Appendix 1 relevant legislation
Appendix 2 further reading
Appendix 3 useful addresses
Kina, Lady Avebury, Chairwoman
Professor Tom Arie, Psychiatrist, lately Professor of Health Care of the Elderly, University of Nottingham
David Brown, Chief Executive, Quantum Care Limited and Chairman, The Care Forum
Dr Michael Denham, Consultant Physician in Geriatric Medicine, Harrow and Hillingdon Healthcare NHS Trust
Pauline Ford, Advisor in Nursing and Older People, Royal College of Nursing
Brian Jones, Association of Metropolitan Authorities
Leonie Kellaher, Director, Centre for Environmental and Social Studies in Ageing, University of North London
Professor Mary Marshall, Director, Dementia Services Development Centre, University of Stirling
Foster Murphy, Chief Executive, The Abbeyfield Society
Anne Parker, Simon Research Fellow, Department of Social Policy and Social Work, University of Manchester
Pat Ramdhanie, Chair, Society of Nurse Inspection and Registration Officers
Bryan Rowe, Manager, Assynt Centre, Lochinver, Department of Social Work, Highland Regional Council
Sheila Scott, Chief Executive, National Care Homes Association
Martin Shreeve, Director of Social Services, Wolverhampton Metropolitan Borough Council
Jef Smith, General Manager, Counsel and Care
Jenny Stiles, Director, The Relatives Association
Derek Whittaker, Chairman, Registered Nursing Home Association
David Wigley, Chief Executive, Methodist Homes for the Aged
Heather Wing, Chair, National Association of Inspection and Registration Of Officers and Association of County Councils
Chris Vellenoweth, Manager, Special Projects, National Association of Health Authorities and Trusts
Gillian Dalley, Director, Centre for Policy on Ageing
Gillian Crosby, Deputy Director, Centre for Policy on Ageing
Richard Hollingbery, Visiting Policy Associate, Centre for Policy on Ageing
by Kina, Lady Avebury
It is a privilege to have been invited by the Centre for Policy on Ageing (CPA) to renew my involvement with Home Life and to have acted as Chairwoman on the Advisory Group set up to support CPA in the work of producing an updated version of the code of practice on residential care and extending it to cover continuing care generally.
Twelve years have passed since the first Home Life was published in 1984 as the officially commissioned guidance to accompany the Registered Homes Act which came into force the following year. There have been several reprints of the original document with over 100,000 copies having been sold and it remains one of the most widely used and authoritative reference points for professional staff concerned with the well-being of vulnerable people in residential settings.
The first version of Home Life was directed towards two main areas of readership: firstly, to the owners and managers of residential care homes and secondly, to the newly appointed registration and inspection staff in local authority social services departments in England and Wales. The first Working Party set up by the Centre for Policy on Ageing in 1982 included two official representatives of the Department of Health and the Welsh Office social services inspectorate, and the code of practice was fully endorsed and welcomed by the then Secretaries of State. This public recognition of Home Life as the main source of guidance on best practice in residential care was greatly valued by the authors and it did much to ensure its widespread adoption as a credible and useful work during the years following its publication.
At the time the first Home Life was commissioned, there had been a rapid increase in the number of homes, both large and small, up and down the country. There had also been a number of highly publicised scandals in both the statutory and independent sectors where old or vulnerable people had suffered neglect, cruelty or exploitation. Public concern arising out of such dramatic instances led to an awareness of the need for greater accountability, better training, better understanding of different needs, more sensitive and skilled responses to these needs and, most of all, care based upon respect for residents and an acknowledgement of their rights.
Nothing in the field of social care stands still, however, and twelve years on there is a general consensus amongst those who welcomed the original Home Life that an updated code of practice is needed. A Better Home Life is CPA's response.
The major pressures to look again at Home Life have been external ones. The Registered Homes Act 1984 has been amended to cover homes for fewer than four people. The NHS and Community Care Act 1990 has had enormous implications for the way social services departments carry out their duty to ensure that appropriate financial support and care is provided to vulnerable people. This Act reflects, in part at least, the wide-ranging and radical analysis of the Wagner committee's report and the late Sir Roy Griffiths' green paper on care in the community. The trend in these two very significant reports was to regard residential care as just one option in a range of choices that people make in a marketplace of evenly distributed commodities.
The countervailing influences are, of course, related to resources, financial and human, and to the constant processes of managing these through periods of changes in culture and organisation. The NHS reforms, mirrored in other sectors, of splitting into purchasing and providing units, have led, not always smoothly, to an acceptance of the esoteric processes of commissioning and contracting for services. As these processes become increasingly refined into higher art forms, and as ends in themselves, there is a danger that the people for whom the whole edifice exists will become less than the prime focus of concern. This new code of practice is one important attempt to ensure that the primacy of residents is enshrined in service specifications and contractual arrangements whether between a home and the resident or between the home and the statutory authorities
The Centre for Policy on Ageing and the Advisory Group feel very firmly that much of the original code applies as strongly in 1996 as it did in 1984. The underpinning values of respect, dignity, autonomy and fulfilment, to name the key ones, are relevant and central to the givers and recipients of care. There are, however, some important differences between this new version of the code and the original. This time, we have decided to direct our work exclusively towards older people, covering the whole range of needs amongst the elderly and the very old. This is in acknowledgement of recent demographic changes in the population and growing awareness of the particular needs of people suffering from dementia, who may not always be able to express personal choices about their lives or care. To have attempted to address the specific needs of other client groups at the same time as extending the discussion on the care of elderly people would, in our view, have risked the danger of bland generalisation and superficiality.
We have also decided to broaden the range of residential settings in this code of practice. The original code covered residential care homes, including those which were dually registered to provide nursing care. This code addresses the issues as they broadly affect sheltered housing, residential care homes and nursing homes. It applies to short-term and respite care services as well as continuing care till death. We hope that readers will be able to distinguish which comments and recommendations apply to which kind of resident and which kind of need. The boundaries between social, personal and nursing care are notoriously hard to define, and maybe it is a sterile exercise to over-emphasise these boundaries except where safety and professional clinical practice demand it. More important, in our view, is the holistic approach to care of people in residential settings where all the different aspects are linked by a commitment to offer the best possible quality of life.
The Advisory Group is well aware of the difficulties homeowners and managers face when they are exhorted to maintain high standards and improve unsatisfactory ones. The arguments, for example, about residents' rights to single bedrooms is a case in point. Objections were raised in 1984 against this particular recommendation and though generally accepted today, these same objections to it can still be heard. The code of practice sets out what we believe to be 'best practice' that is, something to work towards, drawing upon the advice and counsel of registration and inspection units, as well as upon the views and wishes of residents and their families and friends.
In the present world of charters citizens' charters and patients' charters, advocacy schemes and recognition of rights the code recommends the attainable, not the utopian way forward. Our hope is that it will prove just as useful well into the next century as its predecessor has been over the last twelve years.
Finally, I offer my warmest thanks and appreciation to everyone who has contributed to the final document. The Advisory Group, collectively and individually, brought a range of experience, wisdom, clear-headedness and humour and gave much time to the task of producing A Better Home Life. Many other individuals and organisations, including the Department of Health and the major care homes associations, responded to CPA's consultation process and their contributions have been welcomed and many of them reflected in the text. The Director of CPA, Gillian Dalley, and her colleagues have carried the main responsibility for writing and editing this major piece of work. They have helped to maintain the Centre's reputation for reports which are well written, which demonstrate integrity and are, above all, readable.