but it is an opportunityattended by risks. When old age is accompanied by infirmity,ill-health and economic or social difficulties, many problemsarise for the individual and for society. This paper looks atsome aspects of the incidence and nature of old age and at thesupport provided by social services, and the discussion is illustratedby reference to seven elderly hospital patients. The identityof the person found to be most at risk was predictable.     

Group Living in Homes for the Elderly: A Comparative Study of the Outcomes of Care

Correspondence to Tim Booth, Department of Sociological Studies, Joint Unit for Social Services Research, University of Sheffield, Sheffield S10 2TN. Summary This paper traces the theory and practice of group living inhomes for the elderly in the literature and in the field. Itreviews the current state of research and calls for more workon the comparative evaluation of outcomes. It describes andpresents the results from a longitudinal study of matched samplesof residents in group homes and traditional homes which assessedthe relative changes in their personal functioning over time.The findings suggest that group living arrangements have beenoversold—in so far as they promise more than they deliver.     

Evaluating a Group Home: Problems and Results

Summary The need for an evaluative framework for group homes for thementally ill is discussed. Evaluation involves separating implicitfrom explicit objectives. The possible objectives for a grouphome are considered in terms of the questions of who decideswhat the objectives are to be, how they are defined, and theirrelationship to the idea of normality. A further issue in decidingobjectives is whether the client's independence is to be foundwithin the group home or beyond it. The elements of a group home's regime are then considered: theseinclude control and group support. Problems in measuring theelements involved are mentioned. An evaluative scheme based upon this is then drawn up for aparticular group home, and the results described. The residentsare found to have experienced little change overall in theirlevel of independence, and this is associated with a regimewhere residents act in a dependent way towards staff, and staffperceptions of control and support are different from thoseof residents.     

The Effects of Group Living in a Residential Home for the Elderly

Summary The group-living system of care is becoming increasingly popularin residential homes for the elderly. This study examined purposefulactivity, as measured by engagement, in one such home beforeand after changeover to group living. It was found that engagementwas significantly increased after the changeover. In addition,life satisfaction was increased and orientation unchanged bythe changeover in a small sample of residents. These resultsare interpreted as supportive for the effectiveness of groupliving.     

Adolescents Who Sexually Abuse and Residential Accommodation: Issues of Risk and Vulnerability

Summary This article, arising out of quantitative and qualitative researchstudies conducted by the authors, begins with a brief overviewof current knowledge about male adolescent sexual abusers andassociated policies, procedures and services. A particular concernraised by professionals and welfare agencies, who are strugglingto develop appropriate responses to young sexual abusers, concernsthe circumstances and problems of young people who are placedin residential accommodation as a result of their sexually abusivebehaviour, often where there are also child victims of sexualabuse. The vulnerability of young sexual abusers and the riskthey pose to others is considered in the light of the findingsof qualitative research by one of the authors into the constructionand control of children and their sexualities in residentialchildren's homes. This research suggests that the inadequateways in which sexual behaviour in children's homes is perceivedand managed, serves to compound the problems of both the sexuallyabusive and non-abusive adolescents placed there. The findingsfrom both authors' research are then theorized within broaderconceptual frameworks about the nature of childhood, childhoodsexuality and institutionalization and its links with peer sexualabuse.     

Residential Care for Elderly People: Characteristics of Patients Admitted To Residential and Nursing Home Care from Hospital

Correspondence to Mr W. Power, Department of Social Work, Kingston General Hospital, Hull HU3 IUR Summary Fifty consecutive admissions to residential and nursing homecare from hospital were examined and the results discussed.Patient profile fitted the general pattern expected of frailelderly people with high dependency needs. There was a noticeableshift towards placements in private establishments but onlyabout half the patients were likely to have satisfied criteriafor local authority placement or require nursing home care.Breakdown in care-giver arrangements was found to be a majorreason for entry to care. Apart from a significant number ofwheelchair users going into nursing homes, there were no sharpdivisions between the residential care and nursing homes groups.     

The role of family care-givers for an older person resident in a care home

Summary A sample of 61 relatives of residents admitted during the precedingthree years to 35 independent sector nursing or residentialcare homes in four local authority areas was interviewed. Thissample included spouses, daughters and sons. Five discrete rolesfor family care-givers in the care homes were described: checkingthe quality of care, companionship, handling the cared-for personwith personal care. Although family care-givers described themselvesas very satisfied with the care homes as a whole, as many ashalf were worried about some aspect of care. A third of theoffspring felt that their relationship with the cared-for personhad improved following the admission to a care home. None ofthe spouses felt this to be the case and most felt that theirrelationship had deteriorated. Spouses tended to visit veryfrequently. Unlike offspring, spouses rarely took the cared-forperson out of the care home. Because of the lack of privacy,visits could be a difficult experience. Those wanting to continuegiving their partner practical support were discouraged by stafffrom doing so. The research has implications for social workers,care home proprietors and registration and inspection unitsin encouraging care homes to adopt more 'relative friendly'policies.     

Staff Attitudes and Caring Practices in Homes for the Elderly

Correspondence to Tim Booth, Joint Unit for Social Services Research, The University, Sheffield S10 2TN. Summary This article presents the findings from a major survey of staffattitudes and caring practices in homes for the elderly in Fife.The survey was carried out in the wake of the Wagner Reportto examine the diffusion of good practice ideas among residentialstaff and to see how far these ideas are reflected in actualcaring routines. The study points to the existence of a ‘coolingeffect’ whereby adherence to good practice lessens thecloser one gets to operational reality. Finally, the implicationsof these findings for staff training are discussed.     

Child Placement Policy: Some European Comparisions

Summary There is consensus among European countries that the first aimof a social policy for families should be to enable childrento remain in their own homes. However, in all countries somechildren require placement apart from their parents, but thereis no agreement as to the best mode of care for these children.Some countries rely entirely on residential care, others almostentirely on family placements in the community. The articlecompares Sweden (high fostering) with Belgium (low fostering),and England and Wales, which is midway between the two, andsuggests that some European models are relevant to English practice.     

A Profile of Adult Placement Carers

Correspondence to Andrew Gage, Manchester City Council Social Services Department, Adult Homefinding Team, Fenham, 5 Moorfield Road, West Didsbury, Manchester M20 8UZ. Summary This study examines the social and personal characteristicsof the people providing support in their own homes (adult fostering)to people with severe learning disabilities. Comparisons aremade with the general population on social and personal areas.A typical carer is identified and the results lead into issuescurrently affecting carers. Links are drawn between carer characteristicsand service user quality of life which require further study.