Moral dilemmas and the management of private residential homes: the impact of care in the community reforms in the UK

Private residential care homes in the United Kingdom have undergone a variety of management changes in recent years, many resulting from the impacts of national policy changes. During the 1980s, the private residential sector for older persons enjoyed substantial financial support for the care of residents. However, since the 1990 National Health Service and Care in the Community Act was implemented in 1993, homes have had to compete with each other in a market, for a finite number of clients funded by limited local budgets held by local authority purchasers. Based on a three-stage quasi-longitudinal survey of over 100 residential care homes in one county, this paper considers changes in the overall size and structure of a local sector and discusses the specific management strategies that have been adopted by proprietors. The withdrawal of guaranteed state support has impacted heavily on residential home businesses. Indeed, many homes have multiple vacancies and have been facing financial hardships. The paper concludes with a discussion of the ethical and moral issues associated with certain management decisions and their possible effects on residents.