Care, and a community

Terry Philpot

The Government this week published proposals for funding care for the growing number of elderly people. But Religious are also having to think imaginatively about how they finance the residential care homes they run once they can no longer go it alone

The mother house of the Sisters of St Augustine of the Mercy of Jesus, which doubles as the order's largest care home, sits incongruously in the English countryside. The imposing, turreted, white building betrays the order's origins in Belgium in 1842. There are three more care homes in the grounds of St George's Retreat, West Sussex. The residents are the elderly frail, older people with dementia, people with a history of mental health problems, and a smaller group with learning disabilities.

Nine years ago it became apparent to the order that the cost of improving their homes to meet the new care standards would be too great. The sisters eventually came upon the idea of meeting the cost of replacing the homes at St George's by building a care village, with apartments for sale, on the 250-acre estate (complete with cattle farm) where the retreat is situated. Planning permission was given to build 225 one- and two-bedroom apartments, 80 of which will be in the main house when it is refurbished as the final stage of the work. Each of the four building phases contains some social-housing apartments, so that there will be 10 when the project is completed in two and a half years' time.

At first sight this looks like any other upmarket commercial development. The first phase of what is called St George's Park has been completed and sold, and residents have moved in; builders and construction work are seen everywhere; a sales office offers glossy brochures; there's a show flat; and familiar yellow signs for new housing point visitors from nearby towns.

However, the properties can be purchased only by people aged 60 and over. Also, the building of the apartments goes hand in hand, in phases, with the erection of the new care units, the decommissioning of the old ones, and the removal of the residents to the new care units. Thus, the new en-suite, one-person bedrooms for the frail elderly people in the care homes are being funded by the profits from the sale of apartments.

There is much that makes St George's Park self-sufficient: it has its own bus service and a car-pool arrangement, as well as a community centre and bar, a restaurant, a coffee shop, a gym, a hairdresser's salon, a shop, a library (stocked by books which residents have donated), and a room for beauty treatments and alternative therapies. A swimming pool is planned.

The development is one of several - both within and outside the Church - that look to innovative ways of creating new kinds of care for older people while tackling the many problems that beset residential care homes, especially those run by religious orders. All this relies on imaginative financial and other planning, and a vision of what modern services can be like.

This week the Government launched its public consultation on how care for the elderly should be financed in future. In particular, the Prime Minister, Gordon Brown, said that people should not be obliged to sell their homes to pay for residential care. He proposes a new insurance-based system to replace the current means test. All this is against the background of an elderly population that is growing and living longer so that people enter care later, are older, frailer and more likely to have dementia.

The Government does not address the problems facing the owners of residential homes. In the case of Catholic homes for older people these are considerable. In 2002, the only research done specifically into these homes showed that they had been provided by 50 of the 238 orders in England. Twenty-nine of those 50 orders had closed homes or had withdrawn from the sector. But nearly a quarter of those who had not done this still said that they were "just surviving", and 55 per cent were concerned about the future. New homes do open but no one knows the rate of growth.

The residential-care sector has come to be dominated more and more by large companies. Residents' fees paid by local authorities have not kept up with costs, and new standards have made many homes uneconomic to run. However, the fall in vocations to the religious life is a particular problem for Catholic homes because it reduces a significant workforce. Catholic homes often take people with little or no support. But in financially stringent times, while subsidies help they also cause problems: one religious congregation had four residents paying £120 per week, even though each nursing home place costs £459 per week.

There is a particular problem that militates against finding solutions for Catholic homes, and that is that the Church is not structured as a learning organisation, one which facilitates communication, liaison and cooperation. It is organised vertically not horizontally. Bishops have ultimate responsibility for the diocesan agencies, while religious orders look to their superiors. A home in difficulties may not be in touch with a successful home no distance away.

Thus, while Catholic homes and institutions could learn from one another, there is also much they could learn from those outside the Church. The research says that the most successful orders were ones that had found partners, and half of the orders saw partnership with other orders or secular bodies as a way forward. Much is heard today of "faith-based" care and initiatives, but the irony is that it would appear that religious-based care for older people must be subject to the whims of the market.

In the nineteenth century, the Church met the needs of children, but that was not only to offer shelter and a better life but to protect children in their faith. We live in a greying society where the wish for Catholic older people, who cannot live in their own homes, is for somewhere where care is complemented by a sacramental life within an ethos they value. Such homes also allow them to maintain their links with parishes and to live with others with whom they share values, experience and outlook.

If Catholic schools faced the kind of peril now facing Catholic care homes the bishops would be banging on the door of 10 Downing Street and making sure that the cameras were there to record it. What does the lack of any collective urgency and action say about the value which the Church places on its oldest and most frail members?

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