A Daily Telegraph report based on recent care home research says that smaller care homes are being replaced by what it describes as large ‘care warehouses’ after a wave of closures. Smaller care homes are finding it increasingly hard to cope with cuts and don’t have the same economies of scale of larger operations, nor the property market investment strategies of the really big corporates.
What the Telegraph report didn’t mention is that the last annual CQC State of Health and Care report was unequivocal in drawing a correlation between better care and smaller settings:
This isn’t to say that every small care home is great and big ones awful: there are examples of larger services which people enjoy living in and in which they receive great care. But it does suggest that, despite the particular quality challenges faced by smaller homes (eg it’s harder to cope with staff turnover in a small team; there is no corporate training/quality regime to draw on etc), there are elements of providing a caring, safe and perhaps above all, homely, environment, which are inherently easier in smaller settings.
This is certainly the experience of the smallest regulated care settings: Shared Lives schemes, which are limited to a maximum of three people and are homely by virtue of the support offered taking place in an ordinary family home. CQC also says that Shared Lives outperforms even the smallest end of the care homes sector:
There has been lots of talk (including recommendation 7.3 in the NHSE report by Sir Stephen Bubb), post-Winterbourne View abuse scandal, of CQC refusing to register new institutions for people with learning disabilities to safeguard safety and quality, because the evidence is clear that these kinds of facilities are fundamentally incompatible with community living.
If that’s true for people with learning disabilities, why is it not even discussed when it comes to building ‘warehouses’ for older people?