Home

“We all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us. That’s the #SocialCareFuture we seek.”

Social Care Future [1]

We all want to live in the place we call home.

It’s a core element of a shared vision of our social care future – something we can all relate to, and all aspire to. But it represents a significant shift from our current social care ‘system’ with its focus on care – not on living, and on services in ‘settings’ that no one calls home.

So, how do we achieve the shift from ‘placing’ people ‘in care’ to caring for and about people living in a place they call home?

1. Stop thinking ‘them’ and start seeing ‘us’

Earlier this year I wrote a blog post with ten suggestions for letting love (back) in to social care. Stop thinking ‘them’ and start seeing ‘us’ was number 1 on my list, and here it is in first place once again.

The Social Care Future vision starts “We all…”

The future of social care is about us. All of us. People. Human beings.

But right now, social care is about ‘others’. ‘Them’.

‘Service users’. ‘Patients’. ‘Customers’. ‘Clients’. ‘Cases’. ‘Referrals’. ‘Bed blockers’.

‘The elderly’. ‘The disabled’.

‘Our most vulnerable’.

Maybe it’s easier to ‘place’ people in ‘other care settings’ when we don’t recognise them as humans? When we don’t know them as people?

Separate, other settings to keep ‘others’ separate?

Stop thinking ‘them’ and start seeing ‘us’.

We. All.

2. Stop processing people

Yup, this was second on my previous list too.

Elaine James, Rob Mitchell and Hannah Morgan describe “the highly rigid care management environment where your core function is to broker care packages and move the person on to the next setting as quickly as possible” [2], and the language we use shines a spotlight on this sorting office approach.

We ‘place’, ‘transfer’, ‘discharge’, ‘admit’ and ‘refer’ people in to ‘care’.

They follow ‘pathways’ and ‘transition’ between settings.

They ‘enter’ care. They’re ‘put’ in care. They’re ‘detained’ in care.

This language reflects our process-based, paternalistic approach. We pick up ‘our cases’ like robots on a production line or baggage handlers in an airport, apply a few labels and ‘place them’ ‘in care’.

Even when we talk about people living ‘at home’, our language still suggests that we make the decisions, we pull the strings.

We aim to ‘keep’ people at home.

We ‘enable’ people to ‘stay at home’ for ‘as long as possible’.

We ‘allow’ people to live in their own home ‘for longer’.

Do we ever actually ask people where they want to live, or what ‘home’ means to them?

3. Ask people where they want to live

“She has lived in lots of services. She wants somewhere to settle”

Alex Fox [3]

How often are decisions about where people live based on where people want to live?

How often are decisions about where people live based on:

  • what we assess that people ‘need’
  • the availability of care and support for people
  • the lack of support for families and other carers
  • the cost of the ‘care package’
  • pressure to reduce ‘delayed transfers of care’ and free up hospital beds
  • a vacancy or a void?

When it comes to places to live, whose needs are we really meeting?

“Lucille develops a need for a care home placement”

Care and support statutory guidance [4]

We must make care and support available in places that people want to live, not make people live in places where care and support is available.

4. Understand what home means to people

“Many rough sleepers decline or underuse accommodation offered to them. A big reason for this is that once established in a rough sleeping community, social bonds are forged and become difficult to break. Housing is about more than shelter. We must feel connected to feel secure”.

Darren McGarvey [5]

Home is where the heart is. So the saying goes. And our hearts – our emotions – are fundamental here. The place we call home is so much more than just the physical environment in which we live – the place we own or rent, the space we’re physically in.

Home is just as much about a feeling as a place.

And while home looks and feels different to all of us, fundamentally feeling ‘at home’ is feeling safe. Feeling secure. Feeling settled. Feeling connected and involved. Feeling loved. Feeling that you belong.

That true belief that you’re exactly where you’re supposed to be, and that you don’t need to be somewhere – or someone – else.

If we’re genuinely going to shift from placing people ‘in care’ to caring about people living in the place they call home, we need to take time (and have time) to listen hard, observe and be genuinely curious to find out what home really means for the people we’re working with – then support people to find, remain in or return to a place that feels like home.

5. Stop turning homes into institutions

“How could this place be the home she used to have control over? My mum’s home had become a service – she knew it, she felt it, and we just didn’t see it.”

Sarah Maguire [6]

Our standard alternative to ‘putting people in to care’ is home care – care at home.

‘Four calls a day’, time and task, mopping and shopping, life and limb care.

Too often our social care ‘interventions’ involve either removing people from the place they call home or turning people’s homes into places that no longer feel like home. Places with uniforms and strangers and rules and routines and restraints imposed and enforced.

We need to recognise the inextricable link between home and identity, and the impact our interventions can have – in whatever ‘setting’ – on maintaining, enhancing or destroying a person’s sense of home, and in turn, their sense of identity.

“we tend to think of institutions and institutionalisation as about being in a place. But institutionalisation is really about the dismantling of the self…”

Neil Crowther [7]

6. Don’t ‘put’ people in to places that no one calls home

In our social care world, you either live in your ‘own home’ or in a ‘care setting’.

Accommodation. Arrangements. Units. Schemes. Properties. Developments. Beds.

Housing with support.

Residential care.

“Bedded care facilities [8].

The phrase ‘own home or a care home’ is used repeatedly in our practice guidance, professional literature and public information and advice.

We don’t identify these care ‘settings’ as people’s ‘own homes’.

They’re places (placements) for care if you’re ‘finding it difficult to live in your own home’ or you can ‘no longer manage in your own home’. When your “needs are such that you can no longer be supported in your own home’, or ‘when living in your own home is no longer the best and safest option for you’.

Home is more than the type or tenure of accommodation.

Wherever people live should feel like their own home.

7. Calling somewhere a community doesn’t make it a community

In our social care world, you either live in an institution or ‘in the community’.

But living ‘in the community’ just means you don’t live in ‘residential care’. It doesn’t mean that you’re part of a community. That you feel connected. That you belong.

The place we call home extends beyond our four walls – both physically and virtually.

Support people to find, remain in or return to a place where they feel “settled, accepted, wanted and loved – a place where they belong.” [9]

8. A home is a place to live

Social care should support us to live in the place we call home.

9. Make social care the vehicle, not the destination

We talk about people going ‘into care’ and ‘entering care’. People ‘in care’.

Our language reinforces the view of care as a destination – the end point of a ‘journey’.

Care and support plans say ‘24-hour residential care’. Full stop.

Not a plan for a life. For living. Just a plan for ‘care’.

Written up. Signed off. Written off.

Make social care the vehicle, not the destination.


References

[1] Social Care Future

[2] Social work, cats and rocket science, Elaine James, Rob Mitchell and Hannah Morgan, Jessica Kingsley, 2019

[3] A new health and care system, Alex Fox, Policy Press, 2018

[4] Care and support statutory guidance, Department of Health and Social Care, Updated 26 June 2020

[5] Many rough sleepers…, Darren McGarvey, Twitter, 2018

[6] When is a home not a home, Sarah Maguire, Choice Support, 7 August 2020

[7] Somewhere north of Preston, Neil Crowther, Making rights make sense, 21 July 2020

[8] Hospital discharge service: policy and operating model, Department of Health and Social Care, 21 August 2020

[9] Social work, cats and rocket science, Elaine James, Rob Mitchell and Hannah Morgan, Jessica Kingsley, 2019

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