Don’t institutionalise those with care needs, says Rhona Murray
WITH a 30-year career spanning psychiatric and learning disability nursing and managing homelessness services I have witnessed first-hand the failings of institutional care. Now, as the director of Places for People Scotland Care & Support, I oversee the provision of services to young and older people and people who are homeless, have mental health issues or learning disabilities.
When I worked in the Royal Edinburgh Hospital and Gogarburn Hospital in the late 70s there was no suggestion that either institution had a limited lifespan. Although the Royal Edinburgh still exists, the emphasis on admission started to shift in the 90s – when Gogarburn closed – to community-based support.
My experience in homelessness was the management of the closure of two model lodging hostels; the Castle Trades in Edinburgh and the Great Eastern in Glasgow. At the time these closures were deemed impossible; the groupthink was ‘these people’ needed to be in institutions, despite the appalling conditions that existed. The alternative, after all of these closures, has been to offer people their own homes, with support, if needed.
Yet we still use institutions for people. Older people too frail or vulnerable with high support needs often have alternatives other than living out their lives in an institution, cut off from the communities in which they used to thrive. Unarguably, there are care homes which provide a high standard of personalised care and support to people, but they are commonly the care homes that charge over £1,300 per week and have limited options for individual choice.
The Task Force for the Future of Residential Care in Scotland published a report earlier this year with the vision “To support older people in Scotland ... to live in homes where they feel safe and respected as members of their communities”. This is hopefully the beginning of the death knell for care homes.
What are the alternatives? If vulnerable older people stay at home then resources are available to “maintain” them, usually with basic, time-pressured support for medication, food or personal care. A re-enablement model requires more than the basics for one to achieve aspirational health and wellbeing.
Well-paid, qualified health and social care staff delivering services determined by the person receiving the support, as well as digital inclusion, for monitoring and engagement, and time, should be some of the imperatives.
We are not about to venture into a brave new world. Partnership with housing associations was embedded in every institutional closure that I have been involved with and we relied heavily on partnerships with local authorities, NHS and third sector providers. These collaborative closures of institutional care have undeniably worked for people with learning disabilities and homeless people and there is no justification for us continuing to use the institutional model for older people.
With our parent company Castle Rock Edinvar we aim to ensure successful places and enable people to reach their potential, principles which apply both to our services and housing. We have pioneered a range of other options for older people to provide outlets for talent and opportunities to stay involved in the community. We have drawn on creative arts and sustainability issues to develop projects and have engaged with older people, in some cases transforming their lives.
Accommodation-based services with outreach support, such as sheltered housing, are an alternativeto an institution. For older people with higher support needs we offer a 24-hour service with 20 flats. In 2015 we open a groundbreaking age-friendly development for those with multiple needs, at Fortune Place in Edinburgh, enabling older people to stay at home as their needs and circumstances change.
Older people have been badly served for decades by the models of health and social care provision. Change will help to shift the perception that older people are a financial burden to a recognition of how asset-rich we are in the number of older people who are continuing to reach their full potential and contribute to their community.
• Rhona Murray is director of Places for People Scotland Care & Support, a subsidiary of Castle Rock Edinvar Housing Association www.castlerockedinvar.co.uk