Monday, February 22, 2016

Older Adults: Client rights to dignity and autonomy

Social workers must be vigilant in how they wield their power

A social worker comments on a case involving a vulnerable woman with dementia

Barbara* (*Not her real name)  is an 81-year-old woman who has lived alone in a privately rented house for many years. She has no family but for the past four years has relied heavily on the help of two dear friends (A and B) and neighbours. I also know Barbara as a friend and have witnessed her severe decline in functioning over the last year due to her dementia.

Barbara came out of hospital in 2012 and was given a care package of two visits a day which was, until a few weeks ago, reduced to only one morning call, despite her dementia worsening.

Friends and neighbours

This care was intended to take some of the load off her two close friends, both older women with their own health and/or family issues.

Shopping, laundering, bill paying and general love and care continued to be provided by A and B. Other neighbours helped with practical tasks and their time. Three friends held keys to her home as she would not answer the door.

The state of her house can be seen in this news report by BBC London. Her incontinence and wariness meant that one care visit a day was simply not enough to help Barbara live in dignity. She accepted some level of personal care from A and B but the increasingly soiled clothing and furniture could not be their responsibility. They complained to the care agency over many months as that was their only point of contact with the care system.

Giving up caring responsibilities

Just before the BBC piece went to air the care was increased to four visits a day. Immediately afterwards Barbara took ill and was hospitalised.  A and B said then that they wished to give up all care responsibility and relate to Barbara as her friends only. They explained they were simply not able to provide the intensive levels of care which Barbara needed.

They felt she needed a placement in a residential setting with 24-hour supervision. Barbara goes to bed at 6pm and consequently is up in the early morning hours. When she falls she does not use her alarm pendant.  It is A and B who find her in the morning if she has fallen.

The Care Act and the Mental Capacity Act govern how Barbara’s needs are to be met. One of the duties of the social workers in these cases is to promote Barbara’s wellbeing and, as part of this, consider her personal relationships.

Demanded keys be returned

For Barbara, who has no family, that means A and B and her other caring neighbours. Yet when A and B stated their intention to withdraw from being unpaid carers, a social worker demanded that they return the house keys to them.

They declined as they wish to remain good friends and continue visiting Barbara and to do this they need keys to gain access. The council then changed Barbara’s locks and refused to give keys to A, B and another neighbour.

When challenged, the council said they had the right to restrict their access in Barbara’s best interests.

The council holds a different view of Barbara’s capacity to that of A and B. They state that she does have the capacity to decide to return home, which is what she wants, and so they will provide care at home to her.

Changing locks

It is clear that under section 47 of the Care Act social workers may protect the person’s moveable property. But any action they take must be with her consent, unless she lacks capacity and they are acting in her best interests.

In which case the council must believe that “there is a danger of loss or damage” to her property. They have to believe therefore that her friends and neighbours present a danger to her property and this must be stopped by a change of locks. The implication therefore is that Barbara’s friends are likely to be criminals.


Is there evidence her friends are criminals? Given they have been helping to clean up Barbara’s faeces and soiled bedding for many, many months this would be surprising and certainly no such evidence has been presented by the council.

In this case it is hard not to feel a service user is being punished for her friends’ concerns and actions in taking her story to the BBC. They are shattering working relationships with the people closest to Barbara irrespective of the effect it might have on her already deteriorating mental health.

It reduces the client to an object of state-only intervention, where her only relationships are with professionals. It effectively divorces Barbara from her community.

Because she is old and powerless social work is enabled to do this but we must constantly be wary that social work does not become a tool of oppression simply because others are worried about ‘damage control’ to the reputation of an organisation.

Tuesday, February 9, 2016

Global: Social Work for 2016 in the UK: Service user led and relation-focused approach

Social work in 2016 must be service user led

A service user led and relation-focused approach is essential if we are to work effectively with people and families to make the most of their emotional and practical assets as well as accessing the care and support they need. Moving from a deficit to asset/strengths based approach sounds straightforward but a significant culture change is needed. But if we are we to support people in making the changes needed to deliver better and safer outcomes it is imperative that we make this move. 2016 will be a year of seeking and – I hope – delivering even more effective outcomes.

Cooperation, participation and inclusion have long been social work’s unique markers, as we strive to fully involve service users, family members and carers in the pursuit of better lives. The manner and end result of our practice is what matters most, yet often we focus too much on structure, procedure, strategy and planning. We forget these things are all aiming at good practice – not substitutes for it.

And good practice in 2016 should see a sharper focus on assessment and accreditation for post-qualification specialisms in social work, initially in child and family statutory work and with continuing support for the assessed and supported year in employment arrangements for all social workers. This is about promoting trust, confidence and resilience in social work. My wish is that more progress is made this year on improving the public perception of social work and the value of work done by the wider social care sector.

It remains essential for social work to lead on protecting human rights wherever they are threatened, applying holistic, person-centred approaches promoting independence, balanced carefully with protection and care. The ongoing requirement for approved status for social workers undertaking best interest assessor roles under the Mental Capacity Act and approved mental health professional roles under the Mental Health Act enshrines the value we can add and provides career milestones for social workers in adult services. My wish is that we can build on this and develop stronger recognition for advanced practice in these and other areas.

The challenges facing social care given the difficult spending review settlement mean social workers must be even more resourceful and imaginative as they work to identify best options for, and with, people. They must speak up and speak loudly to challenge care decisions and be part of the solution. Hopefully, this will be demonstrated in a proposed pilot scheme with named social workers able to challenge and advise clinical teams considering care and support options, including admitting individuals to assessment and treatment units.

This a golden opportunity to demonstrate the real value social workers bring in working alongside people, particularly those with learning disabilities, to ensure their voices are heard and their human rights respected.
It comes back to empathy. It is the keystone of a social worker’s skill and the basis for building relationships with people who use care services. Not only that, it establishes and sustains positive professional support networks with colleagues across the health and social care sector.

I believe social workers can step up and demonstrate their confidence and leadership to move away from traditional models in favour of personal choice, social inclusion and citizenship. Health has much to learn from social care’s progress in working with service users and carers. Personalisation and outcome-focused approaches are in the ascendant, but there is still more to do to get them right.

My wish is that the NHS can take a much broader view and embrace the value social care can bring to table. It can often feel like the NHS pays lip service to social care and fails to recognise its vital role in truly integrated approaches to responding to people’s health and wellbeing, especially in mental health, primary care and end of life care. With that of course is the wish that social care can be supported at the level required and that we value social care workers delivering day-to-day support.

Have a happy, hopeful new year!

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Tuesday, February 2, 2016

Professional development: Trauma, Self-injury, Anxiety - Vancouver and Victoria

Trauma – Strategies for Resolving the Impact of Post Traumatic Stress
Vancouver: March 7-8, 2016 (early rate expires February 15)
Victoria: March 8-9, 2016 (early rate expires February 16)
Early Rate $375; Regular Rate $420

This workshop provides a framework which describes different stages in resolving the impact of trauma, and includes key principles and strategies for working with individuals.

Anxiety – Practical Intervention Strategies
Victoria: March 7, 2016 (early rate expires February 15)
Vancouver: March 9, 2016 (early rate expires February 17)
Early Rate $198; Regular Rate $220

This workshop provides practical strategies which can be applied across the lifespan and address the physical, emotional, cognitive and social aspects of anxiety.

Self-Injury Behaviour in Youth – Issues & Strategies

Vancouver: February 11-12, 2016 (early rate expires January 21)
Victoria: February 15-16, 2016 (early rate expires January 25)
Early Rate $375; Regular Rate $420

This workshop will help participants understand the experience and motivations of adolescents who intentionally injure themselves, and provide practical strategies for working with youth.

Violence Threat Assessment – Planning and Response
Vancouver: March 30, 2016 (TBC)

For a complete list of upcoming workshops, go to

Professional Development: UBC Continuing Studies - Online & Vancouver

Lynda Monk, MSW, RSW, CPCC
  • Discover how to balance caring for yourself and caring for others in order to stay healthy while still making a difference in your work.

Feb 15-Mar 13, 100% Online, $330

Marilee Sigal, PsyD, RCC

Identify the various stages that couples go through when navigating infidelity; explore your own values; and come away with concrete strategies and interventions that you can immediately put to work.

Mar 4, UBC Point Grey, $245

Cristine Urquhart, MSW, RSW
Gain familiarity with an MI-style of communication, shown to increase engagement, reduce discord and guide conversations to support health and related change.
Mar 11-12, UBC Point Grey, $375

More courses:

Find out more and register or call 604.827.4234