Currently, there are an estimated 380,000 people in approximately 17,000 nursing and residential homes in England. That's around three times as many people as are in hospital at any time. Readers might legitimately ask whether all these residents need to be there? I have no doubt that investment in adequate community health services, in rehabilitation, in social care and crucial support for carers would reduce the number of people in care homes, by providing more people with care in their own homes. So would more Extra Care and age-friendly housing. But even if that happened, some people really do need or want 24-hour care and even countries that have invested heavily in models of care at home still have care homes.
If we accept that care homes are here to stay and are a vital part of our services, we have a few problems to solve. The squeeze on social care funding and difficulties in workforce recruitment, retention and training are making it a harder market to operate in; all this, when public expectation is higher and regulation more systematic. And we expect and demand care that's less institutional and more person-centred than before. Remember, the number of care home places available has fallen at a time of rapid population ageing. Residents are older, frailer, more dependent, more medically complex and unstable than they've ever been. Most have some degree of dementia or cognitive impairment; many are frailer and live with several long-term conditions usually complicated by age-related disability or sensory impairment. They are also, on average, in the last two years of their lives, so that planning for support and care towards the end of life is a key role.
Yet we know that all too often the health care for those residents is patchy across a range of primary, community and specialist health services and practitioners. This happens despite those residents having the same rights to health care as all other citizens. It's not just about what the NHS does to or for care homes but also what care home staff themselves can do with the right skills and support. Getting this wrong can lead to problems such as high admission rates of residents to hospital - even when they are clearly dying - poorly controlled symptoms, avoidable distress or dependence, and a loss of control. So the distinction between what counts as a personalised social and a medical model of care is blurred.
There is a clear need to improve this picture and that's been recognised in various initiatives including My Home Life, the British Geriatrics Society care home commissioning guidance; the Gold Standards Framework movement to improve end of life care for residents; and new care model vanguards, several of which focus on care homes - some of whom shared their work at the Fund's recent event. The Fund has run a conference and two smaller workshops on care homes, building on the momentum from its 2014 paper, Making health and care systems fit for an ageing population but while these events showcased some great services and local collaborations such models aren't mainstream for all care homes or all localities yet - far from it.
Our new learning network aims to support collaboration and partnership-working within six localities and to create a critical learning and development space for anyone working at the interface with home care. It is arranged in four modules, beginning with a broad introduction to the issues; moving on to interfaces and collaboration between care homes and acute hospitals; then care homes and primary and community care; and finally to some "futurology" on where we might go next. Beyond the modules there will be further informal networking and learning opportunities and we will produce a report on lessons we have learned from what participants have told us. The network is aimed at care home managers and staff, housing professionals, local authority workers especially from the social care sector and health professionals from all settings who support care homes or care home residents in various ways.
The network is aimed at care home managers and staff, housing professionals, local authority workers especially from the social care sector and health professionals from all settings who support care homes or care home residents in various ways. Because of this strong cross-sector focus on collaboration, shared understanding and goals, we would particularly welcome multidisciplinary groups from one geographical area but several different agencies.
We look forward to seeing some of you there.
Find out more here