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1. During recent years there has been a growing volume of disquiet over the difficulty of staffing the residential Homes which care for the thousands of men, women and children who, for one reason or another, cannot be cared for in their own homes. Representations have been made from many quarters that a comprehensive enquiry was called for which might lead to constructive suggestions for a radical improvement in the situation.
2. One of the most important social tasks is carried out by those entrusted with the care of these people living in institutions of one kind or another. The pressure on existing accommodation is already very great and we believe (and give our reasons for this belief in a later chapter) that the demand is likely to increase.
3. In view of the present social policy, which emphasizes the value of facilities which enable people in need of help to remain in their own homes whenever possible, it may be asked why there should be any great need for residential care, either now or in the future. The question is very pertinent, because the reasons why people cannot remain in their own homes throw light on the problems of those who care for them in residential establishments.
4. Much has been done, for example, to expand the domiciliary services, both statutory and voluntary, to help elderly men and women to live with their families or on their own; home helps, meals on wheels, specially designed housing, home equipment adapted to the needs of the old, chiropody services and so on. Nevertheless, there are many whose needs cannot be met in this way. With increasing old age (and many more now live to a ripe old age) they become increasingly infirm and can no longer manage the shopping and housework, or they require assistance with dressing or must spend occasional days in bed. In many such cases a daughter or niece living near by can provide all the assistance needed, or a kindly neighbour undertakes the simple duties required. But with the growing amount of personal mobility, the younger members of the family move to housing estates or to the New Towns or to another locality where better work is available, and this leaves a growing number of older people who have no relations living near enough to help in these ways. We are so accustomed to thinking of people as members of family groups that it is sometimes difficult to remember that very many have no kith and kin. According to Professor Townsendās study of old people living in residential Homes, 40 per cent had never been married, and 59 per cent had no surviving children1. In many instances, even where there are members of the family in the neighbourhood, there is not enough room in the flat or house to provide accommodation for an older person whose health calls for a room to himself, or who finds the strain of living in the midst of a healthy noisy younger group too much for him; and advancing age increases the difficulty. The elderly who need residential care are therefore very much older than used to be the case before so much domiciliary assistance was provided; and many of them are infirm or confused. This involves a different kind of care from that needed by those who are younger and healthier.
5. A similar change in the nature of the need is found in other groups. Increasingly, the social services are supporting and helping incomplete and inadequate families so that children do not have to be removed from their homes because of poverty or neglect or lack of care. Sometimes, however, family break-up cannot be prevented or children may need help, guidance and training which cannot be provided in their own homes. Some may need special schooling because of severe physical or mental handicap for which day provision cannot be made. Sometimes, children may need a temporary refuge whilst mother is in hospital or during some other family catastrophe. The tendency today is to place children who have to leave their natural home in foster-homes, but some among them are so difficult in their behaviour or so emotionally disturbed as a result of their life experience that they need skilled, remedial care. Few foster-homes can give such children the help which they need and they are placed in residential establishments. To care for such children and to work with their parents makes different demands on the staff from the provision of affectionate care for less handicapped children. The demands are higher, the skills required are greater and the satisfactions less obvious.
6. There are many other groups who may need residential care ā women with illegitimate babies, adults who, though they are physically or mentally handicapped, can go out to work provided they have the support of a secure home background, discharged prisoners facing a new life, or families without the basic skills to make a home for themselves. If we consider these many different groups, it is evident that the staffs of the establishments who look after them have an extremely exacting task. Such work needs special qualities both of mind and of heartāknowledge of the background of the people for whom they are caring, an understanding of the emotional and psychological problems involved and sympathy and tolerance of the human frailities with which they are confronted.
1 Peter Townsend, The Last Refuge, Appendix 6, Table 94A (Routledge & Kegan Paul Ltd, 1962). 7. But whilst the task is exacting, it is also very rewarding. One of the facts which has emerged forcibly from this enquiry is the amount of happiness and fulfilment experienced by the majority of those engaged in this work. Criticisms of the conditions have been voiced in plenty, and many of these are discussed in following chapters; but it is significant that many of the criticisms have been occasioned by the desire to improve the help given to those in their care, as much as by the desire for an improved status and better remunerated employment.
8. During the course of this enquiry we have talked to a very large number of peopleāmany who attended meetings of the committee in order to give us the benefit of their knowledge and experience, and many whom we have visited in their own establishments in different parts of the country. We have been constantly struck by the amount of sheer goodness we have encounteredāby the sympathy and humanity shown by so many in the approach to their jobs, despite difficult conditions, and by readiness to sacrifice their own leisure and interests. Naturally enough, there have been times when we have not fully endorsed the methods employedāfor views on such matters vary a good dealābut of two things we all became convinced. First, that the large majority give themselves to their work not only with devotion, but with respect for their fellow human beings who need their help; and second, that the happiness and satisfactions they experience in their work, despite its restrictions and frustrations, stem from their belief that they are doing a job that is so obviously worth while.
9. Certainly nobody ever complained of monotony! Every day brings its problems and its challenge. It is not an easy task to create a harmonious group out of people with diverse backgrounds and diverse temperaments, even when they are young and healthy. To do so when the majority are suffering from disabilities and deprivation is so much the more difficult. But, unlike so much of the work in the modern world, this calls forth all oneās capacity and those who undertake it have the additional satisfaction that they can see with their own eyes the results of their efforts in the increased content and happiness of those for whom they work.
10. We have talked to so many people in this work in the years taken by our enquiry, that it would be foolish to say that we have never heard any single individual express the view that the difficulties are too great to be borne; but there is no doubt that the general impression left with us after these many discussions is that the knowledge that this is a valuable and constructive job is a really important compensation for many of the attendant restrictions and difficulties.
11. Unfortunately there has not been in the community as a whole a general recognition of the importance of the work nor of the knowledge and skill required to do it well. Too many people have assumed that this is the kind of work that can be done by any reasonably kindly person; the capacity to run a houseāsee that rooms are kept clean and meals providedāhas seemed to be all that is necessary. How wrong is this common conception will become clear when we discuss the nature of the job in the next chapter. But it is largely owing to this widespread fallacy that so little thought has been given to the right training for this work and the conditions of employment that are suitable for it. For, although the competence, skill and knowledge of those undertaking these jobs affects the comfort and happiness of thousands of men, women and children, there is, at present no requirement that training should be taken for it. Courses of training for the staffs of childrenās Homes have been provided by some voluntary organizations and since 1947 by the Central Training Council in Child Care (Home Office) and these are recognized by an addition to salary. There are also short courses offered by the National Old Peopleās Welfare Council for those taking up work in old peopleās Homes, but little encouragement is given to people to take this training by offering inducements in the form of salary, status or prospects. As will be seen later, only a small proportion of those now engaged in the work have taken the training offered.
12. During recent years it has become increasingly clear that the numbers of people able and willing to do this work has not kept pace with demand. The general trend in social policy has been towards the replacement of the large institution by a larger number of smaller establishments in which a more homelike atmosphere can be created. In a later chapter we shall be discussing the problems involved in this trend; at the moment it is only necessary to call attention to the fact that it inevitably has considerable repercussions on staffing. An institution housing some hundreds of people can employ a specialized staff with carefully defined duties and a well-arranged rota of work; but these cannot easily be introduced in a Home catering for ten or twenty people.
13. At the same time as the demand has increased, there has been a notable growth in alternative employments which demand many of the same qualities as residential work, and this is particularly true in the field of womenās employment. Many of these occupations have realized the importance of recognized courses of training in attracting the more able recruits, equipping them with greater competence and also in giving the work both status and prospects; and this has inevitably diminished the reservoir of suitable people available for the running of residential Homes. For whilst residential care work is by no means confined to women, there is no doubt that it offers very many more openings to them than to men. In a later chapter we shall be showing how serious is this dependence on women in a world in which the unmarried woman is rapidly becoming a rarity.
14. The shortage of staff tends to have a cumulative effect. When there are too few people engaged to allow of reasonable times off or anything but snatched holidays, even the kindest and most willing people come to the end of their capacity for overwork and feel forced to give up. And, naturally enough, the longer the hours of work and the more onerous the conditions, the fewer new recruits are ready to come into this field.
15. The problem facing Homes is therefore twofold: it is to attract a sufficient number of the right kind of person in the first place and then to induce them to stay long enough to provide those in their care with a stable environment. This is the problem we decided to investigate; to see if we could find out the main causes of the present situation and whether we could make any proposals that might lead to improvement.
16. After careful consideration we agreed to limit our enquiry to those institutions whose principal purpose is the provision of a home or social education for the many different groups in the community for whom this is required. This is not intended to underestimate the many other functions carried out by the various establishments that we accepted as within our scope; but it does mean that we excluded hospitals and prisons. Indeed some types of accommodation where the categories of resident are clearly within our terms of reference have also received little attention. This ommission was not because we believed that these groups were not important groups, but because in an enquiry of this kind, ranging over so wide and varied a field, it has proved impracticable to examine every group in detail. Moreover we became convinced, as we studied a large number of different kinds of Home and institution, that our findings and our recommendations have a general application.
17. Residential accommodation for homeless families provides an example of a significant category to which we have been unable to give detailed study. The ways in which evicted or homeless families are dealt with has attracted a good deal of public attention and concern. The problems presented are often complex and long-term, and efforts at care and rehabilitation vary greatly in method and objectives. On a national basis therefore it appeared impossible to identify any general policy or requirements in terms of staffing. We came to the conclusion that our general proposals about recruitment, conditions of work and especially training apply here also. In practice, any members of staff who work with homeless families, or students who wish to prepare themselves for work with such a group, would be greatly helped by the general training we recommend. They would have the opportunity to take subjects of special relevance and, we anticipate, part of their practical work would be planned with agencies able to provide appropriate experience, such as the Family Service Units.
18. The main groups we decided to cover are:ā
(i) old people; (ii) children and adolescents temporarily or permanently without a normal home (i.e. working boys and girls, mentally and physically handicapped children, including those in residential special schools, delinquent children, including those in approved schools, remand homes and probation hostels); (iii) physically or mentally handicapped adults; (iv) mothers and young children in need of residential accommodation.
19. Our first need was to find out the facts. There are legal requirements for the registration of most Homes, apart from those run by local authorities. So far as old peopleās Homes are concerned, there are those provided by voluntary organizations which are non-profit making, and there are those which are run for profit. Both of these must be registered with the local authority, but this does not mean that there is a complete list of them. There are serious problems of definition. A guest house or boarding house or hotel, whose primary purpose in practice is to cater for the elderly, may claim that it does not confine itself to elderly clients, or it may insist that it is prepared to accommodate persons who want ābed and breakfastā for a night or two, or it may argue that it is none of its business to ask for the birth certificates of those who come to live there. There are, therefore, quite certainly many homes which are principally housing old people but whose liability to register is doubtful or ignored. How many of these there are is unknown, and as matters are at present, there is no way of getting in touch with them in ...
