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4th Edition, June 2nd, 2020 Sally Nieman

How will Covid impact on our attitudes to risk and dependency? Some thoughts on working with older adults in care homes

Alongside my day job working in a London local authority, I am also a doctoral student, due to submit my registration in the coming months. My research ideas (before Covid) were growing from the prevailing policy of strengths-based approaches mandated by the Care Act 2014 and my questioning of their tension with attitudes to ageing and institutional care. I was influenced by the largely negative public and political discourse which depicts the care home as ‘the last resort’ when attempts to promote independence have failed (Blood and Guthrie, 2018). My reading further highlighted that the social work role in relation to care homes is limited, largely transactional and often focused on risk and safeguarding (Ray et al, 2015; Manthorpe and Martineau, 2017; Carey, 2016). On the positive side, I was seeing local authorities’ efforts to promote a more strengths-based, personalised and positive risk-taking approach. My research ideas then had begun to crystallise into exploring the social work role in relation to older people in care homes within the context of strengths-based practice (clearly a title that needs work if you get brownie points for snappiness..). 

Now, as Covid has overwhelmed the globe and affected our lives and practice in so many ways, I have been musing on what its impact might be on my research area and social work practice with older people in care homes more generally.  

In a recent blog, Mervyn Eastman proposes that compassionate ageism (the notion that older people are needy and require special policies to support them) can lead to ‘othering’ of older people and reinforce paternalism. Tim Dartington in his podcast, Thoughts on Dependency, explores how the current crisis is encouraging dependency, a reassuring state in times of fear and anxiety. We have, as a whole society, for the first time in generations, been encouraged to put aside our independence, accept extreme restrictions on our lives, and try to eliminate all risk as far as we can. Rationally we know that it is not possible to eliminate risk entirely, but this narrative dominates when we think about older people in care homes and is most notable currently in the way we are protecting and supporting the most vulnerable people in our society. I am not for one moment underplaying the huge public health crisis, baulking against the idea of lockdown or criticising the imperative to protect others; it is interesting though to consider how the response to Covid will impact on our attitudes to risk and dependency as we move through the crisis. The ‘shielding’ policy conjures up military metaphors and the need to protect from extreme danger. At some point, if we continue to force older people to stay indoors, no longer supporting their independence, but encouraging them to rely on the goodwill of others to keep them safe, we should ask whether we are being influenced by ageist, paternalistic attitudes.

When the crisis began, the doors of care homes were quickly locked to protect their residents at all costs, even if this denied some older people the right to go to hospital if they became ill, or to see their loved ones at the end of their lives. It took away all choice from care home residents. Again, I am not minimising the many complexities of protecting people, in an under-funded and under-resourced situation, but we need to at least ask the question whether we might be warehousing older people under the guise of keeping them safe? The current situation has magnified for me the tension between person-centred, strengths based social work practice and its role in supporting older people in care homes. When we move through the crisis towards the repair and recovery stage, we must apply an ethical lens to the argument and focus on how we can respond to dependency without taking away all autonomy and reverting to paternalism. If we don’t, how will we ever get back to a focus on positive risk-taking, a key tenet of strengths-based practice?

I have been thinking what might happen to the social work role in relation to care homes when we finally come out the other side. Covid has created a barrier by literally closing the doors, requiring social workers to carry out remote DoLS assessments and care reviews, and rely on already burdened care home staff for information. Will the social work role be strengthened, helping to repair the huge losses, and well placed to advocate for older people in care homes and speak out for social justice? Or will it be further marginalised and deepen the divide when called upon to criticise the way in which care homes have managed despite the almost impossible situation? Will future reviews by social workers once things normalise be looked at through a lens of compassion? My hope is that social workers will question and challenge the notions of compassionate ageism and think about what role they can play in supporting staff and older people in care homes to live their lives and be visible in the community. 

At the start of the year, I interviewed a social worker as part of the pilot for my research to elicit stories about how social workers see their role in relation to working with older people in care homes. One theme I noticed was how emotional responses in respect of ageing and institutional care might sit in tension with the professional role. I picked up on the social worker’s vulnerability alongside the older person, with a description of an incident that highlighted the difficulty of confronting one’s own ageing and the reality of seeing vulnerable people in care homes. I also detected a sense of uncertainty and not always knowing what to do, suggesting perhaps the conflict between professional and personal self.

This acknowledgement of how our personal experiences are intermingling with our professional roles is a feature of the current situation as the pandemic affects us all in a multitude of ways. Confronting and accepting our emotions and their impact on our work might be something positive to come from this situation and could be relevant to stop us othering older people in care homes. Thinking about the language we use may also help: constructive challenge of the military metaphors so prominent in media coverage, which not only imply that if we fight hard enough we will conquer this virus, but also supports the notion of protection and paternalism. As we start to move into the next phase of the already cliched ‘new normal’, I hope we will remember and re-examine Justice Munby’s well-worn but still highly pertinent comments: “what good is it making someone safer if it merely makes them miserable?” (Re MM, 2007). 

Sally Nieman, Professional Social Work Educator and UEL Doctoral Student 
Twitter: @js_nieman

References


Blood, I. and Guthrie, L. (2018) Supporting Older People Using Attachment-informed and strengths-based approaches London: Jessica Kingsley

Carey, M. (2016) ‘Journey’s end? From residual service to newer forms of pathology, risk aversion and abandonment in social work with older people’ Journal of Social Work 16(3) pp.344-361

Manthorpe, J. and Martineau, S. (2017) ‘Engaging with the New System of Safeguarding Adults Reviews Concerning Care Homes for Older People’, British Journal of Social Work, 47(7) pp. 2086-2099. 

Ray, M., Milne, A., Beech, C., Phillips, J., Richards, S., Sullivan, M.P., Tanner, D, and Lloyd, L. (2015) ‘Gerontological SW: Reflections on its role, purpose and value’, British Journal of Social Work 45(4), pp. 1296-1312