It’s not just a building: the grief behind care home closures.

I’ve spent more than my usual time this past week in TV studios, speaking to journalists and doing interviews. The reason has been a media statement published by Scottish Care about the current state of discussions around the National Care Home Contract. In some of these interviews I mentioned as I have before both in discussions and in this blog that care homes are having to close their doors because they cannot make ends meet. I’m not going to go over the nuts and bolts of those decisions and discussions here, but I want to briefly this week share something of the impact upon those who are in a care home when a decision is made to close.

The first thing to say is that you can never generalise about the closure of a care home. They happen for many reasons but more recently they have been happening on the grounds of cost and sustainability. A recent example of this is one which for me comes very close to home.

Around a month ago the news broke that one of the oldest charities in Glasgow had announced it is to close and carefully wind-down the running of its care home in the west end of Glasgow after nearly 200 years. This was the first care home I ever visited – as a primary school pupil in a nearby school. Even then I was impressed by the palpable sense of love and compassion in the place. I remember going home and saying that it was a ‘special place.’  I have visited friends, acquaintances, and neighbours over the years in the home, a place which I walked by most weeks of my early life. The depth of compassion, of life lived before the end, of family welcome were so memorable – yet after all the challenges of the decades including the hell which was Covid-19 the home is to close. Media coverage stating the reasons as:

“severe and unsustainable cash flow problems stemming from the rising costs and challenges of running a major care facility”, the administrators said.

This included staff shortages, costs of sourcing agency staff, rising food and energy bills, compliance costs and falling occupancy levels.”

I will miss Balmanno House but sadly I know and have been told of so many more care homes which have had to close primarily because of staffing and recruitment costs, of sustainability around energy and other commodities – and all because of an inadequate level of public funding. Closures which hit the local media, but which are going largely unnoticed amidst all the political grandstanding and front-page headlines of recent days and weeks.

It is a generally received wisdom that when a care home closes it has a negative impact on staff and most importantly residents even in shortening life and decreasing wellbeing. That is certainly the anecdotal wisdom of many families and those who work in the sector. Prof Jon Glasby of Birmingham has and is undertaking research in the area and suggests that that may not always be the case if the care home had poor quality provision before its closure. Glasby’s research is probably accurate but what is happening up and down the country these last few months and especially in rural and remote areas is not the closure of homes which were in decline but that high quality care homes are having to close not because they are providing a poor service but because they cannot afford to stay open or cannot get staff. That is very different. The trauma and upset of dislocation from a place of contentment is much sharper and rawer than leaving a place of dissatisfaction.

I want to briefly share some of the conversations I have been having with staff, managers and families in the last few weeks and months because sometimes when you hear about a care home close or when you read numbers and statistics, we can fail to understand the experience and lived reality behind the headline.

Mary was a resident in the care home for five years and when she entered the home she really didn’t want to be there and on her own admission she gave the staff hell because she was so desperate to get home and thought that her daughter had abandoned her. But with perseverance and positivity the staff nurtured Mary’s confidence and slowly as she puts it ‘the ice thawed’ and she began to settle in – indeed it only took a couple of weeks. After that she openly confesses that these last few years have been amongst the best of her life. Of course, she misses her own place, but she will tell you straight out that she just was no longer able to look after herself because of her frailty and that she had had two hips replaced after falls. She was immensely lonely and had sunk deep into herself even though she had good support from homecare staff. What the care home did was to bring her back to life and much to the surprise of family and others she was thriving. She formed new friends and loved the range of activities and what she described as a constant sense of fun. The staff were brilliant but she also said that so many had left after Covid and there were many new staff or staff who only came for a short period, and this had changed the place. Then they got the news of the closure and Mary was not the only one who got really depressed and saddened.

When I met Mary she was trying to be positive for everyone around her but it struck me after years working in the fields of loss and grief that plain and simple what Mary was experiencing was a bereavement, a loss of the familiar in her new place; a loss of relationship with folks she had come to love both staff and residents because most had not followed in her steps to the new home she was now in some 20 miles from where she had been. She was determined not to be down and to fight the black mood – but what I witnessed in Mary was grief pure and simple. A grief that need not have happened, a grief for which many of the staff around her now were ill equipped to support. But more than that and Mary confessed this – she was worried about making new friends, making the effort of getting to know folks for the fear that in a few months it would all happen again. Grief is first and foremost the fracturing of love and if that brokenness is one that could have been avoided you are much more wary of being vulnerable to love.

When a care home closes its impact on residents is personal and profound. It is a loss and bereavement which we need to support but it is also one which we should all be doing as much as we can to avoid in the first place.

Jim was the manager of the care home which Mary was a resident in. To be fair Jim could see the writing on the wall as he attended the meetings of the charity trustees which ran the home. Money was not so much tight as non-existent. Donations for the small community-based charity had dried up so much and there was a black hole in them during Covid from which they never recovered. ‘Folks gave to the big causes that were on TV,’ he would say ‘not to the local places.’ The trustees made the decision to close because they simply were running out of money with all the increased costs, and they could not persuade the local authority funders to pay more for the residential care and support they provided.

Jim had over 30 years’ experience in the care sector and worked across so many different groups, but he found his niche and became a manger – indeed an award winning manager renowned for supporting staff, working closely with families and integrating the home into the life of the local school and community. But as he closed the door on the home for the last time, he told me that he could not but shed a tear for all the stories told inside its doors, all the love and loss, the sheer fun and laughter he had had inside.

Jim too was a man who was grieving – having not just lost his job – indeed he was now working outside the care sector – but having lost the place where he said to me, he had become the person he was when I met him. He was sure that the place and the people had given more to him than he had to them. It as not, in his words, just about bricks and mortar. His last act was in memory for all who had passed through the gate and door – it was to hang a wreath.

For Jim and Mary, you could count many hundreds more. Behind the closure of a care home, the dislocation of its residents and the loss of livelihood for staff, is an undoubted grieving process, a bereavement of place and memory, of folk and feelings, of special times; of safe space and held love.

In all the politics and wrangling over finance and priority, in all the debate over culpability and responsibility – I hope we never forget folks like Jim and Mary – it is their living and loving that is changed forever when a care home closes.

Donald Macaskill