The changing face of residential care from a professional’s perspective

Over the span of recent decades, the landscape of residential care has undergone a notable transformation, mirroring the dynamic shifts in societal values, healthcare paradigms, and regulatory frameworks. What was once characterised by large institutional settings has evolved into a diverse array of person-centred care models, embodying principles such as individuality, dignity, and autonomy. The transformation extends its reach across diverse demographics, encompassing groups such as individuals with mental health needs and seniors seeking solace in their twilight years. Technological progress has seamlessly interwoven itself into the very fabric of care, harmonising compassion with innovation.

Bear Brady, Lifestyle Lead at our Albany Lodge Nursing Home in Croydon, shares her personal story to highlight how much residential care has changed since she first started out in the industry more than three decades ago…

“When I first started in my career in health and social care just over 34 years ago, we had a resident base comprised of remarkable individuals who bravely fought in world wars, making immense sacrifices to secure the freedom that allow us to live our free lives today. This has been the case for most of my lengthy career. However, we are now seeing a diverse range of residents using health care services and care homes.

We are now welcoming younger people coming into care homes who are the generation being born between the late 1950s and 60s. As health care professionals, we understand that with this change we now must review how we deliver care, support, and activities within our services. More and more residents have capacity and understanding of their care needs and can verbalise their likes, dislikes, and wishes. Residents are now included in building their own care plans and support delivery, allowing us to work in a very person centred and individual approach. This is the goal for all care providers.

I remember when the music we used to share with our residents was more from bygone decades – as early as the 1920s and 1930s. This is now changing, and the younger people coming into care homes would rather listen to such genres as disco, reggae, soul, and dance music (some residents even like rap and house music). We now welcome residents who have been hippies, punks, and even some early 1990s ravers who, due to their previous lifestyles, are now living with health issues and often need support for drug and alcohol related health problems.

We still have a few people coming into our services who are of the war generation, and they have such great stories to tell us, such as about their evacuation and how they kept themselves cheerful even though they had often lost parents and family to the war.

With the above in mind as a Lifestyle Lead at the Future Care Group, I sometimes need to think outside the box when delivering meaningful activities to our lovely residents. To help me, I enlist the help of residents and ask them what they would like to do. It is an amazing feeling to be able to involve residents now in our decisions and planning as, historically (until the 1990s), I worked with residents who did not have any choices or input.

Lifestyle activities in care homes have had to change to meet the needs of our increasingly changing residents. We now have a more diverse residents base including a range of nationalities, religions, and gender definitions, and sometimes a game of bingo is no longer appropriate for a lot of our residents. To ascertain what our residents may like to do, we hold regular resident and relative meetings to discuss such things and ensure we are offering meaningful options. These can include social clubs, domino rallies, trips out, remote control car racing and, in some cases, computer games, amongst many others.

In most cases, the activities are a great selling point of the business and are very important. I find this to be true in the current dementia service I work in for The Future Care Group. Without engagement and interaction we find that people can lose a lot of the skills they have, even to the point of no longer being able to use their hands to do a much-loved hobby or having a reduced ability to speak or build and maintain friendships. In the case of dementia, particularly as it progresses, many people have a reduced ability to actively engage with a session. However, they will still benefit from being around others and listening to laughter or conversations and music. We now understand that for people living with dementia taking part or being included in these sessions can be more important than the end result of a task.

Some teams within care services, and especially here at the Future Care Group, are taking the review of care and support delivery very seriously. For example, some of our services have opened little shops for the residents to run and manage if this has been something that they have done prior to their diagnosis; with some support, they are able to enjoy and gain enrichment from this once again.  More importantly, it helps them to know how much they still have to offer and understand their value as an individual.

Residents are now involved in their own dining experiences and have a fair amount of input into menu planning, so we know we are including the choices and favourites of our residents. As Lifestyle teams, we have a different kind of interaction with our residents as we get to know them very well and it feels like being part of a very large family. Our residents expect to get a cuddle and when you greet them, they will often hold out their arms to you to be embraced. For those without families these interactions are especially important and can reduce anxieties and the risk of isolation. We also work with external agencies such as AGE UK who offer a befriending service which, at times, has been invaluable for those residents who (apart from us) have no one else.

It is now so wonderful to work in a care sector which offers so much choice and rights for residents. It allows us to care for them often until they sadly pass away. But right up until they pass, we can sit with them and talk about the things that are important to them and try to make that last journey as calm and stress-free as possible for both residents and their loved ones. I remember one such man who lived with us whilst he was on his final journey. I sat with him and sang Millwall football chants and songs by ABBA (albeit softly) as I knew this was what he liked and even when he no longer could open his eyes he smiled. It is those tiny little things such as a smile or a glint in someone’s eyes that makes what we do so rewarding. I have always said “I would rather live living than live dying”. To care for someone is a complete privilege and there is no other job that is more wonderful than to care for another human being.

At Future Care Group we have lovely bright services which offer a complete change from the old versions of care homes. We employ enlightened staff who share our values of caring, comfort, compassion, and credibility so we can ensure that great care and attention is delivered to our wonderful residents and families.

We must also remember that, historically, care homes were utilised to house only the elderly or those with minor learning disabilities or mental health problems. They were often quite generic in their style, décor (often dark carpets and chintzy wallpaper with the odd doily scattered about), and their approach to care. Thankfully this has changed quite dramatically since my first job in the sector. In the 1950s and 1960s, people started to think about the concept of care in the community and this was also the time when voluntary contribution in care was first seen as having potential. In the UK we saw the major changes happen when the community care reforms (which were outlined in the 1990 Act) came into effect in April 1993. At that time, these were quite revolutionary.

These changes started to have a major influence on residents who resided in hospitals and care homes. For maybe for the first time in their lives, these individuals had choices about their own lives and were able to voice their opinion. I witnessed firsthand how it used to be when I worked in some of the more well known asylums where people did not have their own clothes or belongings and bathing a ward of people was robotic, cold, and more like a sheep dip. In some cases, 14/15 residents sat wrapped in towels in wheelchairs in a line waiting to be bathed with no dignity or respect being shown by staff.

I will not go further into that part of my career, but if you wish to have a glimpse of how it used to be in these large hospitals, where people were locked away for just being born out of wedlock (for example), I urge you to watch a documentary called “Silent Minority” which heavily focuses on St Lawrences in Caterham, Surrey. This treatment was common practice in all asylums as their residents were not valued or understood. It shows you in the film how lack of engagement and appropriate touch can directly relate to (what was referred to as) challenging behaviour or behavioural issues, as it would result in learned behaviour from other, more profoundly disabled residents. These behaviours could include rocking, head banging, biting, and self-harm. At that time, these behaviours were often considered attention seeking, but in fact they were desperate cries of help from lonely, scared, neglected, and confused people who were craving someone to care for them or give them a cuddle.

St Lawrences was a very large establishment with separate wings and outbuildings. It boasted over 1300 residents, including babies, adolescents, and adults. Some were even born in the asylum and never left – not even once.

I have personally made it my purpose in life to ensure I give choice and freedom to all the residents I have looked after, treating them as equals and fellow humans.”

As we reflect on the profound changes in the landscape of residential care over the past decades, Bear Brady’s journey in the health and social care industry serves as a testament to the transformative power of person-centred approaches. From a history marked by institutional settings and limited choices, we now witness a diverse array of residents contributing to their own care plans, sharing in meaningful activities, and shaping their own dining experiences.

The evolution extends beyond demographics, embracing a rich tapestry of nationalities, religions, and gender identities. The incorporation of technology, the emphasis on engagement, and the recognition of individual worth paint a picture of a care sector that has come a long way. Bear’s dedication to offering choice, dignity, and freedom to residents exemplifies the positive impact of these changes.

At the Future Care Group, we recognise the privilege of caring for others and the collective commitment to creating brighter, more enlightened care environments. If you or a loved one are considering moving into a residential care home and would like to find out more about our team of award-winning staff and care facilities, we’d love to meet you and show you around.

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