Returning to care

Around 500,000 adults in England and Wales are care leavers, meaning they were placed as children in children’s homes or foster care.

Of these, some are post-war care leavers, and are now of an age where they may be returning to institutional care in older adult care settings. For those looking after and providing health services to older adult care leavers, understanding the impact of their early years in institutional care is crucial to supporting them with their health and care needs. This is especially true for older care leavers who are living with dementia.

Will McMahon from the Care Leavers Connected Project explains some of the issues arising from older people returning to institutional care, and how to support them.

Experiences of care leavers

“For most care leavers, the effects of being in care as a child can last a lifetime, especially if the care leavers were separated from parents and siblings, or experienced poor or regimented institutional care. Some may also have experienced mental, physical or sexual abuse while in care.

“Research from the Nuffield Foundation has suggested that care leavers’ general mental and physical health is poorer than average, and they’re also more likely to live shorter lives and require support from older adult care settings at an earlier age.

“Many care leavers are much less likely to have the support of relatives as they get older, as families can be fractured or absent because of traumatic events that took place many decades ago.

“This life experience may have remained unprocessed, or may be traumatic to revisit. Some care leavers spend a lifetime being impacted by, and reflecting on, their very difficult childhoods, while others have spent decades hiding the fact they were in care because of the social stigma attached.

How can health and care professionals support care leavers when they re-enter care?

“Many care leavers will have specific needs that need to be addressed when re-entering care.

“The first important step to support somebody is to identify if the person has been in care as a child. Many individuals may not volunteer this information when first asked because of the stigma they may feel or because they are not fully able to express their needs. In these cases, it can be useful to ask relatives, although on occasion relatives may not be aware – some have been known to only find out about the history of a care leaver when managing paperwork in the aftermath of their passing. Exploring several different ways to try and elicit this information is therefore helpful.

“Secondly, it’s important to recognise that for many care leavers, the thought of returning to an institutionalised care setting can be a very difficult and unsettling experience, even if they do not themselves appreciate why.

“Buried memories can be brought to the front of the mind if the return to care feels similar to institutionalised patterns of the previous care experience. For those who remember experiencing abuse in the care system as children, re-entry can create post-traumatic stress with anxieties about what might happen to them once they have been left by relatives or external social care professionals.

“Everyday experiences for care leavers returning to care in later life may also be difficult. Eating together, watching television, and the routines of everyday life in a care home could bring back unwelcome memories.

“Celebrations can also be difficult for some. Birthdays, Christmas, and New Year’s Eve can elicit mixed feelings. Some care leavers may enjoy these occasions, viewing them as a chance to catch up on celebrations they missed as a child. For others, these days can be upsetting, providing a reminder of years spent in children’s homes without close family.

“It's important to remember that many care leavers have had complicated lives with a variety of outcomes. It can take time to understand the complex emotions that result from growing up in care.

“The two key skills that health and care professionals can use to support care leavers with a positive return to care are:

1. the ability to build trust over time
2. the use of trauma-informed practice to manage the distress, anxiety and fear that may be experienced by a care leaver when they find themselves back in an institutionalised care setting they remember from childhood.

“Understanding and appreciating the life experiences and history of individuals who enter a care setting in later life is crucial to providing person-centred care and adapting to their specific needs.

“There are several tools that professionals can use to help support the transition of an older person, particularly a care leaver or older person living with dementia, into care settings. This includes a ‘This is me’ leaflet, which was established to help health and social care professionals better understand who the person that they are caring for really is, which can help them deliver care that is tailored to the person's needs.”