The special kind of care for the elderly that religious orders can offer is as
needed as ever but it is coming under increasing threat, says Terry Philpot he secular welfare state has never found it as easy to cater for the spiritual care of older people, as it does their physical and emotional welfare; still less does it find it easy to allow the expression of that spirituality. And so, care offered by religious bodies becomes all the more desirable for those who profess spiritual values and place stress on a sacramental life.
The Catholic Church is not the only provider of residential care for older people, but it is by far the largest and oldest. Care is provided by 50 of the 238 religious orders in England, and some orders also offer residential care for their retired members. Such care, combined with Catholic schools, hospices or the diocesan children's societies, is a very public expression of the Church's social mission.
Yet, unlike those, it is neglected by public and policy makers and largely unknown to the general public. It rarely features in debate. This is because almost all statistics, media coverage and political concern are about the private sector, which is dominated by small (typically husband and wife) businesses, some large providers. But, new research shows, it is a form of care which is now under threat.
The residential care sector as a whole has been in crisis for some years after burgeoning in the late 1970s and early 1980s when social security subsidies for residents spiralled from £6 million in 1978 to £1.3 billion in 1991. Where people were cared for altered radically: in 1976 for every one person in private care there were five in local authority homes; by 1992 for every one public sector resident, two were cared for in the independent (private and voluntary) sector.
Catholic homes have been buffeted by the same chill winds that have come to affect everyone else notably, fees paid for residents by local authorities have not kept. up with costs. Like others in the sector, too, Catholic homes have faced increased costs arising from the new care standards introduced by the Government. And though the Government has now said that guidance would replace statutory obligation, the research shows that for orders that were considering closure or withdrawal from the sector, standards were the decisive factor.
Lack of money and threatened higher standards meant that in 2001 the sector as a whole lost 13,100 beds. Catholic homes are going the same way 29 of the 50 providing orders closed homes or withdrew from the sector. But nearly a quarter of those not affected said that they were "just surviving". New homes do open but no one knows the rate of growth.
But religious-based homes suffer additional problems: the fall in vocations and the ageing of members of orders. Lay staff cost more and work fewer hours.
True, 90 per cent of residents found alternative accommodation (10 per cent died during closure). Distress, even trauma, is caused to religious, lay staff and residents. The latter had expected to end their days in the home they were living in, whereas they now faced with alarm moving into the unknown. Religious often see closure and withdrawal offering opportunities for new types of ministry but some sisters were said to "have never recovered" and "are sad in their own way all the time", while residents were said to be to be "let down", "distraught", "very vulnerable" and alarmed at the prospect of moving. Questions were raised about who would "care for the marginalised with no money in the years to come".
Many of the reactions, of course, were those which would be found in any good secular home provided by a local authority, private owner or voluntary body facing closure. But perhaps the greatest, and most irrecoverable loss for residents of Catholic homes was the loss of a sacramental life and spiritual ethos in which to live out their last years. Such care also allows older people to maintain their links with their parishes.
In planning for closure or withdrawal (or even seeking to avoid it), congregations are very much on their own. They lack any kind of organisation to offer support and advice, as well as lacking a national lobbying body.
The Care and Housing of Elderly Religious Project (CHERP) was set
up in 1990 to help provide care for congregation members who are retired, sick or physically or mentally infirm. If it were to widen its remit it could act as the support and advice agency. But congregations have also suffered for want of a voice.
Caritas-Social Action, the bishops' new social care umbrella group, could provide the voice for home providers in the same way that it does for the children's societies and, like the children's societies, home providers could participate in the secular lobbying associations without sacrificing their distinctive Catholic perspective.
The present government, like its predecessor, places great stress on the voluntary sector playing a greater role than the welfare state. It also looks to more faith-based schools. And yet faith-based care for older people is left to the whims of the market.
Catholic residential care will survive, even with the difficulties, in a diminished form but it may be that new forms of care will be desirable and the Catholic community may have to think about what part it can play, in the same way that it has supported Catholic education. One new form could be sheltered housing.
Ways need to be found of creating partnerships. Half the congregations interviewed saw partnerships as a way forward for Catholic care. Those who had found partners were the most successful. In education and childcare, partnership with local authorities to name only one kind of partner has been beneficial.
Things cannot return to where they were. Even in a decade the general landscape of residential care as a whole has changed for the worse. Catholic care meets a particular need. That need is not only for humane care which allows as much independence as possible, comfort and dignity; it is also about the creation of an ethos which older Catholic people value as will the younger generation should such care become necessary for them.
The revolution wrought in Catholic residential care offers the opportunity for the Church to think about what it means to be Catholic and elderly, what such a person's spiritual needs are and how they may be met, in terms of social care provision, even if the forms of provision in the future may often be different from what we have come to know.
Terry Philpot is the author of On the Homes Front: The Catholic Church and Residential Care for Older People, published by Caritas-Social Action at I4.50 from 0207 901 4875