Tag Archives: Care

‘Old age,more feared than death’: have we ever care about older people?

Has there ever  been a ‘golden age’ where older people were consistently valued, respected and protected by family and the institutions that make up wider society?

The World Health Organisation (WHO) suggests the abuse of older people occurs in many parts of the world with little recognition or response. This serious social problem is often downplayed or hidden from the public view,  and considered mostly a private matter. Even today, the abuse of older people continues to be a taboo, mostly underestimated and ignored by societies across the world. However, evidence is accumulating to indicate that the abuse  of older people is an important public health and societal problem.

As such, it demands an active response, one which focuses on protecting the rights of older persons, starting with  a change in our perspective on whom, and what, we value in society.

Although representations of old age and societal responses to older people have differed over time it could be argued old age is more often viewed as negative.

In ancient Greece old age was portrayed as sad, with the Greeks love of beauty marginalising the old. Although some commentators suggest the reality was more complex with the portrayal of older people in the classics as ‘both pejorative and complimentary’ (Thane). For Plato reverence toward old people was a guarantee of social and political stability, whereas Aristotle disagreed with such positive images. Cicero’s work De Senectute, written in 44 BC, points to the variety in individual experiences of ageing, acknowledging that for those who are poor and without mental capacity ageing is miserable, however, suggesting older people need to strive throughout their life to remain intellectually and physically able.

Arguably this belief still underpins social care legislation and policy today in respect of older people.

It has been suggested older people’s status in society is linked to their ability to participate in society from an economic perspective, especially in terms of activity in paid employment. Historically where older people have been unable to participate in paid employment, help and support has been provided through a mixture of family and state support, with an emphasis by government on the former rather than the latter. However, commentators suggest post industrial revolution another victim of change were the elderly. The old did not merely lose power, they also lost respect. The rise of the alms-houses, and institutionalised poor-relief, suggests that their children were increasingly shedding responsibility for their support and transferring it to the community..

Although Thane  argues, this may have been due to families own depths of poverty, rather than lack of care or a shedding of responsibility. The abuse of older people was not something government identified as a problem throughout this period, although, self-neglect was identified as an issue which government sought to address in the 1948 National Assistance Act.

This is not to say it did not occur, for example, the 1942 Exceptional Needs Enquiry found most older people living with families were there under sufferance. They were often less well off than those who lived with strangers, and lacked essential items of clothing, bedding or household equipment as families used any provision, such as clothing coupons, for personal use. Whether this constituted abuse is not clear as many families who cared for older relatives were often living in poverty themselves and older people often willingly gave their families any support they could, even if this meant going without themselves. Of course, records do not exist to either confirm or deny whether such relationships were abusive or mutually supportive, however, it might suggest in terms of individual worth and personal identity, a cultural norm existed where the welfare of the younger generation was prioritised over that of the old by both young and old.

However, Peter Townsend’s landmark study of long-stay institutional care for older people in 1950’s Britain, provides a little more insight into the experiences of older people receiving care. One of the interviews he recorded was with a matron of a small private residential home in Greater London, which Townsend suggested was by far the worst home he had visited, whilst his commentary did not discuss the issues raised in terms of ‘abuse’, if, as a researcher today, I were to hear such an account I would make a referral to the local authority and the regulatory body for residential care, the Care Quality Commission, as the interview is clearly describing ‘abuse’ as defined in policy today.

This suggests the abuse of older people has been going on for a long time, but has been hidden from public view, but we do know now don’t we.

The ‘Big Society’ will not necessarily lead to better elderly care treatment by @dianegalpin

A fantastic blog by our senior Lecturer Di Galpin for LSE Policy and Politics Blog a recommended read!!!

The ‘Big Society’ will not necessarily lead to better elderly care treatment.

Di Galpin looks at the Big Society from a philosophical standpoint and questions whether it can be achieved without encouragement from an active state.

‘Big Society’ and the future of health and social care

David Cameron suggests the Jubilee party was a ‘perfect example of ‘Big Society’.  Whilst it’s okay for a knees up, is it a suitable foundation for improving the quality of care  older people receive in Britain?

Unfortunately, David Cameron’s comments on Big Society do little to help us understand what “it” actually is, and to be honest, I am not even sure he  knows what it is beyond the usual sound bytes of ‘kitchen sink economic theory’*.  However, could the concept of Big Society actually have something to contribute to the debate on the future care of older people?

What is ‘Big Society’?

Big Society has been vilified as a return to the politics of the New Right,  a Trojan horse for smaller government,  and feted as the anatomy of the new politics  on which to establish the legitimate nature, and limits, of the relationship  between the  state and individual in a 21st century system of health and social care.  Phillip Blond is a central figure in the development of the concept of Big Society.  Blond  argues both the political Left and political Right have presided over a collapse of coherent cultural values and a shared commitment to a ‘common good’,  suggesting a redistribution of power from the ‘top’ (state) to the bottom (individual) is required, aligned with a more compassionate form of capitalism, to re-establish the common good.  For the current government this rests on the empowerment of local communities founded on voluntary networks of trust and mutuality.  From this perspective the purpose of Big Society appears to be to extend responsibility for the care of older people to local communities, rather than extending the responsibility of the state.

Policy programmes already implemented by the current government to develop Big Society include the National Citizen Service, which organise voluntary opportunities for young people, and the creation of the Big Society Bank, which will act as a central source of investment income for third sector organisations.  The Localism Bills’ accompanying guidance states ‘Big Society is what happens whenever people work together for the common good.  It is about achieving our collective goals in ways that are more diverse, more local and more personal (HM Government, 2010: p.2).

However, whilst at one level Big Society can be viewed as a mechanism of transferring more responsibility onto individuals, allowing the state to reduce public sector spending (Alcock, 2012) Big Society is also about believing in, and building on, the inherent ‘good’ within humankind.

Jesse Norman suggests Big Society involves moving beyond the ‘two way opposition of state vs. individual’ in the provision of care to ‘the three way relationship of enabling state, active individual and linking institution’ (2010,p.7).  For Norman the former is flawed because it ignores the diversity of human beings and their ability to act morally without interference from the state.  By justifying the legitimacy of the state, it polarises the individual and ignores the positive power and potential of individuals to create and maintain a ‘good society’, which cares for one another for altruistic reasons, rather than because the state legislate that society provide care and support.  Norman suggests state interference is a negative response to care provision, quoting Alex de Tocqueville (1805-1859)

“The more [the state] stands in the place of associations, the more will individuals, losing the notion of combining together, require its assistance.  These are cause and effect that unceasingly create each other.”

The ‘associations’ that mediate between individuals and the state can be conceptualised as operating within civil society.  Civil society is the space of un-coerced human action, the place where people take action as moral beings,  via all organisations and associations above the level of the family and below the level of the state.  The place where your jubilee street party was planned presumably.

Importantly for advocates of Big Society the role of government in this ‘space’ and ‘place’ is minimal.

How does this support the current approach to caring for older people?

From this perspective caring for older people, and ensuring care is dignified, is viewed as something we all agree is a ‘good thing’ and freely engage in, rather than something government should regulate or legislate for.  In this context government relies on ‘phillic’ associations, taken from the Greek ‘philia’, meaning friendship ties, affection or regard that are the essence of the space between individual and state.  Government would rather rely on these to guide human behaviour in the care sector than introducing legislation or regulation.

Hence, the governments  support for the introduction of a voluntary dignity code  (The Telegraph., 2012).

Big Society, freedom and money

However, whilst government may think treating older people with dignity and respect is viewed as a ‘given’, assuming we are all willing to  care for, and protect,  older people,  this is not necessarily true, as evidenced by a number of reports on the poor levels of care provision  older people experience across the care sector.

At the heart of the current debate are two related themes.  Firstly, an attempt to understand how the relationship between the state, private sector and individual should be formulated to fulfil a mutual responsibility in supporting dignified care for older people, and secondly  the affordability of care provision.   Successive governments since Margaret Thatcher have relied on a consumerist approach to improving the quality of health and social care provision. The question is has turning vulnerable older people into consumers improved their care?  For some yes, but for many of the most vulnerable older people in society, those older old people with dementia and who are frail, I’m not so sure.  However, what it has done is hide the abuse and mistreatment of older people from collective view for the last 30 years, and led society to engage in debate that does not move beyond the financial.  Research suggests this has had a detrimental effect on the moral health of society and academics are now suggesting the use of market mechanisms can change people’s attitudes and values, having a  ‘corrosive effect’.    Michael Sandel makes a pertinent point suggesting

It calls into question the use of market mechanisms and market reasoning in many aspects of social life, ……to motivate performance in education, health care, the work place, voluntary associations, civic life and other settings in which intrinsic motivations or moral commitments matter‘ (What money can’t buy, 2012, p122).

It is impossible to ignore the effects of systematic inequalities in liberal societies that effectively exclude, or compromise the rights of a variety of social groups.  Nor can we ignore the corrosive effect successive governments use of a consumerist approach to health and social care might have had on those ‘phillic‘ associations so vital to a ‘Big Society’.   The ‘Osborne Supremacy’  assumes the existence of a single unified ‘big society’ when it actually consists of many ‘societies’ with competing interests where the interests of powerful elites are advanced in the name of defending common interests, whilst the interests of marginalised groups, such as older people,  leave them without support.

Big Society or Big Con?

The answer will depend on your political and ideological viewpoint on the legitimate role, and limits, of the state in the provision of health and social care.  Whilst it is true Big Society clearly already exists, evidenced by the number of people already providing care freely in society, what is in doubt is whether it can be extended any further without an active state (Sullivan, 2012).

* Kitchen sink economic theory -this is a term used in my household to describe David Cameron and George Osbornes approach to the financial crisis.  It refers to a vision I have of a post war couple discussing there finances whilst stood washing up at the kitchen sink.  Gladys turns to husband Frank and says “money is tight Frank, what will we do?”  Frank turns to Gladys and answers “never fear mother, we’ll just have to tighten our belts, don’t worry we’re in this together”.  Of course Frank and Gladys are very naive and do not realise their actions will make no difference because the problem is a global financial crisis and not related to Gladys splashing out on a new apron!

Share your experiences of being a child carer

Zoe is exploring the experience of adults, who as children cared for a parent with mental health problems. Through interviews they can share their journey of growing up with, and older with, a mentally ill parent. Shebelieves that the individuals will all have a unique tale to tell and as such will allow the participants to tell their story in their own way.

If you grew up with a parent who suffered with a mental illness which included symptoms such as hallucinations or delusions, are aged 30 + and would like to take part in Zoe’s research, please contact Zoe Cowie through any of the following:

Address: B412, Bournemouth House, Bournemouth University, 17 Christchurch Rd Bournemouth BH1 3LH 

Tel: 01202 967345

Email: zcowie@bournemouth.ac.uk.

To find out more information go to Zoe’s blog – http://zoecowie.wordpress.com/ 

All communications will be treated in complete confidence and contact will not mean that you are committing to take part at this stage.  You will be sent more information before making any decision and will be able to withdraw from the study at any stage should you wish.

There is a million reasons why ‘big society’ and ‘choice’ are not enough when providing care to older people

Research suggests as many as 500,000 older people are abused each year (Action on Elder Abuse), in the main by those supposed to be providing their care.  Therefore, since the election in May 2010 up to one million older people may have been abused.  

This information is not new, successive governments have been aware of this issue for many years but all have stopped short of introducing a coherent legislative framework to protect those most vulnerable in the care system.  The coalition appear to believe in the power of ‘big society’ and service user and patient ‘choice’ in a market led health and social care system.  My difficulty with this approach is it offers nothing new,  it looks no further than the rhetoric of the ‘free markets’  beloved of every government since Thatcher.  Nobody appears interested in thinking deeper and developing care from a philosophical perspective.  Surely we need to understand what motivates us to care before we can reform the system ?

Historically societal attitudes toward older people have always been poor.  In ancient Greece old age was portrayed as sad with historians arguing the Greeks love of beauty marginalised the old, especially women, sounds familiar!  Cicero’s work De Senecute, written in 44BC, pointed to a variety of individual experiences of ageing, however acknowledging that for those who were poor and without mental capacity ageing is miserable.  Sadly, all of this is still true today with research suggesting those at greatest risk of abuse and mistreatment are elderly women suffering from some level of dementia.  This,  along with the fact that the abuse and mistreatment of older people is a global issue identified by the World Health Organisation over a decade ago, suggests the issue  extends well beyond political systems and party politics in the UK.

I’m with social contract thinkers Hobbes (1588-1679) and Locke (1632-1704) when they suggest as human beings we are inherently selfish and our individual pursuit of pleasure is destructive to society, suggesting the law can be used as an apparatus to modify such human desires.  In my view the  continued economic approach to health and social care has fed such selfishness, to the detriment of certain groups in society, i.e. older people,  and we now require a strong lead from government.

Successive governments since Margaret Thatcher have relied on a consumerist approach to improving the quality of health and social care provision. The question is has turning vulnerable older people into consumers improved their care?  For some yes, but for many of the most vulnerable older people in society, those older old people with dementia and who are frail, I’m not so sure.  However, what it has done is hide the abuse and mistreatment of older people from collective view for the last 30 years, and led society to engage in debate that does not move beyond the financial.  Research suggests this has had a detrimental effect on the moral health of society and academics are now suggesting the use of market mechanisms can change people’s attitudes and values, having a  ‘corrosive effect’.    Michael Sandel makes a pertinent point suggesting

It calls into question the use of market mechanisms and market reasoning in many aspects of social life, ……to motivate performance in education, health care, the work place, voluntary associations, civic life and other settings in which intrinsic motivations or moral commitments matter‘ (What money can’t buy, 2012, p122).

So what can we do? Helen Sullivan suggests ‘a big society needs an active state’.   A useful first step would be for government to accept the Law Commissions recommendations on reforming the law in respect of Safeguarding Adults without delay.  Secondly, abandon the rhetoric of ‘choice’ and ‘free markets’  and develop a meaningful dialogue based on concepts such a honesty, morality and dignity from a philosophical  rather than financial perspective. A new approach might be to have a dialogue that goes beyond party politics (and winning the next election) and begins by asking big society what it wants to afford, rather than politician telling us what we cannot afford.

I am sure many will say we cannot afford to reform the system on philosophical grounds, I would ask those individuals “can we morally afford not too?”

The trouble with personalisation is, its not personalisation…….

Personalisation occupies a central position in social work with adults today and was at first welcomed by social workers as a positive step forward,   however, our understanding of ‘personalisation’ is somewhat different than governments.  This is not a surprise when we look at the driving force behind its development.  Personalisation was driven not by social work, but by the think tank DEMOS (favoured first by Tony Blair and more recentlyDavidCameron) and in particular Charles Leadbeater, a journalist and writer who spent ten years working for the Financial Times and who was an adviser to a number of major private companies, including Chanel Four Television and British Telecom.  A key document from DEMOS should have set the alarm bells of social work ringing in 2004.  The ‘Pro-am Revolution’  provided the rationale for delivering personalisation.  The pre title blurb sets the direction of travel

 ‘The 20th century was shaped by the rise of professionals. But a new breed of amateurs has emerged….’

The central tenet of the Pro-Am Revolution is that with the advent of new technologies and educational systems we no longer need to rely on professionals to undertake particular tasks because amateurs are now able to operate at the same level as professionals, but without requiring large organisational structures.  DEMOS looked specifically at areas such as web design and astronomy, suggesting the same premise could be applied to education and social care, going onto say ‘Pro Ams are creating new, distributed organisational models that will be innovative, adaptive and low-cost’ which will also be ‘light on structure and largely self regulating’.  Hmm sounds familiar.

 For DEMOS, a service user was a service user, no distinction was made between the needs of those with disabilities or mental health difficulties or older people (nor for that matter the difference between a web designer and older person with dementia!).  This resulted in a flawed conception of the people who use services and their ability/willingness/desire to manage their care and the markets that would provide care.

 The conception of personalisation in a think tank has never boded well for its implementation.  However, it has been useful at a political level as it has acted as a mirage to conceal a very different agenda linked to the equally nebulous concept of ‘choice’.

Clarke (2005) suggests choice is the engine of public sector reform, with choice seen as desirable in empowering individuals to move from passive consumers to activated and responsibilised citizens. Choice as a concept remains controversial for some as it is also viewed as a route along which the marketisation of public services can travel without challenge. Whilst this is a logical extension of the previous government’s agenda for Cameron and Co, for many in practice a free market approach to service delivery underpins many of the problems experienced in social care today.

Government has exploited the ambiguity in meaning of words such as personalisation and choice to enable the social work profession to retain a semblance of loyalty to its own values, whilst unknowingly carrying out the bidding of politicians with very different ideas about social care.  

Research has explored how organisations encourage workers to engage in an agenda they do not necessarily agree with. Courpasson (2000) introduced the notion of ‘soft coercion’ which induces, simultaneously, commitment and obedience to the organisation and its aims.  Ambiguity in meaning is one such instrument of soft coercion, however, you also need to ensure the workforce accept your perspective.  One strategy used by large organisations has been the ‘company song’, often represented by the company policy which provides an organisational mantra, for example ‘personalisation leads to greater choice’.  

Maybe it’s time to change the company song and for the social work profession to choose its own playlist, if it does not there will be many in government who will be happy to do it for us!