The Covid-19 inquiry is hitting many headlines at present, mainly for the wrong reasons, and it currently seems that its spotlight will not move to the desperately sad loss of older lives in care homes until 2025 at the earliest.
Not only were lives lost, but also during those long periods of isolation, a sense of self-worth, value and purpose disappeared for many along the way, evidencing how the focus on physical survival rather than holistic wellbeing can diminish both older people and, by implication, their carers.
Social care is not all about personal care and safeguarding and task completion and rotas and medication. These are the (often essential) incidentals of a much greater whole, which at its heart should be about mutual relationships of support, respect and love. Without this central focus, it becomes just a delivery mechanism focussed on surviving, not thriving.
Relational care: a new vision
Right now, adult social care as a sector is struggling, and re-thinking our social care system in relation to the NHS and particularly to older people is becoming ever more urgent: with some two and a half million people over 50 in the UK not having their social care needs fully met; with 165,000 vacancies in the care workforce; with a staff turnover of 25%, we desperately need a new vision.
Part of this re-visioning is an understanding of what relational care has to offer. This is a way of living that has existed for thousands of years, yet only now is being seriously considered in the context of changing the social care landscape.
Through my own studies and publications based on the voices of older people and carers, I have helped to describe and name the phenomenon (Making Relational Care Work for Older People, Kartupelis, J. 2021 Routledge), but relational care is no one’s invention. It recognises the universal human truth of co-existence and paradoxically, at the same time throws down a challenge to current views of what matters to older people and to carers.
As humans, we are naturally inter-dependent and most of us thrive in environments of sustained, supportive relationships, needing to serve others as well as be served.
“[Relational care] in essence represents a move away from a one-way flow of care towards mutuality in caring relationships whereby people are not solely ‘givers’ or ‘receivers’. It prioritises the creation of an environment that people can feel is truly their home, where they can contribute as much as they can and wish to the lives of their peers and communities. These networks, in turn, improve wellbeing and increase autonomy, providing more purpose and meaning in life for everyone concerned.”
It therefore questions the primacy of independence and the ‘person-centred’ approach in care planning.
Research defines a new model
Until now, the emerging literature about relational care has been characterised by a lack of conceptual clarity, with insufficient objective evidence about the factors that contribute to the phenomenon, which has likely constrained its potential.
Now research undertaken by the Open University, The Value and Practice of Relational Care launched in May at the House of Lords, defines for the first time the meaning of relational care and delineates the factors that favour its practice in residential and community settings.
Funded by the Hallmark Foundation, and using a qualitative mixed method approach (field research informed by a rapid review of academic and ‘grey’ literature), the key findings of this work are that there are three key components of relational care in practice: an atmosphere of respect, trust and inclusivity that nurtures belonging, a purposeful focus on relationships and a physical environment that facilitates the nurturing of those relationships and of individual autonomy.
This is an exciting, seminal study that is attracting attention from providers, charities, trade associations and the academic community.
The practical considerations
Drawing on the perspectives of older people, care staff and managers, the report identifies the key features of relational care and the environment it requires to flourish and will act as an advocate for a practice that can be transformative in the current context of social care. Its findings have been brought together into a model that underpins the outputs of the research: a full report, a summary for ready reference, a practitioners’ toolkit and, in due course, a new suite of the OU’s award-winning OpenLearn materials.
The toolkit making every relationship matter is available as an easily accessible and lively publication for training or reflection, with striking original illustrations, a case study with links to detailed vignettes, and answers to some of the challenging questions likely to arise.
The team is now hoping that, through the analysis and findings of this Open University research, there will be a greater understanding of the benefits and implementation requirements of relational care, and a resulting effect on future policy.