Charging and Quasi-Markets in Community Care: Implications for Elderly People with Dementia

Social services authorities in the UK are increasingly involved in charging and fee collection activities with clients in receipt of community care services. This article explores the implications of these developments for elderly people with dementia. The starting point of the article is a critique of existing legal and administrative options for handling other people's money, including the difficulties and dilemmas raised for both paid and unpaid carers by the existing arrangements. This is then related to the failure of charging and fee collection systems which have developed as a result of the community care reforms to address the particular needs of elderly people with dementia. A case study of policies in one local authority is outlined and this is followed by the presentation of the view of 37 fieldlevel professionals who were interviewed in focus groups. The concerns of these respondents included the complexity of the assessment task, conflicts between care managers and finance/revenue staff, the difficulty of defining and responding to financial abuse, and dilemmas over the extent to which relatives and carers should be trusted. The final section of the article considers the implications of a move to quasi-markets in social care for elderly people with dementia, particularly in terms of their vulnerability to financial exploitation.     

Staff and family attitudes to fences as a means of detaining people with dementia in residential aged care settings: The tension between physical and emotional safety

This study investigates staff and family attitudes towards the use of the fences that surround many aged care facilities in Australia, in the context of indefinite detention of people with dementia. This indefinite detention has been described in a report from an Australian Senate Inquiry as “a significant problem within the aged care context”, which “is often informal, unregulated and unlawful”. Five focus groups comprising direct care workers, family members, nurse unit managers and facility managers discussed the reasons for and their attitudes towards fences. The results show a tension between the provision of physical and emotional safety. This is to say that even while it is illegal to detain people with dementia against their will, and even while participants understood the negative impact of fences on the well‐being and emotional safety of people with dementia, they accepted and supported the presence of perimeter fences because they provided the perception that fences kept people with dementia physically safe. This has implications for redressing the balance between physical and emotional safety in policy and practice.     

Care, control and change in child care proceedings: dilemmas for social workers, managers and lawyers

This paper draws on findings from an interview‐based study of the ways that local authority social workers, social services managers and lawyers work together in child care cases in England. The study shows how stressful social workers can find care proceedings, and how much they look to the lawyers for support. It also shows how the lawyers’ involvement can bring new stresses and dilemmas. The managers are especially likely to resent ‘over‐involvement’ (as they see it) from lawyers, but lawyers are quick to defend their role and responsibilities. The paper shows how the complex, multifaceted dimensions of care, control and change interweave with professional differences in care proceedings: care for children, parents and social workers; struggles for control against the court, the other parties and sometimes the other professionals on one's own side; and responsiveness to change set against wariness about ‘lawyers’ deals’ and undue risk to children. The paper concludes that the valuing of difference, rather than its avoidance or suppression, is at the heart of effective inter‐professional work. It calls for greater recognition of this in current initiatives to promote interdisciplinary working in children's services in England.     

“Build a friendship with them”: The discourse of “at‐risk” as a barrier to relationship building between young people who trade sex and social workers

Young people in statutory care and protection interact with social workers, who hold potential to provide a supportive adult role in their lives. Many however, run away at an early age and end up on the street trading sex for money or other favours. There is potential to improve outcomes for young people in care if the relationship between young people and their social workers is better addressed. This paper uses data from a qualitative study of 14 young people who traded sex and who had experienced interactions with social workers. A thematic analysis identified three themes: the rigidity of social work practice; contesting the family situation; and resisting the at‐risk label. We argue that to have any impact on outcomes for young people in care, social workers need to prioritise relationship‐building above the need to conform to organizational protocols and guidelines. Such guidelines assist the social worker in assessing whether family situations pose high risk for a young person, but the “at‐risk” label is contested by young people, which results in a lack of trust and a barrier to relationship building.     

Compulsory intergenerational family solidarity shaping choices between work and care: Perceptions of informal female carers and local policymakers in Estonia

Estonians are obliged by law to provide maintenance for family members who are unable to cope by themselves. As a result, 80% of fragile older people receive informal care. Whether this is because the carers themselves feel solidarity and choose informal caring or because they lack alternatives is the question. We applied the cultural approach for explaining the construction of compulsory family solidarity in care provision to older people through the perceptions of informal carers and policy actors. Our interest is in how filial norms framed by individual responsibilities of care provision required by law can influence (i) informal carers’ perceptions concerning their choices between work and care and (ii) impact policy actors’ perceptions concerning eldercare service provision. Analysing the empirical data produced during focus groups with female carers and interviews with policy actors, we demonstrate the triple‐fold pressure to informal caregiving as an expression of compulsory family solidarity. Key Practitioner Message: ? The article demonstrates how the national Family Law Act constitutes a compulsory requirement of family solidarity in society; ? The compulsory family solidarity norm influences local‐level policymaking and inhibits the development of formal care services for older people; ? Informal carers’ choices between work and care are shaped by their personal filial norms, familialistic policymaking, and pressure exerted by older people.     

Ethical Dilemmas and Areas of Social Work Intervention in Spain

Abstract

The purpose of this study is to identify the types of ethical dilemmas that Spanish social workers face in their respective areas of intervention. The intervention areas that have been studied are health, children, immigrants, women, family, marginalized persons, ethnic minorities, young people, prisoners, elderly people, refugees and asylum seekers, schools and social and employment-related integration, mental health, disability and drug addictions. A quantitative methodology was chosen using a version of the questionnaire prepared by Eileen J. Ain in a sample of 700 Spanish social workers. The statistical analysis shows the correlation between the different areas of intervention in Social Work and the most significant ethical dilemmas that such professionals have to solve. The most pertinent ethical dilemmas are found in the healthcare sector (confidentiality, disclosure of personal information and patient autonomy). The article is an important contribution for Social Work at the national level that emphasizes the importance of the ethics of Social Work in social interventions. It is proposed to deepen the investigation of each of the areas of intervention for future research, as well as to carry out comparative studies between different countries.     

Is there a field of social work?: Trainees evaluating social problems and social work

My aim was to study the experiences and priorities of two age groups of social work students practicing in client-centered social work. This article is based on the research on rationality and language games in social work. The target groups of the research project as a whole were the actors: the heads and social workers or activists in public social welfare and health care agencies and institutions and in voluntary associations and action groups, and finally, two subsequent classes of students from a school of social work, during their practicing periods. This article concentrates on the trainees. At first, the trainees wrote essays and kept diaries. Secondly, they marked their standings on graphs visualizing different types of information contents and social relation structures. Thirdly, they made their choices of reasons for and solutions to social problems on a problem wheel. The trainees' study, using different data gathering techniques, partly confirms the results of the research of the other actor groups, in which the data were derived using questionnaires and interviews. The trainees' study shows variation in the respondents' priorities within and between specified social problem categories. Qualitatively analyzed, however, the characterizations of social work, both those who currently act in and those aiming to enter this field, resemble one another.     

Actors,legitimation and cultures of social work*

This article is based on my study of rationality and language games in social work. The study focuses on the actors of social welfare and health care. Included are the heads and social workers of public welfare and health care agencies and institutions, officials of voluntary organizations, and activists in social change-oriented action groups. The objects of this study also differ with respect of their official status, area of responsibility, and position at work. The study tries to increase the understanding of the basic rationalities which are guiding social work as part of the daily routines, and of how the actors articulate and legitimate themselves, one another and the others, i.e. clients etc. The empirical data were collected using questionnaries. The study shows that organizational affiliation and area of concern do not bring about a systematic variation in the views of the respondents. The results then indicate the existence of a specific culture, a code of social work. The actors legitimate themselves according to system rationality. The system is considered to be outside the immediate scene of social work practice, which is articulated according to life-world premises. In client-centered social work, the external controlling and administrating system rationality threatens life-world aspects by neglecting social work as a process based on involvement, dialogue and change.     

Choice and control in social care: Experiences of older self-funders in England

This paper considers the experiences of older self-funders in England in the context of policies promoting choice and control. Self-funders are people who are not state-funded; they pay for social care from their own resources. Choice and control have been operationalized through personal budgets, based on the assumption that managing resources enhances ability to access appropriate care and support. This paper uses data from 40 qualitative interviews with self-funders and their relatives, and 19 with professionals. It explores the impact of the financial and social capital that self-funders are assumed to have and asks how older self-funders experience choice and control. The study found that older self-funders drew on personal experiences, family, and friends for information; were reluctant to spend their wealth on care due to competing priorities; and felt they had more control over the timing of decisions than people who were state-funded. Personal wealth appears to be perceived differently to funds “gifted” to people through cash for care schemes.     

Dilemmas in the daily work of social insurance officers

Social insurance officers, through their work with rehabilitation, have become an important part of the welfare state. The aim of this study was to explore the nature of the dilemmas they experience in their daily work using the critical incident technique. Dilemmas reported concerned 1) cooperation with other agents in the rehabilitation process, 2) internal social insurance routines and 3) direct client management. Consequences of dilemmas were delayed handling, extra work, emotional strain and ethical conflicts. The dilemmas were handled through continued rehabilitation, coordination measures and decision-making. The findings showed the division of medical investigation and benefit decision in two authorities, the lack of education in behavioral sciences among the officers and divergent goals in different authorities. Further studies are needed on the rehabilitation process as well as the daily practice of social insurance officers.     

Representing personal and common futures: Insights and new connections between the theory of social representations and the pragmatic sociology of engagements

To understand social issues and practices such as those related to climate change and technological change that are clearly future-oriented – collectively experienced events that are “not yet” – and co-constructed by different actors, we need nuanced conceptualizations of how people think about, negotiate and co-create futures that allow us to understand not only what people (can) think and do about future-related issues but also how that happens, what for and with which implications. However, so far, one of the key theoretical approaches that has conceptualised how people make meaning in situations of change and uncertainty – the socio-psychological social representations theory (SRT) – has not often engaged with the future or with different forms of temporality. By contrast, the French pragmatic sociology of engagements and critique (PS) has engaged with these notions, conceptualising them in relation to materiality and a plurality of moral orientations – two dimensions often seen as key to how collective futures are made and imagined. To offer a more nuanced and systematic conceptualization of how people represent the future and with what consequences, this paper will present, compare and synthesise SRT and PS, as a first step towards an interdisciplinary research agenda on social change and representations of the future.     

Social Work as a Social Institution

This paper discusses trends in social work in the last twenty-fiveyears. Within the broad theme of social work as a social institution,more detailed attention is focused on: services for childrenand elderly people; manageralism; and social work research andevaluation. Processes of secularization, professionalism andmanageralism have weakened the impetus for social reform. Thishas sharpened dilemmas for social work in balancing benefitsfor service users and public involvement with tight state controland regulation.     

Towards a pragmatic approach: a critical examination of two assumptions of indigenization discourse

The current discourse of indigenization has been dominated by a normative approach that puts culture and social work values at the centre of discussions of social work's transference ‘from the West to the rest’. Taking a social constructionist perspective, this article argues that we need to critically examine some underlying assumptions of this normative approach, which may have led to misunderstandings of indigenization. The pragmatic approach, which I suggest as an alternative, views indigenization as a process in which various actors with various cultural lenses select the components of Western social work that can be integrated with, or replace, existing local social care practices. The purpose of this integration and replacement is to better serve the needs of the receiving society and its people.     

The Political and Economic Impact on the Development of Social Group Work in Taiwan

This article uses a political-economic lens to clarify the development of social group work in Taiwan. During the past 50 years, Taiwan has experienced a great economic and political transition. This article focuses on three different periods of time. Under the political repression of the 1950s and 1960s group activities were a means of social control. In the 1970s economic development evoked social changes that led to relaxed controls over civil organizations and political freedom. Community development and “Americanized” social work education marked the first step for social work with groups. During that period group work in Taiwan placed more emphasis on individual problems. In the 1980s political change brought the expansion of group work in Taiwan. An open political scene and flourishing social movements gave impetus to extension of various forms of group work in all kinds of situations. In particular social action and self-help groups played a critical role in the growth of the interests of people.     

Applying critical social work in direct practice with families

This paper seeks to further discourse concerning the implications of critical social work for direct practice with families and children. It presents and discusses a hypothetical example of how a social worker in a social care agency in Israel can incorporate critical social work notions into an official social work report. The paper begins by presenting key concepts in critical social work, their manifestations in practice and their implications for official social work reports. It then presents a mock report informed by critical social work ideas and discusses its structure and contents. The mock report provides an example of how abstract notions central to critical social work can be actualized. The paper thus offers practitioners the opportunity for a richer discourse on the contribution of critical social work to direct practice with families and children.     

Learning Experiences of Older Volunteers in a Community-based Social Program for People with Dementia

Abstract

This qualitative study aimed to explore older adults’ perspectives on volunteering in an activity-based social program for community-dwelling people with dementia called Stepping Stones. Semi-structured interviews were individually conducted with eight older adults who had volunteered in Stepping Stones. Interpretative phenomenological analysis was used to analyze interview data. Four themes related to learning experiences of older volunteers in Stepping Stones emerged. These themes include (a) self-growth and confidence in working with people with dementia; (b) understanding dementia, people with dementia, and needed support for people with dementia and their families; (c) desire not to develop dementia, while recognizing that anything can happen in old age; and (d) exercising person-centered approaches and taking on advocacy roles. Findings suggest that older volunteers gain feelings of personal growth and confidence in working with people with dementia, better understanding, and enhanced attitudes toward people with dementia through volunteering in an activity-based social program for people with dementia. Older adults will be able to fill the needs of community programs for people with dementia, while experiencing benefits from volunteering and learning in later life. Further research is needed to examine to what extent having previous dementia experiences make their experiences and learning different.     

Exploring the ethics of treatments for depression: The ethics of care perspective

This article explores the ethics of current treatments for depression through the lenses of social work values and ethics. As a vehicle for analysis, the approach associated with ethics of care will be utilized. Particular attention is paid to ethical dilemmas in the treatment of depression under the auspices of managed care companies. A case example is presented to help social workers understand these dilemmas in the context of practice. Adopting an ethics of care perspective would mandate that social workers become more politically active, and work toward integrating direct and indirect practice approaches in treating people who suffer from depression and similar problems.     

Social Exclusion, Inequality and Social Work

This paper sets out the environment of inequality in which social work and the poor have recently operated. It explores pragmatic and idealist arguments concerning whether or not the poor need social work. Finally, policy solutions developed in consultation with social service users and carers are suggested in relation to poverty and social exclusion. Social exclusion can be linked to relative poverty as exclusion from economic and social norms. However, there is a wider brief in our own government’s publications and those of Europe, of examining how people are excluded from actions and policies of agencies who are there to support them. This paper will retain the concepts of poverty as lack of material income, and inequality as the gap between the rich and the poor, while being aware of the policy implications for social service users and carers of the more comprehensive process of being shut out partially or fully from social, economic, political and cultural systems. The debates around social work, social exclusion and inequality that follow establish: that some of the poor do need social work; that the poverty of social service users is related to policies that have restructured welfare in Britain; that the reason for individuals approaching or being referred to social services are complex but are likely to include financial deprivation as a key contributory factor; that if the poor do need social work, advocacy is essential rather than social work being seen as concerned only with social control—taking children into care, mentally ill people into hospitals, and advising the DSS on the suitability of claimants for benefits. Finally, the discussion turns to new policy agendas on social exclusion instigated by the Labour government. What positive difference can such policies make for social service users, their carers and social workers?.     

Would Palliative Care Patients Benefit from Social Workers' Retaining the Traditional 'Casework' Role rather than Working as Care Managers? A Prospective Serial Qualitative Interview Study

Social workers have made a significant contribution to the developmentand delivery of palliative care. Both palliative care and socialwork are rapidly evolving but, given their changing contextsand increasing workloads, can they sustain compatibility? Advancesin treatment of life-threatening illness mean that people livelonger in a period of palliative care. Social work has undergoneradical change in the wake of the 1990 NHS and Community CareAct and subsequent local-authority modernizations, with socialworkers now given the role of care managers, rather than themore traditional ‘casework’ or therapeutic role.This paper aims to explore the current and potential role ofthe social worker in palliative care for people with cancerand other prolonged life-threatening illness. It draws uponevidence from a prospective qualitative, patient-centred researchstudy, which detailed the experiences of forty people with lungcancer and advanced cardiac failure, and their personal andprofessional carers (Murray et al., 2002). A total of two hundredand nineteen qualitative interviews were carried out. We found that social workers were conspicuous by their absencefrom the lives of these forty vulnerable adults, who were livingand dying in the community with many unmet needs which, potentially,could be met by social-work input. The study highlights sixareas of concern in which social-work assessment and interventioncould have impacted on dying patients’ quality of lifeand that of their carers: loss and dependency, family-centredissues, carers’ needs, practical tasks, emotional andspiritual struggles, and finally, support needs of staff. Theseareas are outlined to explore the territory which a social workermight inhabit if resources and policies permitted.     

A comparison of state support for young people leaving care in Norway and Sweden: Differences within comparable welfare systems

The aim of this article is to account for and discuss support to young care leavers within the comparable welfare regimes of Norway and Sweden and to explore key differences between these 2 countries. This model implies that children and young people are included and entitled to support through being family members, not as independent actors in their own right. This makes young care leaver's transition from care to adulthood problematic—as they often do not have access to family support, they may be positioned in a vacuum where they are clients neither entitled to support from the child welfare system nor supported by their families of origin. In Norway, legislators and policymakers have agreed that care leavers need particular attention and targeted support, whereas in Sweden, there has been no such agreement. However, the Norwegian system of giving leaving care services is not strong enough to provide transition support to all care leavers, even if the legislation gives stronger protection than in Sweden. The article discusses the need for targeted measures of support for a successful care‐leaving process.