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Abstract

While care of older people involves both medical and social care nursing homes are essentially an extension of the functions of the home rather than of a hospital. The largest group of employees in residential care settings are nurses and care attendants. A medical model could be said to dominate not a social care approach. However there has been a move away from large institutional settings with a hospital atmosphere to smaller more homely units where there is more emphasis on purposive activity and links with the community. Traditionally many of the day services for older people were provided by voluntary organisations and nuns from religious orders provided much of the expertise. With the decline in the number of religious these services are increasingly coming under the remit of the health board and staffed by people from a variety of nursing and social care backgrounds. This articlel is based on an exploratory study of the provision of care for older people in residential and day settings with particular focus on recreational, social and creative activities. The services and programmes examined were mainly in the Dublin area. The aims of the article are: To outline the structure of provision of residential and day services for older people who need additional support in daily living. To give an overview of policy development in relation to these services. To examine quality of life in relation to provision of recreational and social activities in these services and To put forward an argument for social care education in the provision of training courses for staff working with older people. The article outlines the main institutional services for dependent older people, discusses the principal policy reports that have shaped the services, and describes the historical evolution of services and the main policy developments to date. The article contrasts services based on older concepts of care with more recent practices. The quality of care is examined with reference to legislative requirements and quality indictors particularly related to purposive recreation. The characteristics of a medical model of care are contrasted with a social care approach and an argument is advanced for adopting a social care approach for meeting the needs of the dependent older person. Finally the training implications of adopting a social care approach are considered.

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