Ageing and Disability: Transitions into Residential Care
Ageing and disability: Transitions into residential care by The Open University is made available under a CC BY-NC-SA 4.0 license. Additional permissions can be found in the Acknowledgement section of the text.
This course considers working with people in group care and residential settings. Social workers play a critical role in supporting service users in moves to and from residential care, and they should be capable of assessing needs and the quality of care provision. The activities in the course focus on the lives of three people living in a nursing and residential home for elderly and disabled people. Although many of the practice examples relate to work with older people, the values and principles surrounding this work also apply to other service users who make transitions to and from care, for example, children being accommodated or people with learning disabilities.
First, you consider the emotional impact that moving into a residential home can have and how social workers can support individuals and their families with this transition. Then you explore the characteristics of the residential environment and its impact on the quality of life of residents. Next, the process of selecting a residential home, the development of personal care plans and the role of the social worker are discussed. Finally, links to practice learning opportunities are suggested, relating to the requirements specified within the key roles: ‘Preparation for assessment of need’ and ‘Support, representation and advocacy’.
The term ‘transition’ implies a change, and change has implications for the identity of the person who experiences it. It is likely to require a period of adjustment to assimilate and respond to it. Hopson and Adams (1976) suggest that a major transition, however triggered, can result in a cycle of changes to an individual's self-esteem. For example, moving into residential care is a major transition in anyone's life, yet older people are often assessed for, or seek, residential or nursing care in an atmosphere of crisis with little time to prepare (Youll and McCourt-Perring, 1993). A move may occur when someone is ill and therefore particularly vulnerable. A number of stresses may arise from such a transition, caused by:
change of place (loss of home)
changing relationships (for instance, death of a partner, gaining and losing friends or local community connections, making new relationships)
change of role or status (moving into care is a change in status from householder to resident)
loss of independence, possibly increased dependence
feelings of loss of dignity, for instance, if support is needed for physical care.
Lee et al. (2002) suggest that the magnitude of the changes associated with this kind of transition accounts for why the perceived likelihood of entering a residential care home is one of the most pervasive sources of fear affecting older people. Therefore, Activity 1 focuses on feelings of loss that service users and their families may experience following a move into residential care and ways that professionals may support them. It also considers some of the tasks that social workers may undertake with service users, their families and other professionals who are involved with the admission of people to residential care.
The way a care environment is designed and organised can have a profound impact on the residents' lives, and careful consideration of factors such as the physical environment and the care home's values can have positive effects on their quality of life. For example, Philpot (2005) reported on the design of a building that illustrates the kinds of things that make life easier for people with dementia.
Hubbard et al. (2003) identify that within institutional care settings, social relationships among older people are important for supporting residents. They note that older people with the most severe disabilities, and those for whom communication is most difficult as a result of sensory or cognitive impairments, are particularly likely to experience social and emotional isolation in care settings. Within care homes, strategies for establishing and sustaining relationships among residents and staff are often created through the use of groupwork.
Many care homes have residents who experience dementia, and therapeutic groupwork, such as reminiscence work, may help. Reminiscence work with groups of people with similar or related experiences provides a way of helping people to come to terms with their feelings. Schweitzer (2004) suggested that for older people from minority ethnic groups, it can help to create a ‘community of experience’ with others who have made similar life journeys, enabling them to understand their lives within a broader historical and social context. However, care workers need to be sensitive to the fact that it may be too distressing for some people.
At Drummond Grange a number of group activities are timetabled each week, such as the Newspaper group and the Art group. These provide opportunities for people to express their creativity. Making provision for people to pursue individual interests creates opportunities for development and growth in later life. Bradley and Specht's (1999) research found six features of successful ageing:
having a sense of purpose
interaction with others
opportunities for personal growth
Bradley and Specht's respondents identified a relationship between creativity and successful ageing. Creativity was perceived as helping individuals to stay engaged and feel good about themselves. Creativity can be expressed in a variety of ways, such as singing, cooking, gardening, crafts, reading and writing. The value of retaining and developing interests within a care setting was stressed by the three residents interviewed at Drummond Grange: Eric enjoys the creative experience of writing; Elizabeth derives great pleasure from maintaining the peace garden; Bill enjoys the challenge of using his computing skills to create various kinds of documents.
The social work task of supporting a person's admission to care involves many skills. Social workers must be able to assess the person's needs and coping mechanisms, and the quality of provision to meet needs. They must be familiar with the National Care Standards for their nation. To liaise effectively with service users, families, home providers and other professionals involved in assessment, good communication and negotiating skills are essential.
If there is a need for residential care, social workers may play a role in providing information about it to service users and their families. Phillips and Waterson (2002) found that while the task of searching for suitable accommodation was generally undertaken by families, they appreciated advice, guidance and recommendations on selecting a home and on the financial implications. The role of the social worker here has been described by Phillips and Waterson as an ‘honest broker’, offering impartial advice to empower service users and their carers to make an informed choice. This may involve the social worker putting them in touch with organisations such as Help the Aged or Age Concern, which can provide advice and guidance on many aspects of care homes and funding.
Personal financial resources remain significant when considering inequalities in provision between local authority, voluntary sector and private providers. Those who are reliant on financial assistance from the local authority to pay fees may be disadvantaged in many ways. For example, additional personal resources such as a telephone in their room may not be available. The residents at Drummond Grange all stressed how important it was to create their own personalised space and to be able to get in touch with the outside world easily by having a phone in their rooms.
Inequalities persist, and there is more choice of provision for those who can afford it. An important task for the social worker supporting an older person's move into care will be to undertake a financial assessment to ascertain their eligibility for financial support towards the cost of their care. This may be distressing for the older person, especially if selling their home to contribute to the cost of their care is a possibility. The older person may experience feelings of loss akin to those associated with bereavement.
You may have the opportunity to work with a service user who is considering entering residential care. Perhaps you can support them by helping them to identify priorities and accompany them on visits to potential homes. A joint visit enables you to assess with them how well a particular establishment is equipped to meet their needs. In considering the suitability of residential placements, you will find it helpful to think about the features of care environments that you met in this course. Also, look at the Care Standards for your nation so that you can consider whether these appear to be being met. Using the material in this course, devise headings for areas you will focus on when assessing the quality of provision.
Similar work can be done with service user groups other than older people in residential care, for example adults moving to hostel accommodation, children moving into or out of foster care, or learning-disabled young people changing supported accommodation. Care has to be taken to support adults through transitions. You should always consult the Standards that apply to the residential provision you intend to visit, and gain as much information as you can about any possible placement and share it fully with the service user concerned and significant relatives.
In this course you have considered a range of responses and feelings that services users may experience during the transition into residential care, and have identified strategies that can be used to support them with this move. Passing on comprehensive information about the service user to care providers will help them to respond more effectively to the service user's needs. Being able to provide relatives and service users with information about possible placements and negotiating with providers on their behalf to ensure that service users' needs are catered for is an important aspect of the social work role. Supporting service users and their families in the transition to residential care will provide opportunities to demonstrate competence in key roles.
Moving into residential care can be experienced positively and social workers can play a significant role in supporting service users with such transitions.
All assessments of needs should take into account the life experiences, strengths and preferences of service users.
Residential care homes should respond to the diverse physical, emotional, spiritual and cultural needs of residents.
All service users, children and adults, who move to or from residential care will experience feelings about the transition which need to be understood.