Nursing home care in the United Kingdom

In 2002, nursing homes in the United Kingdom became known as care homes with nursing, and residential homes became known as care homes.

In the United Kingdom care homes and care homes with nursing are regulated by separate organisations in England, Scotland, Wales and Northern Ireland. To enter a care home, a candidate patient needs an assessment of needs and of their financial condition from their local council. The candidate may also have an assessment by a nurse, should the patient require nursing care.

History

The workhouse

Main article: Workhouse

Workhouses were the first implemented national framework to provide a basic level of care to the old and infirm. Pictured, is "The workroom at St James's workhouse" from The Microcosm of London (1808).

The first government attempts at providing basic care for the elderly and the infirm took place at the dawn of the industrial era with the New Poor Law of 1834. Mass unemployment followed the end of the Napoleonic Wars in 1815, and the introduction of new technology to replace agricultural workers and the rise of factories in the urbanized towns, meant that the established system of poor relief was proving to be unsustainable. The New Poor Law curbed the cost of poor relief, which had been spiralling throughout the previous decades, and led to the creation of workhouses for those who were unemployed. Most workers in the workhouse were set tasks such as breaking stones, bone crushing to produce fertilizer, or picking oakum using a large metal nail known as a spike.

Although conditions in the workhouse were intended to be harsh to act as a deterrent, in areas such as the provision of free medical care and education for children, inmates were advantaged over the general population. By the late 1840s most workhouses outside London and the larger provincial towns housed only "the incapable, elderly and sick". Responsibility for administration of the Poor Law passed to the Local Government Board in 1871, and the emphasis soon shifted from the workhouse as "a receptacle for the helpless poor" to its role in the care of the sick and elderly. By the end of the century only about 20 per cent admitted to workhouses were unemployed or destitute, but about 30 per cent of the population over 70 were in workhouses. The introduction of pensions for those aged over 70 in 1908 did not result in a reduction in the number of elderly housed in workhouses, but it did reduce the number of those on outdoor relief by 25 per cent.

Expansion and privatization

A Royal Commission of 1905 reported that workhouses were unsuited to deal with the different categories of resident they had traditionally housed, and recommended that specialised institutions for each class of pauper should be established, in which they could be treated appropriately by properly trained staff. The Local Government Act of 1929 gave local authorities the power to take over workhouse infirmaries as municipal hospitals and elderly care homes, although outside London few did so.

Eventide: A Scene in the Westminster Union (workhouse), 1878, by Sir Hubert von Herkomer

Although the Act formally abolished the workhouse system in 1930, many workhouses, renamed Public Assistance Institutions, continued under the control of local county councils. It was not until the National Assistance Act of 1948 that the last vestiges of the Poor Law disappeared, and with them the workhouses. Many of the buildings were converted into old folks' homes run by local authorities; slightly more than 50 per cent of local authority accommodation for the elderly was provided in former workhouses in 1960.

In Britain in the 1950s and 60s, the quality of nursing care steadily improved, with the mandatory introduction of central heating, single rooms and en-suite lavatories. In the 1980s a significant shift from the public sector provision of elderly care to private sector homes occurred, with the proportion of private facilities increasing from just 18% in 1980 to 85% by the end of the century.

In 1977 there were 1,249 Registered Private Hospitals and Nursing Homes in the UK with 34,546 beds. These figures include 117 private hospitals with facilities for surgery. There were at that time 116,564 people aged 65 or over in residential accommodation provided by or on behalf of local authorities, compared with 51,800 patients in NHS hospital departments of geriatric medicine.

Means testing

The cost of a care home is means tested in England. As of April 2009, the lower capital limit is £13,500. At this level, all income from pensions, savings, benefits and other sources, except a "personal expenses allowance" (currently £21.90 per week), goes towards paying the care home fees. The local council pays the remaining contribution provided the room occupied is not more expensive than the local council's normal rate.

The NHS has full responsibility for funding the whole placement if the resident meets the criteria for NHS continuing healthcare. This is identified by a multidisciplinary assessment process.

Regulation

Care homes for adults in England are regulated by Care Quality Commission, which replaced the Commission for Social Care Inspection, and each care home is inspected at least every three years. In Wales the Care Standards Inspectorate for Wales has responsibility for oversight, In Scotland Social Care and Social Work Improvement Scotland otherwise known as the Care Inspectorate, and in Northern Ireland the Regulation and Quality Improvement Authority in Northern Ireland.

In May 2010, the Coalition Government announced the formation of an independent commission on the funding of long-term care, which was due to report within a 12-month time frame on the financing of care for an Ageing population. It delivered its recommendations on Monday 4 July 2011. The Care Quality Commission have themselves implemented a re-registration process, completed in October 2010, which will result in a new form of regulation being outlined in April 2011.

See also

• Care Quality Commission (previously known as Commission for Social Care Inspection)
• Eileen Chubb
• Home care in the United Kingdom