•         Legislation is in place to ensure that adequate standards of care are maintained by care providers and managers, and by local authorities. For example, the Health and Social Care Act 2008 (Regulated Activities)Regulations 2014 identifies fundamental standards to be met by registered persons, including those relating to: ‘person-centered care’, ‘dignity and respect’, the ‘need for consent’, and ‘good governance’[2]. The Care Act 2014 also identifies general responsibilities for local authorities, including the promotion of ‘dignity’, ‘domestic, family and personal relationships, and ‘protection from abuse and neglect.’[3] Nonetheless, the findings of the investigative report mentioned above raise questions about care home residents’ day-to-day experiences of living in a regulated environment.
•      The Liminal Spaces Project uses the concept of liminality (a state of ‘in-between’, neither one, nor other)[4] to explore the roles and limits of the law in regulating health related issues. One way the lens of liminality might be helpful here is in framing care homes as sites of liminality and flux, both as institutions, and for those who spend time there in their respective roles. Liminality is central to the lives of residents, care workers and families involved, albeit in different ways. We can see, however, that apparently flexible modes of regulation might not always act as an adequate vehicle for achieving ‘care’, as ethical standard. Liminality may offer us the following insights and points for further investigation:

–   Those who live there may move between, or at time overlap categories, from resident, to patient, to acute patient, sometimes within a short space of time, and sometimes not at all – how can we better account for their experiences at different stages? 

–   In many cases elderly residents are often experiencing their own liminalstate (as a resident/patient/acute patient/dying patient) be it with physical or mental health, especially in cases concerning cognitive degeneration. Their care requirements are thus not unchanging, and often ebb and flow with their condition (for example, those with memory disorders, like dementia, often have ‘good’ and ‘bad’ days): how do we accommodate these constantly changing (and at times conflicting) requirements?

•     These questions focus of course on residents, but other important actors must also be considered; visiting family members can experience flux, particularly in an emotional sense. Some find the competing concerns of their relative’s health and independence troubling. What are the rights of family members? How do we avoid practice of relatives being banned from visiting their family members/fearing exclusion if they complain?
•     The roles of care workers are not invariant; each patient often requires varying degrees of physical assistance and/or medical care – how do we support care workers with adequate skills and ethics of care to accommodate these needs?