Improving Policy and Practice in Long-Term Care

Abstract

When Peter Townsend published his landmark study about long-stay institutional care in England and Wales 50 years ago, he could not help calling these institutions ‘The Last Refuge’ (Townsend, 1962). He was ‘both daunted and shocked’ by what he had seen and heard, from overcrowded dormitories ‘with ten or twenty iron-framed beds close together’ (p. 4). He noticed ‘isolated persons sitting alone in a wash-room, standing in a corridor and one looking out of a staircase window weeping silently’ and he found heavily restricted privacy together with authoritarian matrons in uniforms and inappropriate staffing (p. 5f.). A ‘revisiting study’ by Johnson et al. (2010) found that 37 out of the 173 care homes visited by Townsend in the late 1950s were still providing long-term care (LTC) for older people. Results for the 20 homes that were sampled for revisiting revealed that:

(…) residential care for older people, insofar as it is now catering for an older and more infirm population has been transformed into a radically different instrument of social policy when compared to the 1950s (…) While the physical environment may have improved, we recorded many institutional features which appear to characterise the twenty-first century care home. These features reflect not only the changed function of residential care but also an increasing concern with risk and safety.

(Johnson et al., 2010, p. 209f.)