Estructura teórica y científica que sustenta el estudio (teorías, modelos)

We were interested in the views of the elderly people and their carers on both local authority and private residential homes. How people viewed a particular type of home might have influenced which home the elderly people moved into. More than half of the elderly people simply did not know what differences there were between local authority and private homes (57 per cent). Local authority residents were less likely than private residents to be aware of any differences between the two types of home. Around 10 per cent considered that there were no differences and that local authority and private homes were exactly the same.

The main difference cited by local authority residents was that local authority homes were less expensive than private homes. Private residents also referred to this difference but were also more likely to say that private homes offered better care and more attention and were smaller than local authority homes. Three-quarters of the local authority residents did not know what advantages private homes offered, and the same proportion of private residents did not know what advantages local authority homes offered. Sixteen per cent of the private residents felt that local authority homes offered no advantages, while a similar proportion of local authority residents said the same about private homes.

Very few elderly people, therefore, were able to comment on the advantages of the two sectors and those cited tended to be offered by residents living in that type of home. Local authority homes were seen to be cheaper and to employ well-trained staff. Private homes were thought to provide good care and attention, in a smaller environment more like a home, with fewer rules and regulations and more privacy, usually because of the provision of single rooms.

Carers, on the other hand, who were frequently very involved in the decision about whether to move into care, were much more likely to hold strong opinions about public and private residential homes. The main differences were thought to be in the quality of care provided, the standard of accommodation, the size of the homes, the type of resident and the motivations for running the homes. But carers of elderly people who had moved into the different sectors held very different views.

Carers of local authority residents considered that the main advantage of local authority homes was the high level of regulation and inspection: ‘The checking procedures. I think things run by the local authority are more likely to be checked to keep up standards concerning hygiene and the daily care of old people...’ This was seen to be related to the accountability of the authority: ‘It is more accountable. They have more of a set standard to be maintained. Their recruitment of staff is probably more exacting...’

They also considered the staff to be well-trained and qualified and felt reassured by the fact that the homes were run to provide care for people and not for the profit of the home owners: ‘I think it’s better if they are not there for profit and they haven’t got their own ends in sight. Then they look after the residents’ interests...’

A wide range of other advantages were cited, including good quality care, security of tenure, permanency of staff, cost and the organisation of activities and outings. But a quarter of the carers of local authority residents could not think any advantages of local authority homes.

Carers of local authority residents were less familiar with the advantages of private homes. Forty-three per cent felt unable to comment, while 17 per cent said that private homes offered no advantages. The main advantage cited by these carers was the luxurious standard of accommodation: ‘The decor and ambience, if you like. The private ones are plusher. That’s the way they get them in. They look better, they’re in better settings. The council ones are more institutionalised, with stark corridors and stark rooms...’

But many, like the daughter of an elderly woman living in a local authority home in the southern area, questioned whether the care would be better than that provided by the local authority: ‘More top coating! Thicker carpet, an extra coat of paint, but who knows if the care is as good...’

Some felt that private homes would arrange more activities, while others referred to the fact that residents could choose which home they wanted to go to and once in, might be treated as an individual and have more say.

Carers of private residents, on the other hand, held, if anything, stronger views on the two types of home. They thought the main advantages of the private sector were the small size of the homes and the high number of staff per resident. These advantages were thought to result in a high quality of care and attention. These carers also commented on the the fact that private residents were less likely to be confused.

Other advantages cited included single rooms, a high standard of accommodation, the possibility of finding a place and moving in when necessary, without the wait associated with local authority homes, and residents being treated as individuals. There was also a feeling that if you paid for the service, then the quality must be better! The daughter of an elderly woman in a private home in the London area expressed this opinion: ‘You like to think that if you’re paying, you get that little extra treatment. If you pay more, it must be better...’

Carers of private residents saw cost as the main advantage of the public sector homes. A fifth of them commented on the high price of the private homes and the economic advantage of local authority homes: ‘The worry about a private home is that as the cost of living goes up, the charges go up. How you meet them, I don’t know. They drain your resources to the limit...’

Like local authority carers, the private carers acknowledged the high level of regulation and inspection of council-run homes, possibly indicating some concern about what they saw as the relative infrequency of inspection of individual private homes: ‘The staff don’t have an axe to grind. The council ones

are subject to tiers of management. They are top-heavy, but there are stringent controls. I suppose the private must be but I don’t know how much the private are inspected as against the public ones...’

Some carers felt that more activities were organised in local authority homes, and that the homes generally had more amenities and facilities.

Overall, carers of both local authority and private residents generally considered the type of home in which the elderly person was living, whether local authority or private, offered more advantages than the alternative type of home. But carers of private residents recognised the cost advantages of local authority homes, as well as what they saw as the regulation and inspection of the homes by the local authority. Carers of local authority residents, on the other hand, recognised the higher standard of accommodation provided by the private sector. It was also clear that carers of private residents had more idea of the pros and cons of each type of home, and were more likely to have considered the different types of home, than carers of local authority residents.