OLD PEOPLE'S HOMES
Old people's homes (also called residential homes) are the responsibility of the Social Services department. Up until recently they were really the only provider of care for the frail elderly, unless the person had money and could afford a private rest home in the country or on the south coast. All this has now changed with government encouragement to social services to use private rest homes. This has led to many local authorities closing down their old people's homes, either through lack of demand (in areas with fairly affluent old people and lots of private homes) or because they are too expensive to run and it proves cheaper to place people in private homes inside or outside the area. Inevitably, this allows choice in affluent neighborhoods and none in poorer ones.
The original concept of old people's homes was to provide the level of care that a relative could reasonably be expected to provide. This was fine until the numbers of very old and frail people began to rise. The homes were not designed for or staffed in sufficient numbers to cope with the increasing disability levels. Add to that the problems of mobility and mental confusion, as well as the lack of staff training, and there was a recipe for disaster. Many homes became feared and hated places, akin to the old workhouses - they became part of the retirement nightmare. After some scandals and much despair and unhappiness, things are beginning to change; for example, homes are being redesigned, moving away from large impersonal buildings to smaller areas of group living.
Most local authorities use a panel system for admission to their old people's homes. In many ways it implies a needs tested approach, but it does also mean that a social worker has to be allocated to the case and present their client's problems to a multidisciplinary panel. In this way those at risk of entering the home due to undetected illness will hopefully be picked up, and for others some way of caring for them at home will be arrived at by the panel. Specific questions on mobility and continence are asked of the social worker: a person must be independently mobile (using a frame is fine) and not incontinent (apart from the rare accident). They must also not be so confused as to be disruptive. This screening of prospective clients, allied with staff training on aspects of old age, means that the quality of life for all residents is increased.
Ideally the person should visit a home before any decisions (on either side) are made, and many homes like a probationary 24-4 8-hour visit before the place is offered permanently. There then usually follows a month's trial to make sure the person settles in and that both sides are happy. It is vital that in this interim period neither carers nor social workers get rid of the person's original home. Some old people find that the advantages of living in residential homes do not measure up to their expectations, and the disadvantages of their old home suddenly don't seem so bad - in short, they want to go home.
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GENERAL HEALTH
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