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Introduction

The Open University — Thu, 16 Jun 2011 15:02:01 GMT

This unit considers working with people in group care and residential settings. Social workers play a critical role in supporting service users in moves to and from residential care, and they should be capable of assessing needs and the quality of care provision. The activities in the unit focus on the lives of three people living in a nursing and residential home for elderly and disabled people. Although many of the practice examples relate to work with older people, the values and principles surrounding this work also apply to other service users who make transitions to and from care, for example, children being accommodated or people with learning disabilities.

First, you consider the emotional impact that moving into a residential home can have and how social workers can support individuals and their families with this transition. Then you explore the characteristics of the residential environment and its impact on the quality of life of residents. Next, the process of selecting a residential home, the development of personal care plans and the role of the social worker are discussed. Finally, links to practice learning opportunities are suggested, relating to the requirements specified within the key roles: ‘Preparation for assessment of need’ and ‘Support, representation and advocacy’.

This unit is an adapted extract from the course Applied social work practice (K216)

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Learning outcomes

The Open University — Thu, 16 Jun 2011 15:02:01 GMT

By the end of this unit you should be able to:

recognise some key factors which determine the way people experience and manage transitions;
identify elements of good practice for supporting people through transitions;
discuss how care environments can promote service users’ identity, strengths and autonomy;

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1 Transitions

The Open University — Thu, 16 Jun 2011 15:02:01 GMT

The term ‘transition’ implies a change, and change has implications for the identity of the person who experiences it. It is likely to require a period of adjustment to assimilate and respond to it. Hopson and Adams (1976) suggest that a major transition, however triggered, can result in a cycle of changes to an individual's self-esteem. For example, moving into residential care is a major transition in anyone's life, yet older people are often assessed for, or seek, residential or nursing care in an atmosphere of crisis with little time to prepare (Youll and McCourt-Perring, 1993). A move may occur when someone is ill and therefore particularly vulnerable. A number of stresses may arise from such a transition, caused by:

change of place (loss of home)
changing relationships (for instance, death of a partner, gaining and losing friends or local community connections, making new relationships)
change of role or status (moving into care is a change in status from householder to resident)
deteriorating health
loss of independence, possibly increased dependence
feelings of loss of dignity, for instance, if support is needed for physical care.

Lee et al. (2002) suggest that the magnitude of the changes associated with this kind of transition accounts for why the perceived likelihood of entering a residential care home is one of the most pervasive sources of fear affecting older people. Therefore, Activity 1 focuses on feelings of loss that service users and their families may experience following a move into residential care and ways that professionals may support them. It also considers some of the tasks that social workers may undertake with service users, their families and other professionals who are involved with the admission of people to residential care.

Harry Venning ©

Harry Venning

Figure 1

Activity 1: Supporting people with transitions

1 hour 0 minutes

In this activity you will consider the impact of moving into residential care on service users and their families. You will also consider how professionals can provide support. Make notes on the following:

The issues to consider when working with people moving into residential care.
The feelings of loss that individuals may experience when they enter residential care.
The feelings a new resident's family may have about the move.

Watch Video 1 below, focusing on the transitions.

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Now listen to the audio below as Maria Hutchinson, the home manager, and Rose Guthrie, the home's counsellor, talk about some of the feelings and anxieties of residents and their families. (We apologise for the background noise on this recording.)

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Discussion

Feelings of loss are not experienced just by the person entering residential care, but may also be felt by those involved in their care. Carers and relatives can also experience the transition as painful, and are sometimes overwhelmed by feelings of guilt because they cannot support their relative or fulfil their sense of family obligation (Phillips and Waterson, 2002).

Social workers are involved in preparing for and carrying out the assessment of need and supporting transitions into care. The information that the social worker provides about the service user when planning admission can help make the transition into residential care a more positive experience. In assessing and then planning changes with older people, social workers should be aware of how ageism affects them. For example, it is ageist to assume that all older people's needs and expectations are similar: it should be remembered that each person has their own distinctive biography (see Aids to Practice card on ‘Biographical Work’, linked below).

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Listening carefully to what people say about their needs, and involving them and their families in planning their own care, helps to overcome ageist practice. If the social work assessment incorporates some biographical details of a new resident and notes their preferences, staff at the home are able to consider how they can help them maintain links – their social networks – and continue to engage in activities that interest them. This is particularly important for service users from minority ethnic groups, where maintaining cultural links helps to smooth the transition to care. Taking into account service users' backgrounds and preferences also helps to preserve their identities and sense of self-worth.

Hopson and Adams (1976) developed a model to explain personal responses to major transitions. They suggest that individuals may pass through seven identifiable stages in a major transition:

Immobilisation (a sense of being frozen, unable to act or understand).
Minimisation (denial that change is important).
Depression.
Acceptance (realisation that there is no going back).
Testing (trying out new behaviours to cope with the situation).
Seeking meanings (reflecting on change).
Internalisation (the new meanings discovered become part of behaviour and a new identity).

This work has influenced practitioners' understandings of the feelings about loss that arise not only from the death of a close friend or relative (Parkes, 1993), but also in relation to failing health and mobility. Importantly, the identification of these stages may also help practitioners to understand the experiences of people moving into residential care and to recognise the emotions that can be aroused by such transitions. However, the stages outlined may not always be experienced by people in the sequence outlined here, and the model does not provide explanations for variations in people's experiences. There are numerous variables which affect personal responses to transitions. It is important to listen carefully to how each individual experiences the process and expresses their feelings about it.

Korbasa et al. (1981) examined why some people appear to cope more readily with stressful life events than others. Their conclusion was that differences in coping may be due to the presence of certain individual characteristics. They studied two groups of executives: one group had become ill after stressful life events; the other, although subject to similar life events, did not. Their findings led them to develop the concept of ‘hardiness’ to explain why, in similar circumstances, some individuals become ill and some do not. They accounted for differences by the presence of certain personality traits which they claimed make people ‘hardy’ enough to cope. These include:

control: feeling that they can influence their lives
commitment: valuing strong social bonds with family, friends and people in the community
challenge: viewing change as a challenge rather than as a threat.

For social workers who meet adults and children in transitions, hardiness is a useful concept, closely linked to some ideas in the literature on resilience in adversity (Gilligan, 2001). Activity 2 further explores the value of the concept of ‘hardiness’ for gaining an understanding of individual responses to change.

Activity 2: Responses to change

1 hour 0 minutes

If you have just completed Activity 1, you may want to take a break before continuing.

In this activity, you will consider the concept of ‘hardiness’, which Korbasa et al. (1981) suggest enables some individuals to cope with major changes.

Watch the video clips below in which Elizabeth, Bill and Eric talk about the experiences of living in residential care. For each of these residents, and Elizabeth's husband, make notes of their responses under the following headings:

Control – feeling that they can influence their lives.
Commitment – valuing strong bonds with family, friends and people in the community.
Challenge – viewing change as a challenge, not a threat.

You might also note other factors, such as personality, degree of optimism and good general health.

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Click to view Video 3: Bill's story (6 min 54 sec)

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Click to view Video 4: Eric's story (5 min 22 sec)

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Discussion

You may have noted the similarity between the concepts of ‘hardiness’ and ‘resilience’ as both ideas identify how some individuals have a capacity to resist or rebound from difficulties. While these concepts include psychological characteristics, social resources also matter. Research studies suggest that resilience in older people is connected to a number of protective factors, including the physical, psychological, social and spiritual domains of their lives (Nakashima and Canda, 2005). In situations where social and economic factors threaten an individual's capacity to cope effectively with a major transition, social workers can explore the service user's strengths and build on them. This may involve helping the person to strengthen their personal support networks.

Pearlin and Schooler's (1978) analysis of individuals' ability to cope with change also acknowledges the importance of personal and social resources (Korbasa et al., 1981). Pearlin and Schooler distinguish between coping responses and coping resources. Coping resources can be seen as what is available to the individual in developing their coping repertoires. Coping resources are sub-divided into psychological and social resources. Psychological resources that the individual possesses can be employed to respond to change, and are analogous to Korbasa et al.'s three Cs. Social resources are the interpersonal networks in which the individual is embedded. Coping responses refers to what a person does in response to change. For example, the ability to mobilise social networks at times of stress is seen as a coping response. Pearlin and Schooler also stress the significance of negative social and economic factors, such as poverty, discrimination, unemployment and social exclusion, on an individual's ability to cope effectively with change. Exploring these three areas with service users is part of the ecological assessment framework.

Sometimes older people enter care as a temporary measure for respite stays and intermediate placements following discharge from hospital. Thinking about coping resources and coping responses is useful when supporting a new resident to ‘settle in’. Reed et al. (1998) suggest that the key to successful adjustment to life in a residential home is social relationships. Residents who have inner personal resources and effective social skills are more likely to have the ability to establish new friendships.

Children and young people and other adults may also move into supported accommodation. It is often temporary and for a short stay, but is sometimes over a longer term, and often people experience several moves. Social workers who support people leaving care and moving on to different living arrangements, perhaps to independent living, find that assisting in developing service users' life skills can be helpful. Whatever kind of changes a person experiences, social workers need to appreciate how each individual interprets and feels about the event. By their insight into what is involved, social workers can help the person manage more successfully. Working with service users to identify what they perceive as making the move more or less difficult provides an opportunity to consider sources of support that may smooth their transition.

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2.1 Design and organisation of the care environment

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The way a care environment is designed and organised can have a profound impact on the residents' lives, and careful consideration of factors such as the physical environment and the care home's values can have positive effects on their quality of life. For example, Philpot (2005) reported on the design of a building that illustrates the kinds of things that make life easier for people with dementia.

Box 1: Design for dementia

The open plan of [Stirling University's Dementia Services Development Centre's] Iris Murdoch Building is a dementia design principle – everything and everybody can be seen. The building is light and non-reflective, there are no shadows and high-quality acoustic tiles on the ceiling combat any echoes. There is a glass-fronted fridge and the cabinets, drawers and doors have glass panels. Carpets are blue, not patterned as these can cause confusion. Different textured carpeting indicates where you are.

As people with dementia can have problems with three-dimensionality, each stair has a different coloured nosing, the skirting is stair-shaped, and the banister is pillar-box red. Different colours distinguish the seat, pan and back of the toilets, the whereabouts of which are indicated by door signs combining symbols, words and pictures. Light switches are in vividly contrasting colours to the plain walls.

(Philpot, 2005, p.36)

Dementia Services Development Centre ©

Dementia Services Development Centre

Figure 2: Transparency in dementia design

Mary Marshall, who influenced the design of the Iris Murdoch Building, argues that appropriate design principles make daily living easier for people with dementia, or other cognitive impairments such as autism, learning difficulties or high levels of stress (Philpot, 2005). Research also shows that careful consideration of living arrangements for children in residential homes is important (Whitaker et al., 1998).

Activity 3 asks you to consider care environments further through reading about some research. This article was first published in 1993 and refers to observations made in the 1970s. Since then much has changed in residential care homes. Standards have been raised by the introduction of Codes of Practice for social care workers and employers. Staff are usually better qualified and provision is more responsive to service users' needs than it was. However, the article usefully offers an illustration of how different philosophies of care and organisational arrangements can produce different qualities of care, irrespective of resources.

Activity 3: Encouraging autonomy in care environments

1 hour 0 minutes

Read the article linked below, ‘Does group living work?’ by Julia Johnson, where two different environments for residential living for older people are described. As you read:

Consider the features of each care environment. Make two lists:
- the factors that promoted residents' autonomy
- the factors that restricted residents' autonomy.
Consider any other contexts of care for older people, residential or non-residential, that you know about. What has changed (or has remained unchanged) in recent years?

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Discussion

1 Your lists may have included some of points listed below.

Factors that promoted residents' autonomy

Short distances between communal and personal living areas.
Strategies to promote residents' physical independence.
Promotion of self-reliance by encouraging participation in normal daily tasks and activities, which also increases social interaction among residents.
Mixed-need groups, providing opportunities for more able residents to support those who were less able.

Factors that restricted residents' autonomy

Communal and personal living areas not located near each other.
Staff discouraging residents from using their rooms.
Lack of control over getting-up times, bedtimes and mealtimes.
No attempt to reduce residents' reliance on walking aids.
Residents dependent on staff for moving around the building.
Lack of opportunity to engage in daily care tasks.

2 The author of the article told me in a recent interview that her current research into residential care homes for older people shows that provision intended to enhance residents' lives still varies in quality:

My current research is already demonstrating that some homes are almost paralysed by bureaucracy – health and safety regulations, care standards, and individual risk assessments, which make these kind of enabling environments almost impossible to create. It's depressing that these kinds of developments provide the excuse for why residents are deemed not capable of doing this, that or the other. However, our research is also showing that there is huge diversity in residential care provision which suggests that there may be scope for creativity nonetheless (this I think depends very much on the person in charge of the home).

In terms of providing opportunities for enhancing residents' autonomy, Arden House and Parkview appear to be at opposite ends of a spectrum. Arden House represents a progressive service user-centred approach, while Parkview takes a more traditional service-centred approach, with more features of institutionalised living. Drummond Grange has elements of both care environments. The use of the building's space has more similarities with Parkview, but without a tendency to impair the independent movement of residents. Eric, Bill and Elizabeth, as wheelchair users, welcome the wide corridors and easy access created for them to move about independently. While many of the residents at Drummond Grange are highly dependent on staff to assist them with daily care and living tasks, great emphasis is placed on sustaining interests and enabling residents to engage in activities that interest them. They are also encouraged to personalise individual rooms to create their own space.

Care environments that constrain autonomy can have negative psychological effects that contribute to depression (Boyle, 2005). In Activity 4 you will consider how the dominant values promoted in residential homes can affect residents.

Activity 4: Care home values

0 hours 15 minutes

In this activity you will consider how the dominant values promoted in a residential home can affect the daily living experiences of the residents.

Listen to the audio clip below as Maria Hutchinson talks about the ‘philosophy’ of Drummond Grange and delivering ‘quality care’. Make notes on what Maria believes to be the guiding principles.

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Discussion

The principles underpinning National Care Standards mean that care home providers should meet the diverse needs of residents. The Standards describe what people can expect from service providers and focus on the quality of life service users should experience. For care providers, this entails making provision for the range of physical, emotional, spiritual and cultural needs and preferences of the people who come to live there. Homes should take account of service users' cultural preferences when, for example, planning menus or activities and should ensure that residents can practise their religious beliefs. This may mean establishing links with organisations outside the care home, and creating networks to provide relevant services to meet these diverse needs. Careful assessment of needs, competences and abilities enables staff to provide for service users' needs and preferences. Staff working in residential care environments can help to preserve and increase service users' control by recognising and promoting their interests and abilities.

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2.2 Opportunities for creativity and personal development

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Hubbard et al. (2003) identify that within institutional care settings, social relationships among older people are important for supporting residents. They note that older people with the most severe disabilities, and those for whom communication is most difficult as a result of sensory or cognitive impairments, are particularly likely to experience social and emotional isolation in care settings. Within care homes, strategies for establishing and sustaining relationships among residents and staff are often created through the use of groupwork.

Many care homes have residents who experience dementia, and therapeutic groupwork, such as reminiscence work, may help. Reminiscence work with groups of people with similar or related experiences provides a way of helping people to come to terms with their feelings. Schweitzer (2004) suggested that for older people from minority ethnic groups, it can help to create a ‘community of experience’ with others who have made similar life journeys, enabling them to understand their lives within a broader historical and social context. However, care workers need to be sensitive to the fact that it may be too distressing for some people.

At Drummond Grange a number of group activities are timetabled each week, such as the Newspaper group and the Art group. These provide opportunities for people to express their creativity. Making provision for people to pursue individual interests creates opportunities for development and growth in later life. Bradley and Specht's (1999) research found six features of successful ageing:

having a sense of purpose
interaction with others
opportunities for personal growth
self-acceptance
autonomy
health.

Bradley and Specht's respondents identified a relationship between creativity and successful ageing. Creativity was perceived as helping individuals to stay engaged and feel good about themselves. Creativity can be expressed in a variety of ways, such as singing, cooking, gardening, crafts, reading and writing. The value of retaining and developing interests within a care setting was stressed by the three residents interviewed at Drummond Grange: Eric enjoys the creative experience of writing; Elizabeth derives great pleasure from maintaining the peace garden; Bill enjoys the challenge of using his computing skills to create various kinds of documents.

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2.3 Making choices and developing a personal care plan

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The social work task of supporting a person's admission to care involves many skills. Social workers must be able to assess the person's needs and coping mechanisms, and the quality of provision to meet needs. They must be familiar with the National Care Standards for their nation. To liaise effectively with service users, families, home providers and other professionals involved in assessment, good communication and negotiating skills are essential.

If there is a need for residential care, social workers may play a role in providing information about it to service users and their families. Phillips and Waterson (2002) found that while the task of searching for suitable accommodation was generally undertaken by families, they appreciated advice, guidance and recommendations on selecting a home and on the financial implications. The role of the social worker here has been described by Phillips and Waterson as an ‘honest broker’, offering impartial advice to empower service users and their carers to make an informed choice. This may involve the social worker putting them in touch with organisations such as Help the Aged or Age Concern, which can provide advice and guidance on many aspects of care homes and funding.

Personal financial resources remain significant when considering inequalities in provision between local authority, voluntary sector and private providers. Those who are reliant on financial assistance from the local authority to pay fees may be disadvantaged in many ways. For example, additional personal resources such as a telephone in their room may not be available. The residents at Drummond Grange all stressed how important it was to create their own personalised space and to be able to get in touch with the outside world easily by having a phone in their rooms.

Inequalities persist, and there is more choice of provision for those who can afford it. An important task for the social worker supporting an older person's move into care will be to undertake a financial assessment to ascertain their eligibility for financial support towards the cost of their care. This may be distressing for the older person, especially if selling their home to contribute to the cost of their care is a possibility. The older person may experience feelings of loss akin to those associated with bereavement.

One way of supporting service users and their families with finding suitable care accommodation is to help them devise a list of questions that they can ask about the care provided when visiting homes. You will explore this in Activity 5.

Activity 5: Being an ‘honest broker’

0 hours 10 minutes

Make a list of questions that a service user might find it helpful to ask in order to make a judgement about the suitability of a placement for them.

Discussion

Our list included:

What are the fees charged for care and what precisely is included in them?
Is the location good for maintaining relationships with family and friends?
What are the links with the local community?
Does the home have suitable facilities to cater for the service user's needs and preferences?
Can residents choose when to wake, when to retire to bed, when and what to eat?
Will the home be able to meet the service user's spiritual and cultural needs?
Does the atmosphere feel right?
Are the staff friendly, approachable and sensitive?
Can service users bring their furniture and/or pets into the home with them?
Are written policies and procedures readily available?
How are service users involved in the running of the home?
Can residents entertain visitors when they like?

Further information to help with the selection of homes is found in inspection reports which provide information about the quality of care within establishments. These reports note the strengths of provision and indicate areas where improvement is needed. When assessing the quality of care, inspectors incorporate the views of service users, relatives and staff working in the home, in conjunction with their own observations. The challenge for residential providers is to create an environment for care which respects group needs and individual differences, and responds by offering appropriate support.

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Figure 3: The challenge of meeting group needs and responding to individual differences

Once the choice of placement has been agreed, work begins on developing personal care plans with staff in the home. At this stage, social workers may help families negotiate effective ways of continuing to play a part in the care of their relative. Wright (2000) identified five discrete roles that family caregivers might assume in care homes. These were described as:

checking the quality of care
companionship
handling the cared-for person's finances
giving practical help
assisting with personal care.

The last two roles were taken on by the minority of respondents in Wright's study. Accommodating a family's preferences about the roles they may want to play in care of their relative helps to sustain the relationship between the service user and their relatives after admission. All decisions about relatives' involvement should be recorded on the service user's personal care plan. You will consider important features of person-centred care planning in Activity 6.

Activity 6: Developing and reviewing personal care plans

0 hours 30 minutes

This activity looks at care planning for residents at Drummond Grange. Watch the video clip then listen to the audio clip. Both are linked below.

Note the key features of a service-user approach to personal care planning as you watch and listen.

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Discussion

The information derived from a single assessment process should enable the service user's needs and preferences to be at the heart of the personal care planning process. The inclusion of the service user's perspective is essential for anti-oppressive practice. Where service users have difficulty communicating verbally, social workers may need to use alternative strategies to gain an insight into their views. Social workers may also need to draw on the understandings of family and close friends. In some instances, they may act as advocate for service users in negotiating their care plan. ‘Support, representation and advocacy’ is a key role for social workers to undertake. However, sometimes it may also be good practice to secure the involvement of an independent advocate to ensure that there are no conflicts of interest.

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3 Practice links

The Open University — Thu, 16 Jun 2011 15:02:01 GMT

You may have the opportunity to work with a service user who is considering entering residential care. Perhaps you can support them by helping them to identify priorities and accompany them on visits to potential homes. A joint visit enables you to assess with them how well a particular establishment is equipped to meet their needs. In considering the suitability of residential placements, you will find it helpful to think about the features of care environments that you met in this unit. Also, look at the Care Standards for your nation so that you can consider whether these appear to be being met. Using the material in this unit, devise headings for areas you will focus on when assessing the quality of provision.

Similar work can be done with service user groups other than older people in residential care, for example adults moving to hostel accommodation, children moving into or out of foster care, or learning-disabled young people changing supported accommodation. Care has to be taken to support adults through transitions. You should always consult the Standards that apply to the residential provision you intend to visit, and gain as much information as you can about any possible placement and share it fully with the service user concerned and significant relatives.

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3.1 Conclusion

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In this unit you have considered a range of responses and feelings that services users may experience during the transition into residential care, and have identified strategies that can be used to support them with this move. Passing on comprehensive information about the service user to care providers will help them to respond more effectively to the service user's needs. Being able to provide relatives and service users with information about possible placements and negotiating with providers on their behalf to ensure that service users' needs are catered for is an important aspect of the social work role. Supporting service users and their families in the transition to residential care will provide opportunities to demonstrate competence in key roles.

Key points

Moving into residential care can be experienced positively and social workers can play a significant role in supporting service users with such transitions.
All assessments of needs should take into account the life experiences, strengths and preferences of service users.
Residential care homes should respond to the diverse physical, emotional, spiritual and cultural needs of residents.
All service users, children and adults, who move to or from residential care will experience feelings about the transition which need to be understood.

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Next steps

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After completing this unit you may wish to study another OpenLearn Study Unit or find out more about this topic. Here are some suggestions:

If you wish to study formally at The Open University, you may wish to explore the courses we offer in this curriculum area:

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References

The Open University — Thu, 16 Jun 2011 15:02:01 GMT

Bradley, J. and Specht, D. (1999) ‘Successful ageing and creativity in later life’, Journal of Ageing Studies, vol. 13, no. 4, pp. 457–472.

Boyle, G. (2005) ‘The role of autonomy in explaining mental ill-health and depression among older people in long-term care settings’, Ageing and Society, vol. 25, no. 5, pp. 731–748.

Gilligan, R. (2001) ‘Promoting positive outcomes for children in need: the assessment of positive factors’ in Horwath, J. (ed.) The Child's World, London, Jessica Kingsley.

Hopson, B. and Adams, J. (1976) ‘Towards an understanding of transition’ in Adams, J., Hopson, B. and Hayes, H. (eds) Transition: Understanding and Managing Personal Change, London, Martin Robertson and Co.

Hubbard, G., Tester, S. and Downs, M. (2003) ‘Meaningful social interactions between older people in institutional care settings’, Ageing and Society, vol. 23, pp. 99–114.

Korbasa, S., Maddi, S. and Courington, S. (1981) ‘Personality and constitution as mediators in the stress-illness relationship’, Journal of Health and Social Behaviour, vol. 22, pp. 368–378.

Lee, D, Woo, J. and Mackenzie, A. (2002) ‘A review of older people's experience with residential care placement’, Journal of Advanced Nursing, vol. 37, no. 1, pp. 19–27.

Nakashima, M. and Canda, E. (2005) ‘Positive dying and resiliency in later life: a qualitative study’, Journal of Aging Studies, vol. 19, no. 1, pp. 109–125.

Parkes, C.M. (1993) ‘Bereavement as a psychosocial transition: processes of adaptation to change’ in Dickenson, D. and Johnson, M. (eds) Death, Dying and Bereavement, London, Sage in association with The Open University.

Pearlin, N.I. and Schooler, C. (1978) ‘The structure of coping’, Journal of Health and Social Behaviour, vol. 19, pp. 2–21.

Phillips, J. and Waterson, J. (2002) ‘Care management and social work: a case study of the role of social work in hospital discharge to residential or nursing home care’, European Journal of Social Work, vol. 5, no. 2, pp. 171–186.

Philpot, T. (2005) ‘Design principal’, Community Care, 8 September, pp. 36–37.

Reed, J., Roskell Payton, V. and Bond, S. (1998) ‘Settling in and moving on: transience and older people in care homes’, Social Policy and Administration, vol. 32, no. 2, pp. 151–165

Schweitzer, P. (2004) ‘Ah yes, I remember it well’, Community Care, 25 March, pp . 40–41.

Whitaker, D., Archer, L. and Hicks, L. (1998) Working in Children's Homes: Challenges and Complexities, Chichester, Wiley.

Wright, F. (2000) ‘The role of family care-givers for an older person resident in a care home’, British Journal of Social Work, vol. 30, pp. 649–661.

Youll, P. and McCourt-Perring, C. (1993) Raising Voices: Ensuring Quality in Residential Care, London, HMSO.

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Acknowledgements

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The content acknowledged below is Proprietary (see terms and conditions). This content is made available under a Creative Commons Attribution-NonCommercial-ShareAlike 2.0 Licence

Grateful acknowledgement is made to the following sources for permission to reproduce material in this unit:

Audio/Video Materials

Illustrations

Figure 2 with kind permission of Dementia Services Development Centre;

Figures 1 and 3 Harry Venning.

Unit image

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