Listening and taking action


Photo Georg Arthur Pflueger

The way we care for older people, and the value society places on them and their carers, has become an ever-more urgent topic. The advent of Covid-19, prompting the discharge of older people to care homes without testing, that in turn led to tens of thousands of deaths, has shown a tendency to side-line the over-70s when it comes to collective responsibility. At the same time society demanded they ‘shield’ at home for their own sakes but in some cases failed to provide adequate support. Concurrently, our home secretary’s approach to post-Brexit immigration has been based on the idea that care workers are ‘unskilled’ and should score low on any points system. This would mean the value of overseas carers in the UK would be even further under-rated and, if their presence is tolerated, could be subject to short-term arrangements.

These two factors influencing prevalent attitudes to social care are by no means unrelated. If older people fail to be seen as part of our social fabric, with little to offer, then those who devote their working time to their wellbeing are also devalued. There is however an opposite side to this coin and a much more positive approach. This is to understand that care giving is not a one-way street where the recipient is disempowered and the giver exploited.

My own work over the last five or so years, undertaking surveys in care homes and community projects, has entailed listening with purpose to some 150 older people, care staff, managers and volunteers. Sharing their perceptions has been a revelation and has inspired me to develop further the nascent theory of relational care: that contentment, purpose and meaning in life are supported by networks of two-way relationships based on mutual knowledge and trust.

What most matters in helping people achieve greater emotional and physical wellbeing? The answers are complex but can be summarised as: engendering a knowledge that one is recognised and accepted as an individual, is known and knows others in one’s community, is able to contribute through words, deeds or presence, and is cared for as a fellow human being. 

There are many tangibles that foster an environment favourable to good relationships and these are explored in two books that have arisen from the interviews and analysis cited above. Two years ago, Developing a Model of Relational Care was published and outlined the key findings of survey work commissioned by The Abbeyfield Society and, in early October, Making Relational Care Work for Older People: Exploring innovation and best practice will become available. Both provide practical suggestions to foster a supportive network of relationships ranging from subtle changes to the environment through to a complete revision of the philosophy of elderly care. Examples include, using proven and innovative intergenerational models: introducing Montessori principles, adopting interior design and architectural guidelines that encourage positive interaction, and building community care teams that are empowered to work in fresh and more effective ways. These all have profound effects on daily life.

However, there must be a will to endorse and promote practical ways forward. In the many projects and homes that have shared their knowledge during our conversations, this will is exemplified where owners (whether private or public) have committed to a philosophy of hope and moved away from ageism and the grudging attitude that casts older people and their carers as somehow second class citizens. What we need to see now is this will for change reflected in national policy. Older people are our future selves; social carers are not unskilled and, whether ‘home grown’ or from overseas, they should be nurtured and rewarded so that they can form longer-term sustainable relationships. 

Attitude change is as important as finance but let us end with the thought that a poll by the Public Health Foundation conducted late last year revealed that there was not only deep public unease about the impact of Brexit on health and social care, but also, on a much more positive note, an increasing willingness to fund social care through income tax; this was perceived as much more fair even if it meant an increase in tax.

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