Teaching and Learning Dignity

Yesterday there was an announcement about a new report and consultation  on the issue of ‘Dignity in Care’ (NHS Confederation – pdf).

I wrote a piece about this for the Guardian Social Care Network and don’t want to repeat myself here.

But I did engage in a brief conversation on Twitter whilst on the bus on my way to work (!) about how dignity can be assessed at interview level and how it can be possible or if it’s possible to train dignity into staff.

Apart from reverting to my possibly over-simplistic point that people are far more likely to treat others with dignity if they are treated with dignity themselves, I also reflected a lot on my role as a Practice Educator. I take social work students on placement and see them through their practice learning opportunities which (in my experience) last between 90-120 days.

It’s pretty clear to me gain insight into someone’s values over this period. Information, policies, protocols and law can be taught. Values seem to be inherent. While I think the idea of testing ‘compassion’ on interview is faintly ridiculous, there is a lot that can be learnt when you work alongside someone (not necessarily as their supervisor) over a period of months.

One thing I am very sensitive to is dismissive language. Of course, some people are unaware of the intrinsic pain that some labels can cause and that’s an issue of education. To some, an affectionate and endearing ‘old dear’ might be a term of respect but to some it might be patronising and offensive. In that sense language can be taught.

Actions speak loudly as well. I have heard of university courses that marginalise work with or about older people or mental health courses that are very dismissive of organic mental illnesses. They are somehow ‘different’ and by implication less ‘important’ to know about.

It’s easy to throw words around but words reflect values. I will be patient and explain that the first or second time if I hear patronising language or words that over generalise the needs of older adults and assume a homogenous group of over 65s – because sometimes it’s about the intent behind the language as well. I expect some learning though.

I think the needs of older adults should be reflected far more in social work training and not marginalised. Yes, it’s difficult in a generic programme to cover everything but just judging from the knowledge levels of the students who come to our team (from a number of different universities), I am surprised that there’s not more work being done on challenging ageism alongside other discrimination on the training courses.

As well as language there are many attitudes that remain worryingly present in the social work and social care field. The assumptions that older adults are dependent or vulnerable solely by virtue of their age or that age is something to fear. We need to make age more celebrated in this country, in this culture and in this area of practice so that we can better regard everyone and incorporate dignity, respect and compassion into all sectors of society – not only health and social care. That’s when the issue will truly be tackled. As for the report – I’ll give it about 2 years before we see an almost identical one giving almost identical recommendations. Cynical? Well, maybe just a little bit!

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A Dignity Code for Older People?

Old hands

The Daily Telegraph today prints a letter which sets out the need for a ‘Dignity Code’ in Health and Social Care calling on Hospitals, Care Homes and other institutions to prevent ‘issues of abuse and neglect’.

The article accompanying the letter, the Telegraph says, will encourage care workers to have this code written into their contract.
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Creating Solutions in Care for Older Adults

We’ve seen a lot of discussion over the past week or so about the ‘problems’ created by older people who sometimes remain in hospital when there are no appropriate and suitable services in the community to assist in their rehabilitation goal – which is callously referred to in policy-making ivory towers as ‘bed blocking’ – a term I’m wholly opposed to.

Last week, Mike Farrar, the Chief Executive of the NHS Confederation stated that 1 in 4 people who were in acute hospital beds could recover at home if better support were available.

Over the weekend, the government in their own now predictable fashion, entered the ‘policy making’ platform by flinging £170 million at the ‘problem’ of older people taking up these valuable hospital beds. That computes according to this article in the Guardian as a one off payment of £1m to each council to help deal with this awkward problem.

The thing is while not wanting to scoff at money offered, it’s hardly the best targeted or thought through way of delivering a better system of care for older people.
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Downsizing, Ageism and Housing

There has been much discussion following the publication of a report by the Intergenerational Foundation called ‘Hoarding of Housing : The intergenerational crisis in the Housing Market’.

Perhaps a deliberately provocative title was chosen for the report (no, I’m not completely naive in terms of creating press interest!) and there were the requisite reports  and comment pieces written about ‘Baby Boomers’ who are hoarding homes (via the Guardian) which concludes

As the foundation says, they need to be discouraged from hoarding and made to realise that someone further down the generational chain is suffering as a consequence.

Maybe these property owning,  middle class ‘hoarders’ exist in different worlds from the one that I occupy but I didn’t see that as the main issue with housing in this country. It is not necessarily a like for like swapping of those with property to those without. I also worry about the bitterness with which some of the commentary has been based and that there is an attempt, even in the name of the report, to build an ‘us’ versus ‘them’ type situation where in order for older people with the value in their property to be ‘winners’ there has to be a ‘loser’ – the younger adults trying to build families in smaller houses.

The  failing is not on the older people who live in homes that are, after all, their own homes,  but more the way the housing market has behaved over the last couple of decades.

It’s Mother’s Work posts a great blogpost  on the topic explaining and illustrating some of the undertones to this debate including the difference in the way the government considers under occupancy of social housing as opposed to that of private housing and then those second home owners.

That’s an important issue as the government will increasingly use the ‘benefits’ system to force people to give up rooms that are not needed but this report refers as well to home owners.

The housing market is biased and unbalanced but to place the blame at the door of those who are older and try and use sometimes not terribly masked ageism to force guilt is not, I don’t think the answer.

The large houses which it is proposed that older people move out of will likely be unaffordable for most people with young families. It is hardly likely to be an equivalent swap. The problem is that the cost of housing has risen at such an astronomical level that it is out of the reaches of many who did not jump on the proverbial ‘ladder’ at the right time.

Looking at the report itself, beyond the title and the headlines, there are some  interesting proposals like the abolition of universal benefits for those who live in housing which is valued over £500,000 or taxing the value of property but I would see practical difficulties with that.

I work in an area where housing costs are high and have definitely come across older people who would might be property rich but cash poor who would be terribly affected by these sorts of moves. It is possible to be ‘property rich’ through not thoughts of ‘hoarding’ but just by living in a house whose value has increased due to the location and style and to force someone away from their community due to the cost of their property feels uncomfortable to me.

I do think that more should be done to protect tenants. Short term assured tenancies tend to favour the landlord and the goal of ‘home ownership’ only exists because it is the only possibility of a secure tenure apart from increasingly rare social housing tenancies which are increasingly targeted by the government now – making them less secure.

I have a toe on the ‘housing ladder’ in the sense that I live in a ‘shared ownership’ property. Was I particularly bothered about owning a home? No, not really, but I made this move solely because I had been moved and shifted around by landlords and just wanted to live somewhere where I wouldn’t be asked to leave with a couple of months notice.

I certainly didn’t buy to invest or to rent. More social housing would be an obvious solution, as would longer term and more secure lets but the government doesn’t seem to want to consider that as a possibility. Their proposal of the extension of the ‘right to buy’ scheme seems more than wrong-footed by pushing more to property ownership rather than looking at making longer term tenancies more secure.

We have allowed ‘buy to let’ landlords to make millions on the property market and perhaps the government has no wish to tackle this group head-on to affect their profits but I think that’s the way I’d prefer policy making to go after all, if we look at the Southern Cross debacle, it’s worth remembering that it was an empire built on the value of the property rather than the value of the people who lived inside the homes.

Guilting older adults into feeling they are depriving the younger generation – well, it leaves me with a nasty taste of ageism.