How to use the code

1.1 What the code covers

The code applies to the range of continuing care provided to older people by the NHS, local authorities and the independent sector. This means in particular:

• residential care homes;
• nursing homes;

• long-stay hospital wards and units;
• sheltered housing;
• sheltered housing with extra care.

The spirit and the principles of the code, however, are relevant across the board.

The code sets out a model of good practice and describes the principles which underlie the provision of good quality care. Readers should take note of the following points:

• in the case of homes setting up for the first time, particularly where they are being newly built, it is realistic to expect the code to apply in all respects;
• the size of a home should not mean that the principles (for example, of the importance of domestic scale) are not observed;
• where standards cannot be achieved immediately (because of financial constraints, the physical limitations of existing buildings or planning and building regulations) the code should be regarded as developmental. It sets out standards which should be aspired to and achieved over time;
• legal requirements and regulations must always be observed;
• some standards which may not be required by law or regulation should nevertheless be regarded as minimum standards. It is recommended that providers meet them in all circumstances;
• arguments that financial constraints may excuse low standards and poor quality of care are never acceptable; at the same time
• funders of services should acknowledge and accept the financial implications of raised standards and quality improvement programmes.

1.3 Content and context

The experience of coming into care, of living in a home, of the pattern of daily life, of receiving treatment and care and ultimately of dying is encompassed in the code. Some parts of the code may be more applicable to residential homes, for example, than to nursing homes or hospital wards. Other parts may be more applicable to sheltered housing. Users of the code will need to consider the applicability of some of its aspects to their own situation. The intention is not to have unrealistic expectations of residents' capacities and inclinations but to ensure that, in whatever setting, the interests of the older people living in care are served.

The code will be read by all those with an interest in continuing care and older people. In particular, it will be of value to:

• older people contemplating moving into care;
• their families, friends and other supporters;
• owners of homes; managers of homes; staff working in continuing care settings;
• inspectors;
• purchasers of continuing care in the statutory services;
• architects and planners;
• members of community or local health councils and other advisory organisations;
• any person involved in setting standards and assessing quality.

The model of good practice which the code sets out provides a benchmark against which existing provision can be judged. It shows prospective residents what they might reasonably expect in a good home. It offers owners and managers of homes a model of excellence to which they should aspire and actively work towards and, in certain areas, sets out standards below which they should not fall. For staff, it provides a wealth of information about how their own practice can improve. Like its predecessor, the code will also be able to be used by inspectors as a guide during their regular inspection of homes. Above all, A Better Home Life can be used as a basis for quality assurance for anyone working in continuing care. It sets out principles of high quality care and shows how they can be put into practice.

The code does not go into the detail of the legislation and regulations which underpin residential and nursing home care (establishments which are required to be registered) and others (sheltered housing and hospitals). Reference to these is made in the appendices and covers:

1.6 Glossary

Many terms and words have specific meaning within the residential and nursing home context. Some relate to the law and regulations, others may be used by professionals or health and social services agencies in ways which may not always be clear to the general public. In some instances, the code has made decisions about usage for the purposes of clarity and consistency.

The following glossary of terms sets out the most commonly used:

• fit person a person deemed suitable to be registered under the Registered Homes Act 1984;
• person in charge the person responsible for the day-to-day management of the care of residents;
• manager the person who may be the responsible person in charge of day-to-day care in a residential care home or the person who may be concerned solely with business or financial affairs of the home;
• resident a person living in a residential care home or nursing home or other continuing care setting;
• assessment the process led by the social services/work department in which a person's needs for services are considered;
• care manager the person organising care services for an individual whose needs have been assessed;
• key worker a member of staff who is given prime responsibility for ensuring that a resident is looked after in all respects;
• care plans a written statement setting out what care and support a resident needs and how it is organised;
• registration the formal process of ensuring that only those who are suitable in all aspects to offer care to vulnerable people are awarded a 'licence to trade';
• inspection the process of ensuring on a periodic basis that certain establishments in all sectors of care continue to meet agreed standards and appropriate legal requirements;
• inspection and registration unit an independent body located within a local authority or health authority that regulates a wide range of care services, having the duty to inspect establishments and with enforcement powers;
• dual registration where homes are registered both with the local authority (for residential care) and the health authority (for nursing care).

• must is used to apply to something laid down by law or required by medical direction;

• should denotes good practice which is expected in most circumstances. Exceptions need good reason;

• may denotes good practice which is not of highest priority and is not always applicable.