Global Social Justice for Older People: The Case for an International Convention on the Rights of Older People

Older people are beginning to represent a large proportion ofthe general population and have become a major area for socialprogramming in many parts of the world. However, neglect orviolation of older people’s rights is common. Until recently,there has been a surprising lack of advocacy on the part ofnon-governmental organizations (NGOs) and human rights activistsfor a legally effective international convention on the rightsof older people, as compared with other vulnerable groups suchas children and women. This paper argues that the introductionof an international convention on the rights of older peopleis long overdue. Such an international convention should containcomprehensive and legally binding provisions which would requireratifying states to promote older people’s rights. Itshould be reinforced by a strong monitoring system that wouldinvolve key members of the international community. This paperoutlines the arguments in favor of the creation of a transnationalhuman rights agreement for older people and proposes that internationalNGOs and human rights advocates should work toward creatingsuch a convention.     

The Single Assessment Process in Primary Care: Older People's Accounts of the Process

Recent government policies have been active in addressing socialinclusion and active participation of older people in many aspectsof societal life. Independence and well-being animate thesedevelopments and are evident in the emphasis on person-centredservices within the single assessment process for older people(Department of Health, 2002b). Drawing on a feasibility study of the Single Assessment Processas a ‘case-finding’ approach, this paper presentsfindings drawn from older people’s accounts of this experience.These accounts indicate the potential of the process for identifying‘low-level’ need, whilst raising issues of accessto formal services and resource constraint; also they underlinethe importance of understanding how older people seek ways ofmanaging their own health and well-being, whilst continuingto contribute to the social cohesion of society by providingsupport to their peers and to younger generations. Interdependence, it is suggested, rather than dependence shouldunderlie any approach to assessing older people’s needs,if we are to appreciate and build upon the complexity of olderpeople’s strategies for actively managing their lives.     

Young People, Risk Taking and Risk Making: Some Thoughts for Social Work

Policy makers, professionals and the public have become increasinglyconcerned with identifying and managing young people who arenot only troubled or at risk, but troubling or risky. Socialwork, however, has been relatively silent on the subject. Insocial work practice, young people have become largely ‘someoneelse’s problem’; in the academy, relatively littlecritical attention has been given to their risk taking, or tothe way we ‘make’ or construct it. This paper takesan exploratory rather than systematically comprehensive journey,across a range of discursive terrains, to open up the debate.Examining current concerns with youth and risk, it exploressome of the social and psychological theory bases whereby youthis constructed as a risky business. Drawing on empirical researchfrom several disciplines, it examines patterns and dynamicsof young people’s risk taking, and explores concepts ofrisk culture and cultural learning, identity capital and Bourdieu’snotion of ‘habitus’, to frame these. The discussionhighlights the need for critically reflective social work tounderstand the complex interplay of identity and agency, structure,culture and context that underpins young people’s risktaking. It encourages us to scrutinize our judgements of whatis acceptable or unacceptable riskiness, what within and whatbeyond the pale.     

Keyworkers Re-examined: Good practice, quality of care and empowerment in residential care of older people

Correspondence to Rosemary Bland, Department of Applied Social Science, University of Stirling, Stirling FK9 4LA, Scotland Summary Social work definitions of ‘good practice’ in residentialcare which were originally developed in work with children andyoung people have also been applied to residential settingsfor other user groups, including older people. However, anylink between such elements of practice and positive outcomesfor users has not always been demonstrated. The introductionof market principles and orientations into social welfare inthe 1980s re-defined the social work ‘client’ asa ‘consumer’ with the associated power to make choicesin the area of social care. The success with which such an approachcan be applied to services for people who are very often, notin a position to exercise much choice, is debatable. Alongsidethe notion of the ‘consumer’ or ‘user’of services has grown the ideology of ‘empowerment’of people who use social work services. Drawing on findingsfrom a recent study, this article explores the contributionof the keyworker role to good practice and the empowerment ofolder people living in residential homes. It concludes that,because their understanding of the concept and practice is largelyundeveloped, the role as currently interpreted is not consonantwith good practice and tends rather to reinforce the power ofstaff.     

Care Management and Professional Autonomy: The Impact of Community Care Legislation on Social Work with Older People

Correspondene to Mark Lymbery, Centre for Social Work, School of Sociology and Social Policy, University of Nottingham, University Park, Nottingham NG7 2RD, UK. e-mail: Mark_Lymbery{at}nottingham.ac.uk Summary The 1990 National Health Service and Community Care Act appearedto herald a new dawn for social work with older people, whichhad previously been a relatively neglected and undervalued areaof social work practice. The legislation proposed a new rolefor social workers as ‘case managers’, with considerableautonomy and flexibility about the way in which the ‘casemanager’ responded to need. By the time community carepolicy was implemented, the role of ‘case manager’had been transformed into that of ‘care manager’,with a focus which emphasized procedural and managerial requirementsrather than a more flexible professional practice. This paper explores the extent to which this shift has substantivelyaltered the nature of social work practice with older people.It outlines key theories of professions and their applicabilityto social work, and critically analyses the impact of the ‘newmanagerialism’ within social services departments. Thepaper also examines the nature of social workers' practice witholder people following the impact of community care legislation,and concludes that the impact on the social work professionhas been to locate an increasing control of practice with socialwork managers, with potentially serious consequences for thecontinuation of a distinctive social work role in relation toservices for older people.     

A Child's Eye View: Dementia in Children's Literature

This paper explores accounts and understandings of dementiathat are encountered infrequently. Children’s views ofdementia are under-explored and yet children, too, must be beinginfluenced by the growing public knowledge of dementia as anamed disease, particularly of old age. The first section notesthat many children will encounter dementia among family members,their grandparents and great-grandparents in particular. Thesecond section considers fictionalized accounts of dementia.These are assuming greater exposure, not so much in the professionalwelfare domain, but as a plot or character device in contemporaryfiction. This paper combines these two areas by discussing anumber of publications written for young people where dementiais a central issue, motif or characteristic. These include dementia-relatedmaterial targeted at a children’s readership. This isfollowed by development of themes arising from analysis of threenovels written for young people, emanating from Canada, Australiaand the UK. The paper ends with a series of discussion pointsfor social-work practitioners, educationalists and voluntary-sectorsupport or self-help groups working in dementia care and inolder people’s services.     

For the Sake of their Health: Older Service Users' Requirements for Social Care to Facilitate Access to Social Networks Following Hospital Discharge

Facilitating older service users’ requirements for accessto or re-engagement in social networks following hospital dischargeis recognized in social care analysis and policy as criticallyimportant. This is because of the associated benefits for restoringphysical health and psychological well-being. However, it tendsto be a neglected dimension of current social care/intermediatecare. Our paper draws on a qualitative study of voluntary sectorhospital aftercare social rehabilitation projects in five UKlocalities, which focused on addressing this issue. Throughexamining older service users’ feedback and experience,our study confirms the health benefits of social care facilitatingaccess to social networks at this crucial juncture. By providingsensitive interpersonal interaction, advocacy and ‘educational’assistance, social care workers supported older service users’re-engagement in a variety of networks. These included friendship,recreational and family groups, health care treatment programmesand locality based contacts and organizations. As a result,material, interpersonal and health care resources were accessed,which contributed to restoring and sustaining physical healthand psychological well-being. The process of such social carealso emerged as critical. This included ensuring that objectivesreflected service users’ priorities; integrating ‘low-level’home care; offering befriending; and challenging the pre-settime frame of intermediate care.     

Free Personal Care in Scotland: A Narrative Review

The advent of free personal care for older people was a definingmoment in the development of UK political devolution. Afterall the controversy surrounding the 1999 Royal Commission onLong Term Care, Scotland’s decision to implement the mainrecommendations of the Sutherland Committee was a decisive breakfrom Whitehall’s approach and seemed to offer a key opportunityto learn from the implications of this policy for an Englishcontext. Against this background, this paper summarizes theorigins, nature and impact of free personal care, providinga narrative review of the policy to date.     

Helping Older People in Residential Care Remain Full Citizens

New Labour’s project of modernization has involved thepromotion of interlocking ideas about active citizenship andnew modes of democratic engagement combining to produce whathas described as ‘participative governance’. Concernsabout legitimacy, a ‘democratic deficit’ and theneed to shift power and responsibility to the ‘citizen’have led to the emergence of a range of new deliberative foraand democratic processes. This has led to debates about howto ensure that social diversity can be represented in the decision-makingprocess. A challenge has been how to engage with the issuesof an ageing population and represent older people in all theirdiversity. In recent years, there have been growing calls toextend advocacy rights to older people living in residentialcare. Mostly, this has been to ensure that as consumers, theyhave a fuller say in how their service is run. Older care homeresidents are service users but, as persons, should not be reducedto this role only; they are also citizens in the broadest senseand should not be cut adrift from debates at the national, localand community levels on issues that concern them. This paperexamines how the moves to bring older people into deliberativedemocratic processes have tended to focus on those in their‘Third Age’. Those in institutional settings, beingin the ‘Fourth Age’, occupy a much more marginalposition. This effective disenfranchisement is yet another reasonwhy, for many, the move into residential care—a difficulttransition for a variety of reasons—becomes regarded asthe ‘last refuge’. It contributes to the sense ofloss of identity, lowering of self-esteem and a reduced senseof personhood. This article accepts that there should be moreeffective involvement of care home residents in decision makingabout their personal care. However, there are dangers in adoptinga too narrowly consumerist approach. This can reinforce a reductionistview of care home residents simply as ‘service users’—aform of ‘othering’ in itself. As citizens and membersof a wider community, they should be included in consultationsabout any community and wider political debates that affectthem. Such a proposal implies a widening and deepening of advocacyservices available to this group. As most older people in residentialcare are there following the intervention of a social care professional,then ensuring that they have access to advocacy must surelybe a key task. This paper argues that this is frustrated bythe lack of suitable services. Without a significant investmentby the Government in independent advocacy services, not onlyis the social work task with one of social care’s coreclient groups rendered impossible, but the Government cannotdeliver on its own agenda of empowerment, active citizenshipand inclusion.     

Risk, Mental Disorder and Social Work Practice: A Gendered Landscape

Whilst the importance of gender for social work practice, riskand mental health has been recognized theoretically for sometime, few attempts have been made to explore this area empirically.This paper presents findings from a mixed-methods study of socialwork practice in relation to mental health service users perceivedto be ‘high-risk’. Findings suggest, first, thatthe concept ‘high-risk’ was gendered because theprimary focus in social work practice was on the risks posedby male service users to others. Second, female social workersin the present study were found to have more female serviceusers from their caseloads who had been defined as ‘high-risk’compared with their male counterparts. The paper goes on toexplore this apparent congruence between female social workersand female service users and highlights how the management ofrisk could be considered gendered because it reflects a worker’s(perceived) capacity in cultural terms to ‘decode’the nature of the risks that their clients face as genderedsubjects. The paper demonstrates how the intersections betweenrisk, mental disorder and social work practice can thereforebe understood as a gendered landscape. It concludes by highlightingthe implications of these findings for social work practiceand research.     

Young Male Street Workers: Life Histories and Current Experiences

The current study aims to reveal the experiences of young malestreet prostitutes in Israel, providing a stage for the voiceof this marginal group to be heard, as we believe youth workersneed to know more about these young people’s lives beforewe can offer meaningful responses. The study was guided by twomain questions: (1) What accounts do young men who work as prostitutesprovide for their involvement in the sex industry? and (2) Whatare their experiences as young males engaged in prostitution?Using the life story interview and thematic analysis, four mainthemes were revealed: (a) a life-long path to prostitution;(b) entering prostitution; (c) interpersonal encounters whileengaging in prostitution; and (d) the consequences of workingin prostitution. The results highlight the lack of meaningfulinterpersonal relationships in the lives of these young men.Practical recommendations are made to better inform youth workersassisting this high-risk population.     

Man-made Care: Community Care and Older Male Carers

Correspondence to Mike Fisher, Department of Social Work, University of Bristol, 8 Woodland Road, Bristol BS8 1TN. Summary Recent evidence about the extent of caring for older peopleby older people themselves, and about the importance of spousecare, has challenged existing debates about gender and care.Male carers, particularly older husbands, have been ‘discovered’.This paper attempts to reconceptualize the debate about genderand caring to take account of these developments, particularlyto develop an understanding of the caring activities of oldermale carers and to elaborate the implications for communitycare policy. The evidence suggests there are circumstances where men acceptthe obligation to care, undertake intimate personal care, andderive identity and reward from their caring work, driven bysimilar motives and experiencing similar struggles as women.Rather than seeking maximum distinction between the motivesand experiences of women and men carers, the paper suggeststhat one important way to promote non-sexist community careis to explore the conditions where men's caring is undertakenand how it can be understood and developed.     

Cost and Stakeholder Views: A combined approach to evaluating services

Correspondence to Jackie Powell, Department of Social Work Studies, University of Southampton, Highfield, Southampton SO9 5NH Summary This paper focuses on the decision-making process at a strategiclevel in the context of implementing a ‘community care’policy for older people with mental health problems. It is basedon the findings of an evaluative study of the implementationof one district health authority's strategy for the decentralizationof its mental health services for older people. The study wasan attempt to develop an evaluative approach which acknowledgedthe importance of cost, but also the need to include the viewsof the several ‘interested parties’, not least thosewho used the service. The reconciliation of what might be seenas the conflicting interests of the wider public for a carefulutilization of resources with the individual's needs for anaccessible and responsive service represents a major challengefor planners, managers and practitioners within the public sector.This paper argues the need for dialogue as the basis for partnershipbetween those with a primarily financial focus to their workand those more intimately concerned with individual needs.     

Resilience across Cultures

Findings from a 14 site mixed methods study of over 1500 youthglobally support four propositions that underlie a more culturallyand contextually embedded understanding of resilience: 1) thereare global, as well as culturally and contextually specificaspects to young people’s lives that contribute to theirresilience; 2) aspects of resilience exert differing amountsof influence on a child’s life depending on the specificculture and context in which resilience is realized; 3) aspectsof children’s lives that contribute to resilience arerelated to one another in patterns that reflect a child’sculture and context; 4) tensions between individuals and theircultures and contexts are resolved in ways that reflect highlyspecific relationships between aspects of resilience. The implicationsof this cultural and contextual understanding of resilienceto interventions with at-risk populations are discussed.     

Investigation or Initial Assessment of Child Concerns? The Impact of the Refocusing Initiative on Social Work Practice

This paper is based on a qualitative research study of socialworkers’ and parents’ experiences of attempts to‘refocus’ child protection practice in England sincethe late 1990s. A review of the research base for the refocusinginitiative is presented, leading to an exploration of one ofthe key changes arising from the initiative: the move away frominvestigations in ‘borderline’ cases towards lessintrusive initial assessments. Methods involved qualitativeinterviews with parents and social workers in twenty-three casesdrawn from two local authorities. The main conclusions are thatinitial assessments, as developed through the refocusing initiativeand the Framework for the Assessment of Children in Need andtheir Families (Department of Health, 2000), provide a formof practice that offers benefits in terms of balancing childprotection and child welfare approaches, and in terms of relationshipswith parents.     

Mapping the Needs of Children in Need

This paper reviews the literature on mapping needs, with particularreference to children in need, and locates this within the legalmandate for children’s services planning and New Labour’smodernization policies for social care work. The paper surveyspossible approaches to mapping needs and highlights the challengesinvolved. One research project, which collected informationon children in need from a variety of different agencies withinone geographical location, is then used to question mapping’scontribution to the achievement of quality, co-ordination andresponsiveness in modernized child care services. The paperincludes a critical review of the extent to which mapping researchinforms practice, of the contested nature of need, and of anapproach that rests on identifying those in greatest need andtargeting available resources at those most at risk.     

Critical Commentary: Who Decides Now? Protecting and Empowering Vulnerable Adults Who Lose the Capacity to Make Decisions for Themselves

The implementation of the 2005 Mental Capacity Act in Englandand Wales heralds a new era for social work practitioners andresearchers. Protecting and empowering vulnerable adults—animportant element of adult-care social work—relies ona legal framework that attempts to balance adults’ rightswith the desire to protect them. The new Act is part of thatframework, addressing the fundamental issue of when and howdecisions can be made on behalf of people who lose decision-makingabilities (‘capacity’). The Act encompasses themeaning of incapacity and best interests, advance directivesconcerning treatment, managing people’s affairs and makingdecisions for them, overseeing the delegation process, and research.In explaining how the Act addresses some of these challenges,the article alerts practitioners and researchers to the keyareas in which the Act will make a major impact.     

Race and Place: Exploring the Intersection of Inequity and Volunteerism Among Older Black and White Adults

Although the historical impact of racial segregation and ongoing health and economic inequities between older Black and White adults is well documented, little is known about the relationships among race, individual- and neighborhood-resources, and formal volunteering in later life. This study explores this intersection. Individual-level data from 268 respondents aged 55+ were collected in the St. Louis metropolitan area through paper-based mail surveys. Objective neighborhood data were obtained at the zip code level from secondary sources and matched with respondents. Using exploratory factor analysis, we constructed a 14-item environmental scale with 3 neighborhood dimensions (economic, social, and built environment). Older Black adults had lower levels of education; had fewer financial assets; lived in neighborhoods with less economic resources and lower built environment scores; and fewer formally volunteered when compared to older White adults. Individual resources (financial assets, health) and neighborhood resources (social and built environment) were positively associated with formal volunteering among older Black adults. Only individual resources (age, marital status, financial assets, health) were associated with formal volunteering among older White adults. A coherent set of policies that bolsters individual and environmental capacities may increase the rate of volunteerism among older black adults.     

How to be Modern: New Labour's Neoliberal Modernity and the Change for Children programme

In England the New Labour administration is seeking to embeda ‘transformational reform agenda’ within children’sservice. Social workers, among others appear, however, to bewary of the agenda which is now rhetorically rooted in the EveryChild Matters: Change for Children programme (CfC). The mainsocial work practice elements of this programme are associatedwith the introduction of a Children’s Index, a multidisciplinaryCommon Assessment Framework and the role of Lead Professional.In terms of the promotion of this programme, the governmenthas maintained that the focal aim is to create a ‘modern’children’s workforce. However, the entire ‘transformationalagenda’ can be interpreted as reflecting New Labour’sneoliberal modernity. This is particularly apparent in the termsof the ideas associated with ‘flexibility’ whichare so central to the CfC programme.     

Disabled Children's Experience of Permanency in the Looked After System

Research with seven local authorities in England provided dataon the ‘care careers’ of 596 foster-children overthree years (Sinclair et al., 2005). One part of this studylooked at the experiences of disabled foster-children comparedto non-disabled foster-children. The research aimed to identifyif there were any particular difficulties in pursuing permanencyfor disabled looked after children. This article introducesa concept developed by the author from this work: the idea thatdisabled children may be at risk of experiencing a ‘reverseladder of permanency’; being less likely than their peersto receive permanent placements such as adoption and returnhome. The results of the study partially supported this hypothesis,reinforcing existing findings and highlighting some new ones.Foster-children with learning but not other impairments wereless likely to be adopted. All disabled children were less likelyto return home and therefore remained in foster-care for longer.Disabled children who were adopted, or who returned home, didso after a greater delay compared to non-disabled children.By contrast, children who were ‘clearly disabled’achieved a greater degree of permanence within the care system.The article concludes by considering the implications of suchfindings for policy and practice.