by Dr Jenny Kartupelis, Trustee of St John’s Hospital Almshouses, Bakewell

Writing about the care of older people [1] and working with a team based in the Open University [2], I have been involved in research into ‘relational care’ particularly as it applies to ageing and paid-for care. 

Relational care describes how a network of relationships can be created between older people, carers, families and community, built on a foundation of reciprocity and ‘interdependence’: an essential state for most human beings. A problem with care-giving, whether formal or family based, is that it is often predicated on a ‘giver’ (the carer) and a ‘receiver’ (the older person).  This can put undue burdens on the carer and diminish or disempower the other person as though they had nothing left to offer.

Rebalancing relationships

This problem can be addressed by re-balancing: recognising the wish and ability of older people to contribute to their relationships and community wherever they can, even in what may be difficult circumstances. The benefits of more equal relationships are manifold, and apply to formal and informal care alike, including community-based interactions such as those in clubs, schools or meeting centres. Older people may offer their wisdom, time, stories, experiences and practical knowledge such as craft skills.

The importance of human connections

There are few people who would disagree that good interpersonal relationships play a key role in almost everyone’s life, from birth to death. Partners, friends, relatives and neighbours are there for us and vice versa in times of need, and to share times of joy. We may think that we generally choose with whom we will form relationships: selecting friends and keeping them close; making the life-changing decision of committing to a partner.  But of course many more people come our way by chance, as we move for education, jobs and homes, yet they are the people who can become absolutely critical to our well-being, as we can be to theirs.

The implications of ageing and almshouses

Ageing may bring more losses than new relationships, making people who are close to us all the more important. And the chances are that at least some of them will be with us by force of circumstance, especially if we need professional care.  What are the implications for almshouses, and how can they respond to help make care relationships work?

A model for relational care

Almshouses, which have been supported and developed by and for their local community over hundreds of years, offer an excellent model in which relational care can flourish. Not only can paid and unpaid care be brought in by residents or their families, they provide a real home in which the relationships of care can be ‘held’ and nurtured.

Creating the right environment

The environment where encounters take place has a critical role in enabling this to happen naturally. It needs to offer a real home, not an institution or a hotel: a place where everyone feels they belong, whether living, working or visiting as friends and trustees. A secure base from which to interact with the world. A place of acceptance, where all can be involved in making decisions and being heard, where there are rooms and gardens offering easy conversation and private spaces to be alone.  

The role of trustees

Trustees have a critical role to play in achieving an environment which works in this way, and which remains financially and physically secure over the years: their choice of managers, residents, investment in maintenance and new developments will profoundly affect the atmosphere and sustainability of their almshouses.  Knowing their residents well, they are uniquely placed to discreetly help them achieve the right balance between privacy and company; have their independence with a sense of security; be part of a unique home that gives them freedom to enjoy life there and further afield within a network of relationships.

[1] Making Relational Care Work for Older People (Kartupelis, J, 2021, Routledge, London and New York) – shopping link

[2]  Gopinath, M., DeLappe, J., Kartupelis, J., Larkin, M., Wilson, A. (2023) ‘The Value and Practice of Relational Care with Older People’. Open University. DOI: https://doi.org/10.21954/ou.ro.00015a63

posted 10 September 2026