Social Work Practice with Older People

A Positive Person-Centred Approach

Rory Lynch, Author

• Publisher: SAGE Publications Ltd
• Year: 2013
• Print ISBN: 9781446201848, 9781446201831
• eBook ISBN: 9781446286692
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

Older people are the biggest service user group for social workers and an increasing proportion of the population. In this refreshingly positive and practical textbook, Rory Lynch draws on years of practice and teaching  experience to show how to achieve best social work practice with older adults. He takes a person-centred approach, which fosters respect by valuing the fact that elderly people have more lived experience than others.

Exploring the key theoretical approaches and methods of intervention, this book helps social workers to identify, understand and facilitate their service users' wishes for well-being and a fulfilling older age. Chapters are practice-driven, containing case studies drawn from a range of care settings, reflective questions and exercises.

Mapping directly onto the key modules on the social work degree, this is essential reading for all student social workers, especially as they prepare to go on their practice placement. It is also valuable reading for qualified social workers.

Rory Lynch is Lecturer in Social Work at Robert Gordon University.

1 Historical Context, Law and Policy

Learning Outcomes

This chapter looks at:

• How older people are perceived within a structural context.
• Retirement, poverty and the future of an ageing population.
• The legislative and policy context of ageing and how this may be socially constructed.
• The role of the family and carers in supporting older people’s needs.
• What does the future hold for older people, particularly within the context of major financial upheavals within the UK?

Introduction

Old age and ageing is something of a moveable feast. While individual older people may seek to answer specific questions of ‘who am I?’, policy makers and legislative developers may take the more pragmatic response of ‘what are you?’ This divergence of the existential aspect (Thompson, 1992) and how older people are engaged with and represented through policy and legislation may be increasingly at odds in a society where older people are referenced as net ‘takers’ as opposed to ‘contributors’. I intend in this chapter to address these issues through a historical perspective of old age and ageing itself and how policy and legislation is developed for older people within a postmodernist society. This will include an examination of Fook’s (2003) multiplicities of ‘knowing’ and how there is an increasing focus on the research-practitioner and the roles of the practitioner through experiential working in knowledge and skills development. This will also include a significant emphasis on the roles that carers and service users may play and how they may influence future policy and legislative practice through the processes of inclusive and ethical social work engagement. Concurrent structural themes and a focus on the ‘serenity’ of older age can also be misleading within practice as this may have more to do with the perceived invisibility of older people than an acknowledgement of their real, expressed need. Rogers (1980) refers to his increasing anger in old age with more extreme ranges of emotions and sensations and that sense of the intuitive/existential/spiritual matrix that he defined as the new ‘frontier of knowledge’. It does not take a huge intellectual leap to acknowledge that these finer philosophical points of existence may hold little sway when it comes to the functional aspects of how policy is derived to meet those fundamentals of existence as defined by Maslow (1987), in the current era.

World view of the older person

At the risk of stating the obvious, the longer a person lives the older he or she becomes, and the more the individual becomes identifiable as an older person. This is important in the context of the perception of ageing and its changing focus through the ages. In pre-industrial societies the choices may have been stark where an inability to contribute to food production may have had dire consequences. Similarly, cultures that prized the wisdom of age may have both venerated and supported the older person as a repository of experience and knowledge across the age of that society. These concepts of ageing are not new and in a postmodernist society practitioners need to consider the paradox of ageing as exemplified by Dewey (1939) where he suggested that as a society we value maturity but deprecate older age.

Concurrent with this is the sense that while younger people may be denigrated purely because of youth, this is a condition that they will inevitably grow out of. It is a period of transition (Garstka et al., 2004), whereas old age is a stage that is grown into and may deny older people a consideration of what is the social truth and reality of their circumstances. There is in fact no real evidence to indicate that older people make increasing demands on the welfare system or that they make unreasonable demands on that system (Bury and Holme, 1991). What there is evidence for is that older people may not be treated as equitably as other members of society when it comes to accessing services such as pensions, health care, housing and the social attitudes that prevail in relation to this group (Hughes, 1995).

Exercise

• Write down four key words or phrases that you associate with old age.
• Can you assess these words/phrases in the context of ageing and ageism?
• Where do you think your attitudes to older people and ageing come from?
• Can you contextualise these thoughts/opinions within a theoretical framework?

How do we define an ageing population?

McIntyre (1977) identifies how older age has been perceived as a ‘social problem’ by policy makers, where there is a tendency to frame the needs of older people within the language of dependency and crisis. As practitioners we cannot deny the reality of the increasing demographic of ageing. Almost 16% of the population is over 65 years of age and almost 2% are over the age of 85 years, with a perceived significant increase in the ageing population generally through improved medical and health care. It is all too easy to lose sight of the real discourse that should be taking place in relation to ageing and a consideration of how this is socially constructed and where older people need to be supported and encouraged to take more control over their lives (Tulle and Lynch, 2011).

It is certainly not helpful to draw any comparative analysis between chronological ageing, retirement (again constructed) and the ageing process itself where people age at different stages and with different experiences of the ageing process. This sociological consideration is important if we are to recognise that it is not the inevitability of ageing that creates poverty and dependence but poorly constructed policy that relates to insufficient benefits provision (Walker et al., 1993).

This over-focus on the ‘cost’ of ageing fails to address the bigger picture of the contribution that older people have made within society as well as the actual contribution they currently make both within the wider economy and caring roles within the home. Indeed, a perceived lack of resources to meet older age benefits can also be interpreted as the reduction of contributions from increased unemployment and employers who have managed to persuade employees out of the pension system (Naegele and Walker, 1999). This, coupled with the modern societal values of individualism, and even body image, can have a detrimental impact on the practitioner. He or she may subtly absorb these values and deny that sense of individualisation within a more homogeneous overview of the older population.

A world standard of care

The Care Minister Paul Bustow, supported by his Labour shadow Liz Kendall and a group of agencies including Age UK and the Royal College of Nursing, has recommended a ‘dignity code’ that all staff would sign up to within care settings for older people. This is to ensure that older people are not ‘spoken down to or denied their dignity’ (Bingham, 2012). While any policy decision that raises the profile of the older person and a wider public awareness is to be lauded, I do wonder what role existing legislation has to play? (I refer here, for example, to the Care Standards Act 2000, the guidelines published in the mid-1990s by the Department of Health Social Services Inspectorate for standards within care homes for older people and the Human Rights Act 1998.) The danger is that the waters can become somewhat muddied here by reactive policy as opposed to a reinforcement of existing strategies for older people.

Reflective Question

• Do you consider dignity an aspect of social work ethical practice or a feature of human rights? Discuss.

Retirement

There is no logical reason why people should retire when they reach an older age, although some older people will want to devote energies to areas and interests they may feel they have missed out on during the course of their lives. Some older people may also feel that they have done their bit and it is now time to take stock of themselves, their relationships and what the future may hold. Historically, it was perceived within a capitalist ideology that older people would be effectively more expensive to maintain within the workforce. This stance had more to do with an ingrained ageism and an erroneous thinking that an older workforce would be less productive (Walker, 1992; see also Loretto, 2010). Dean (2009: 9) suggests this is not the case and more enlightened companies such as B&Q have recognised the value of employing older people ‘because of their enthusiasm for the work, much lower absenteeism and their greater rapport with customers’.

Enforced redundancy

At the same time, any formal sense of enforced retirement has more to do with social constructionist thinking and is a product of a post-capitalist society where making older people redundant effectively frees up work opportunities for younger people (Phillipson, 1982). This will also have the effect of ensuring the hoped for beginnings of a new tax-paying cohort of people, who in their own time may become superfluous to economic need. The Employment Equality (Age) Regulations 2006 follow the European Directive on age discrimination and make it unlawful for an employer to treat someone less equitably because of their age. Unfortunately, the UK government decided on a ‘default’ position by making it mandatory for men and women to retire at 65, thus negating the possibility for older men and women to work on beyond this age except in exceptional circumstances (R on the Application of Age UK v. Secretary of State for Business, Innovation and Skills (2009) EWHC 2336).

In the meantime the state pension age for both men and women will increase to 65 years by 2020 with an additional sliding scale of increases through until approximately 2050 (Age UK, 2011a). The government identifies this as a means of ensuring there will be enough taxpayers within any age cohort to ensure there is funding and resources available to meet the needs of those more vulnerable in society. This would also take account of any potential decrease in the population up to that date.

Retirement and employment

Paradoxically, as forces impact on older people to ensure they retire, often at an age that is not of their choosing, the projection for the future is that we will need over 13 million more workers to make up for a shortfall in retirements and new and more advanced methods of working (UK Commission for Employment and Skills projections for 2007–2017). Since these figures have been published there has been a dramatic downturn in the economy generally, with over 1 million young people now out of work. The focus for the future will be the dichotomy that exists between a competitive market for employment generally that may disadvantage older people and the potential downturn in taxpayers to fund the needs of older people in the future. Interestingly research carried out by Walker and Maltby (1997) within a European perspective clearly showed that both younger and older respondents were opposed to any idea of people retiring in their fifties to make way for a younger generation. This has probably more to do with a consensus view that those who have devoted their time to both personal and career development should not be stigmatised or penalised by this application.

At the same time as this debate continues there is evidence within the UK to show that while employers may seek to retain employees past retirement age, not least to ensure transferable skills do not devolve to another competitor, there is little evidence to indicate that companies are actively recruiting new older people (McNair et al., 2007). The worrying feature for the future however is that a younger generation may blame and stigmatise an older generation for taking for granted that which they struggle to achieve.

Exercise

• What do you consider retirement to be?
• What do you consider the positive and negative aspects of retirement?
• What are the key features (either resources or support) that you think older people would value in retirement?

Poverty and older people

In his seminal work on poverty Townsend (1979) recognised that any discourse on poverty had to have a consideration of those wider inequalities that exist within society. He suggested that an emphasis on the disparity that existed between the haves and have-nots would give a better picture of the demographic of wealth distribution and structural inequality and poverty. What is clear is that, where there is a significant level of pre-existing discrimination and poverty, even small adjustments to the income of older people will have a significant impact (Smale et al., 2000). Walker (1981) suggests that since information on older people has been collected ‘systematically’ there has been clear evidence that older people have been one of the largest groups who habitually experience poverty. They have been identified as the group more likely to be poor than any other sector of society. The authors of the Poverty and Social Exclusion Survey (2006) have suggested that between 32% and 62% of all older people households will experience some degree of poverty (Patsios, 2006).

Indeed, Scharf (2009) identifies that an average under-claim of benefits by older people of £28 per week may not appear significant but may have the capacity to move someone from a basic subsistence level to an increased quality of life. While the Welfare Reform Act 2008 went some way to addressing this issue by identifying where direct payments could be made, this needs a reinvigoration to find those older people who are eligible, particularly within the current financial climate.

Already we see that within the benefits system there is evidence that older people are depriving themselves of the basic necessities of life to cover amenities such...

Table of contents

• Cover
• Half Title
• Acknowledgements
• Title Page
• Copyright Page
• Acknowledgements
• Contents
• Contributors
• Introduction
• 1 Historical Context, Law and Policy
• 2 Values and Ethics
• 3 Skills in Working with Older People
• 4 Community Care
• 5 Mental Health and Well-being
• 6 Dementia
• 7 Assessment and Intervention
• 8 Gerontology
• 9 Care Settings for Older People
• 10 Being a Research-Practitioner
• Conclusion
• References
• Index