Case study

The Last Refuge revisited

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Author: Julia Johnson, Open University, Sheena Rolph, Faculty of Health and Social Care, Open University and Randall Smith, School for Policy Studies, University of Bristol

Date: 2005-2007

Type of case study: Research

About the research

The research was carried out by Julia Johnson, Senior Research Fellow, and Sheena Rolph, Senior Research Fellow, from the Faculty of Health and Social Care at the Open University and Randall Smith, Honorary Professorial Research Fellow, from the School for Policy Studies, University of Bristol.

Effective care for the elderly is a major issue in British society and one that engenders much debate. This study explored the state of residential care for older people in the United Kingdom addressing contemporary concerns about the management of residential care homes and their changing nature. Rather than taking a short-term approach to the situation this project took a longer-term view comparing the current state with that of almost fifty years ago. It was inspired in this by the ground-breaking research of Peter Townsend and his seminal book The Last Refuge (1962). The research team used the original data from Townsend's work as the foundation of their follow up study and were encouraged and supported by Townsend himself. The current research has found that there has been both change and continuity in the way the homes functioned in the past and currently. It is clear that legal regulations have resulted in improvements and refurbishments to the buildings and environment. There have also been major changes in the varied ethnicity of the staff, with some homes now being staffed almost completely by individuals from abroad as well as by British Indians and Africans. In terms of continuities many similar to the findings of Townsend on such challenging issues as funding, freedom to make choices, activities and quality of care. Alongside the negatives, positively there is some evidence that voluntary homes retain their status today as they did in 1959 as comfortable, warm and welcoming: 'Inside the home: it is quite untidy but not unpleasantly so – more like a family home – and interestingly, that is just how Townsend described it too. He was pleased to see untidiness. It looked lived-in to him.΄

About the data

In the late 1950s Peter Townsend conducted a major investigation of long-stay institutional care for old people in Britain. The results were published as The Last Refuge (1962). Townsend questioned whether long stay institutions for the elderly were still needed and, if so, whether improvements could be made in the nature of such provision. The study was groundbreaking in its use of qualitative research methods focusing on such specific themes as old age, the residential care of the elderly, care of dependents, retirement, isolation, nursing and welfare services. In-depth interviews were conducted with numerous local authority chief welfare officers and with serving staff and residents of almost two hundred institutions. The collection held at the University of Essex contains interviews from several 1958 pilot visits as well as participant observation notes, interview summaries and reports created as part of the main investigation. In addition the study contains diaries kept by several of the residents and staff. Further there is a fascinating collection of photographs of the buildings, facilities, staff and residents taken by Townsend as part of the research.

SN 4750 The Last Refuge, 1958-1959


'The Last Refuge Revisited' began with a review of Townsend's research material and subsequent findings and recommendations. Following that a tracing study was conducted to find out and document what had happened to the original institutions visited by Townsend. It was discovered that almost forty still existed as registered care homes. Twenty of these homes formed the basis of a follow-up study where the current research team visited the homes over several days interviewing managers and some residents. They also carried out a survey of the building, taking photographs and noting any changes and refurbishments. This methodology replicated as far as possible the approach taken by Townsend and his team when they conducted their original research in the late 1950s.

Publications and outputs

Publications emerging from the project include:

Julia Johnson, Sheena Rolph and Randall Smith (2010) Residential Care Transformed: Revisiting 'The Last Refuge', Basingstoke: Palgrave.

Julia Johnson, Sheena Rolph and Randall Smith (2010) 'Uncovering history: private sector care homes for older people', Journal of Social Policy, 39(2) pp. 235-253.

Sheena Rolph, Julia Johnson and Randall Smith (2009) 'Using photography to understand change and continuity in the history of residential care for older people', International Journal of Social Research Methodology, 12(5) pp. 421-439.

Julia Johnson, Sheena Rolph and Randall Smith (2007) 'Revisiting "The Last Refuge": Present day methodological challenges' in Bernard, M. and Scharf, T. (eds) Critical Perspectives on Ageing Societies, Policy, pp. 89-104.

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