Care Home Day 21 – A blog from our Membership Support Manager

Membership Support Care Home Day 21 Blog

In volunteering to write a blog for this important day in the Scottish Care calendar – Care Home Day ’21 –  I feel a little underqualified to share my thoughts with you. In part because I am relatively new to social care, or because I only started in the role of Membership Support Manager in February of this year, so what do I know? Granted, I have been with the organization for nearly 2 years in other roles here at Scottish Care, but do I really have enough to say that is important or relevant or valuable that shares how I feel about all of you and the work you do? How you should be celebrated not just on Care Home Day, but every single day of the year, for the work and the service you provide to loved ones everywhere?

One thing I have realized during my time with Scottish Care, that it is not the individual role any of us play that counts; it is all of us as part of the sum, part of the whole, that has kept things going these last 12 months.  By ourselves, we can all do our little bit, but together we can, and we have created a movement. We have created an environment where no one is left behind and everyone is taken care of, no matter their level of need, all are loved and cared for – but often times this has been to the detriment of those who do the caring – YOU the amazing care workers, our incredible members.

It is so easy to say how much we admire you, how you inspire us and how we know the value you bring to the people you take care of. Because it is true. I can only speak to my experience working with all of you and I am in awe. I speak to you every day – learning about your struggles, your challenges, the issues you must deal with daily, especially in this last year when things have been so very hard. I sit in meetings and hear the passion, the spirit, the frustrations, the sadness even – and I truly cannot believe you get up and do this day in, day out, 24/7, 365 days a year.  I try to be creative, solution-oriented, and supportive for you and I always promise if I cannot help you, I will find someone at Scottish Care who can. Because it takes all of us to get to where we need to be – as a sector, as care home providers, as individual care workers, together we are stronger.

I truly believe it is this can-do attitude that personifies social care and all of you who have been working tirelessly in care homes this past year. You care SO much for the residents and their day-to-day experiences. You speak passionately to regulatory bodies, local authorities, HSCP’s, Scottish Government, to anyone who will listen – that this is about the care home being the resident’s HOME, somewhere they need to live with dignity and with love. You advocate for them in ways far above and beyond what some may feel is your role. Why?  Because you CARE – CARE as in CARE home, CARE as in CARE worker, CARE as in CARE home day and CARE as in CARE FORWARD. The skill, talent and dedication you bring to work every day, even those days when you feel you just can’t do it– this is what we must shout to the world! YOU have the power, you have the GIFT, you need to be recognized again and again and again for who you are and what you do – with LOVE, with RESPECT and with DIGNITY for those you care for. Thank you seems so little for all you have done but truly, thank you sincerely for all that you do, for all that you have undertaken this past year and let us hope that this next year will be all about YOU and that you can and should be CARED for too!

Stefanie Callaghan

Membership Support Manager

 

 

 

Care Home Day 21 – A innovation blog from our Workforce Lead

Innovation is about Reshaping Services not Cutting Costs

Some of the most exciting work I am involved with at present is research that has received UK Research and Innovation funding to develop innovative resources and products that will assist care home workers to stay healthy for longer. I believe that this work is vitally important as the social care workforce has an incredibly difficult job both physically and mentally and any measures that can be put into place to support them should be implemented where possible.

One of the best parts of this programme is that there is an intention to make sure that some of the ideas being generated come directly from the care home workforce and that they will be supported to bring these ideas to fruition. So many discussions and decisions that will impact social care staff take place amongst policymakers and social care stakeholders who are not delivering actual care services. This results in front-line workers often asking why they are not consulted more on these decisions that are being made and that directly affect them and how they carry out their roles. Care home staff are the experts in their field, they are the ones who work with individuals every day and night and are responsible for building vital relationships with people they care and support in order that care is provided in a manner that is appropriate for that specific person. It makes perfect sense that they would be hugely instrumental in deciding what measures will be easier to implement and what will be realistic to achieve.

My hope is that another benefit to this research is that it will open up other types of work opportunities and careers for care home staff and will attract new people into the social care sector. Social care roles often include using technology and digital devices that require the worker to have these additional skills and experience. Including them in discussions around how technology can be utilised effectively within social care settings is vital in order to ensure this approach is undertaken in a person led manner and takes into account human rights in the process. We have already seen fantastic examples of what can be achieved by care providers who recognise there is an issue or a gap in the social care system and create a solution to that. Many care homes will be implementing creative ideas and solutions at an organisational level that can be scaled up and implemented across the whole sector should they receive the support and funding needed to achieve this.

It is also important to address the perception that innovation is a cost-cutting measure and that services must work in innovative ways in order to make savings within the social care sector. This is absolutely not how innovation should be implemented and care organisations need the tools to challenge that narrative and state that if they are going to be innovative, which could come with cost savings in the longer term, this must be appropriately resourced and funded to achieve the positive changes that are needed and will benefit the workforce in years to come.

I am extremely excited to witness changes within the care home sector that will be developed collaboratively with the workforce to aid and support them in their roles and to ultimately shape the delivery of care and support services in the future.

Caroline Deane

Workforce Policy & Practice Lead

Care Home Day 21 – A blog from our Nursing Lead

Leading to Care – Who are we if we can’t care?

 All staff within our care homes need to have the ability to care, the desire to care is not enough, staff need to be enabled to care. As we look ahead, we must understand how care can be compromised. It’s not just about the number of staff available each shift to provide care but the skill mix, the expertise, the skills staff have to allow them to care they way they need and want to. Intrinsic to this is that nurses and care staff provide care underpinned by dignity, humanity and equality.

We need a future where we have leadership at all levels, where kindness is at the heart of everything we do for those residents who rely on being cared for as well, as our staff who must also feel secure, valued to provide care. Staff must have a voice and be listened too and only then will we have a workforce that can have the tools to care through safe staffing, helping enhance the lives of the people they care for. Then care can be compassionate, not a practical responsibility, it will ensure relationships are re-established, the family of care staff are reunited, and the home is restored.

Care is multi-dimensional, it’s about showing empathy, being responsible but most of all it should be about enhancing lives. It should be a constant in everything we do, not a fleeting gesture. It should embody everything.

Looking forward we want a workforce that is not only satisfied by the care they provide but see the visible changes it makes to residents. Being outcomes focused is the key, shape care around what matters to people not a predetermined output.

You will know it’s been achieved when you see smiles, hear laughter and witness a caring physical embrace. Often care needs no words. So, let’s all look towards a future where we invest in care by investing in our nurses and care staff.

There is no forever?

Then maybe that is why it is so beautiful.

Knowing our time is limited

and all we have is now

is more than enough reason we need

to exhibit love at its most radical.

———————writings of M.

Jacqui Neil

Transforming Workforce Lead for Nursing

@TransformNurse

Care Home Day 21 – National Director Blog: Vulnerable Leadership & Workplace Wellbeing

Vulnerable Leadership and Workplace Wellbeing

It is great to be celebrating another Care Home Day, although I am sad not to be having my usual visit to celebrate in person. Indeed, like many others, I have spent much of this year thinking about lost connections because of the pandemic, and actively working to make it safe for those connections to be re-established.

I know many of our care home staff have felt the same pressures, and most likely more as they take on board the many additional tasks asked of them. I also know that our staff are exhausted, burnt out and in need of a break. I have spoken with staff who want to quit social care and even some who have felt suicidal.

And so, on this Care Home Day, I want to talk about workplace wellbeing. But I want to do this different from how I have done so before, from my spare bedroom happily preaching to others about the importance of self-care whilst completely ignoring, or more accurately, not being open about my own situation. In applauding our workforce for their resilience, we are creating a culture where we cannot talk about the reality. I want to flip things around and open doors for others. Because, as a colleague of mine said earlier this week, the impact of the pandemic is showing.

I am calling for a campaign where instead of talking only about the nice things we can do to make us feel better, we speak truth to power and talk openly about our own experiences and in doing so, create safe spaces for others to do the same. We cannot continue to gloss over experiences of stress and trauma with toxic positivity. What makes social care different from many other sectors is its reliance on humanity. Something which applies as much to the workforce as it does to those accessing care and support.

Today my phone pulled out a ‘this day last year’ photo of me and I was shocked. It was taken during lockdown when, like many others, I was home-schooling and working at the same time. I had back-to-back meetings, phone calls and I was receiving 600+ emails a day. In a reflection of frontline experience, Scottish Care was working tirelessly to support members locally and nationally through knowledge mobilisation and influence. I am so very proud of what our team achieved in those darkest of days and continue to do now. To be able to play our part in history is a real honour, I really do have the best job in the world.

The photo was taken the day that I realised I had to ‘put on my oxygen mask before helping others’ and I had decided to go for a run. My face was bright red, and I was 30lb heavier. I had got into the habit of working odd hours around the kids, grabbing food instead of preparing it, not sleeping enough, and finishing most days with a glass of wine. My back was aching from sitting on a dining room chair in front of the computer on our camping table for most of the day. I might have been smiling on the outside, but on the inside, I was beginning to ‘go through the motions, every day was the same, and there was a black dog at the front door pining to come in. My poor colleagues and family met my inner grump too. I knew I needed to get my energy and my lust for life back. My work deserved it, my family deserved it and I deserved it.

I first started to carve out patches of time just for me – to get away from my desk at lunchtime for 10 min and play with my kids or go for a walk, to connect with colleagues and peers, to catch up on admin, I pushed back on those back-to-back meetings or scheduled them for a shorter length so that I could squeeze in a short social chat, or to grab a cuppa. I bought a proper desk chair and made sure to move every hour. I showed up to meetings post-run in my workout clothes because getting the run in was far more important than how I looked. We introduced the weekly surgery sessions so that we could respond to more people more quickly, being more effective and efficient with our time across the organisation. As my lifestyle changed, my energy levels picked up, I found I could accomplish more too.

I joined ‘Wild Sea Women’ and became a leader, now hosting beach breathing sessions followed by wild sea dipping and swimming. On solstice, we hit our covid max of 50 with at least another 20 on a waiting list. It was a pivotal moment on my journey.

When I felt things slipping, I found a mentor that I met every week for a few months for just 20 min to keep me on track, and I have developed a virtual peer support group who do this for each other now. I also made better use of my time – walking meetings or doing my learning whilst walking by listening to audiobooks and podcasts.

It was then that I found the book Burnout by Emily and Amelia Nagoski, (if you do not think you have enough time to read a book, start with the Brene Brown podcast interview with them both – you can listen whilst doing chores or driving. Start small, as my mentor says, “progress not perfection”).

In it they write ‘The cure for burnout is not ‘self-care’; it is all of us caring for one another”. If we can create safe spaces for people to be how they feel in the moment, then they can have the space they need to heal and to grow and to prevent or process trauma. Something which I know our entire care workforce needs.

I hope that by telling my story I have helped to do this for others but also that I have inspired others to share their stories too.

Before I finish, I want to share more words from Emily and Amelia they have been my guide now for many months and I am finally fulfilling the last line:

“Trust your body,

Be kind to yourself.

You are enough just as you are right now.

Your joy matters.

Please tell everyone you know.”

 

Karen Hedge

National Director

@hegeit


#carehomeday21

#careforward21

Care Forward – renewing care home life

Next Wednesday is Care Home Day which this year carries the theme Care Forward. Care Home Day is an annual opportunity to focus on care homes and their vital role and contribution to Scottish society. This year’s theme both recognises the challenges and trauma of the last eighteen months but also seeks to move us forward to a revitalised and renewed care home community. In order to do that I think we need to focus on three areas, restoration, rehabilitation and renewal.

For all of us, I would hope, a day to focus on care homes in the present and future has to start with an honest reflection of where we are now. Our present is one which is far from where anyone would want to be. We are still living in the face of a pandemic with cases on a scale which are disturbingly high and with high levels of community transmission, albeit thankfully low death rates especially in our care homes. We are in an environment where new strains like the Lambda strain dominate a concerned population. We are in a situation where staffing is a real challenge and in the past week, I have heard of more and more care homes shutting up again and excluding family visits on the advice of local public health. We have a tired and exhausted workforce, managers searching for the trust and professional respect which seems to have been stripped from nurses and carers in the sector. We have fundamental problems about the fiscal sustainability of a diverse system with more and more charitable and private operators calculating that they cannot continue to deliver quality care on the resource allocated to them. And against it all we have an approach to infection prevention and control which seems insensitive to the realities of living with dementia and living together in community, in a ‘home’ alongside others.

For so many people it seems as if we have never left the shadows. There are still so many constraints. There is nothing normal or natural about the situation. Having to book a timeslot to make an appointment with love and for a limited period of time seems a huge distance from life as normal. Having to undergo testing and checks, to maintain social distance, to continue to wear masks – which are all immunologically understandable – make it hard to feel that we are in anything other than a twilight existence.

The first priority must therefore be to restore care home life as urgently and as safely as possible to that which people used to experience. Given that the average life expectancy of someone in a care home is close to two years then we have already lost a huge amount of precious time in the last eighteen months. Fundamentally we have to ask the question as to whether or not we have created such a climate of fear and risk aversion, such an impugning of guilt and anxiety upon care homes and their staff, that whilst we are keeping people alive with vaccination and precaution the quality of those lives are ones which are poor.

As we move to a situation where we are required not to suppress the virus but to live with it and balance its harms, we do need to ask questions to those who matter the most – the residents and their families in our care homes. What matters more – being so cocooned that you are safe but detached from contact and family or reducing protection to a level where people can be together in a much more natural and human manner? We have to honestly and in an informed way explore the risk appetite of people and find a space between suffocating protectiveness and dangerous naivety.

Care home life is more than just keeping people alive – it is giving a richness and fulness to the last years, months and days of life – and that depth and richness cannot be achieved without family, friends and presence; it cannot be achieved without interaction and activity, without normality and community. We need to make sure that the right for family to have natural access and contact with their loved ones does not diminish when there are outbreaks and as we prepare for an autumn and winter upsurge of threat.

Critical to restoration has to be an emphasis upon rehabilitation. I have frequently written over the months in this blog about the physical and psychological damage and deterioration caused by both lockdown and the pandemic itself. We are slowly seeing a return of allied health and primary care professionals into our care homes. This must not suffer as priorities begin to be re-directed in the next few weeks and months. Determined and focussed attention needs to be given to a population who have suffered too much and most especially this means attending to the urgent needs of those living with dementia.

But rehabilitation is never just a return to what was or a response to the inevitable decline that a degenerative disease results in. Rehabilitation must also carry with it a re-focus and new direction, a taking into account of changed circumstance and condition. Again, I have written about this before, but every day I am hearing of residents who have been impacted by the deaths of their friends in the care home. We need an urgent prioritisation of grief and bereavement support in our care home sector.

The direction restoration and rehabilitation combined offer us is a dynamic which is about renewing and reforming our care home sector. This is not the space to reflect and argue about resource and recognition, about investing in training and skilling staff, and rewarding them in a manner appropriate to the dedicated skill and professionalism they possess. This is not the space to argue for a more robust wrapping around of community healthcare and social service support for our care home sector. Both are critical but rather, in this space and in this week, we need to urgently focus on how we renew the spirit and positivity, the joy and happiness of the places we have so often in the last eighteen months painted and pictured with words of sadness and loss.

Care homes have to be allowed to re-discover the dynamic of infectious fun and love which is their core. For even in sadness the healing of laughter and enjoyment can bring immeasurable benefit. We have to as a whole health and care and as a political system, to allow care homes to re-discover the art and the gift of making a pile of bricks and mortar into a place where someone feels content to call it their home. We have to allow love to flourish both from the hand of family and staff.

One of my favourite poems is one by Diana Hendry. It is entitled ‘Poem for a Hospital’ but actually I think it speaks just as well to a care home setting – just change patient into resident. It reads:

Love has been loitering
down this corridor
has been seen
chatting up out-patients
spinning the wheels of wheelchairs
fluttering the pulse of the night nurse
appearing, disguised, as a bunch of grapes and a smile
hiding in dreams
handing out wings in orthopedics
adding a wee drappie
aphrodisiaccy
to every prescription.
No heart is ever by-passed by Love.

Love has been loitering down this corridor
is highly infectious
mind how you go. If you smile
you might catch it.

On Wednesday as we celebrate Care Home Day we celebrate the raw incarnating of love into tiny action, touch and tenderness.

Love is there despite the smell of chlorine, an infection prevention and control tidiness which seeks to remove the marks of living, which puts in the drawer the mementoes of memory lest they hold infectious risk.

Love is there despite the silence of activity, despite the empty chairs distanced from contact, without the bustle of busyness and belonging.

Love is there in every touched hand, mopped brow, supported arm, reassured fear and eye that smiles.

Love has been there even in the midst of fear and saddening loss and is there still in times of uncertainty.

But that love needs to be brought into flourishing so touch can be close, distance can disappear, and the ordinary gossip of exchange can stretch across the spaces which have been so unsocial and harmful.

We are all longing for the day when we will accidentally bump into life and love without appointment or planning, without testing or trial, without fear and distress. It is the infectiousness of love that we want to catch as we loiter around our living. And on that day, we can truly celebrate the restoration, rehabilitation and renewal of our care homes.

Donald Macaskill

The Diana Hendry poem from Borderers (Peterloo Poets, 2001). See https://www.scottishpoetrylibrary.org.uk/poem/poem-hospital-wall/

 

The language of vulnerability : a personal reflection

In a recent video conference, I found myself gradually getting more and more uncomfortable when one of the participants continually referred to ‘vulnerable service users,’ ‘vulnerable old people’ and ‘vulnerable disabled people.’ I began to reflect on my discomfort and realised that in essence it has to do with the use of the term vulnerable. It is one which is increasingly being used by commentators in the media and in politics. In this brief blog I want to reflect on the way in which the word vulnerable can result in the ‘othering’ of a person or group and the damage which can arise from that, and secondly and not contradictorily why I believe we need to accentuate the positive in our understanding of vulnerability.

‘Vulnerable adult’ was a phrase that was much used in the context of adult protection and safeguarding and to a degree still is. However, when Scotland was developing its new Adult Support and Protection legislation – which came about in 2007- there was a lot of debate on the appropriateness or otherwise of the term ‘vulnerable’. Many self-advocacy groups from the disability and older people’s movements were rightly uncomfortable with the use of the term. The reason for the discomfort is that the term used as an adjective can have the effect of diminishing, limiting and categorising a group or individual. In adult protection terms, it can both lead to a situation where individuals are treated as a group -continually at risk – devoid of distinct identity and capacity, and at the same time can lead to situations where someone is not considered to be at risk of harm because they either do not see themselves, or other professionals do not define them, as ‘vulnerable.’ So it was that the Scottish legislation, not least after some robust judicial contribution, decided not to use the word ‘vulnerable, and in its accompanying Guidance and developments there has grown up an understanding that we are all of us vulnerable to harm from the malevolent actions of another. There is therefore nothing inherently ‘wrong’ about being vulnerable, rather it is an essential characteristic of our humanity. Being vulnerable is part and parcel of human relationship where we take of the masks of pretence and expose the nakedness of who we are to another. Harm can sometimes arise when someone uses our individual characteristics including our vulnerability to cause hurt to us, it is not inherent to vulnerability.

There is a related issue as to why the use of the term vulnerable is unhelpful and it is perhaps especially a development we have witnessed as the pandemic has advanced. There is a danger that the use of the word ‘vulnerable’ risks the ‘othering’ of a person or group. What do I mean by that? Othering treats a group as ‘them.’ To ‘other’ a group or person means to so categorise and distance them that they lose autonomy, individuality and control. They become the object of our concern or care, the centre of our action on their behalf – they lose their voice and agency – their ability to be autonomous and in control. We make the decisions and do so out of paternalistic regard. If we denote a group as being ‘vulnerable’ it seems to almost add justification to the way in which we diminish their autonomy and take actions ‘in their best interests.’ Thus, we have heard words such as ‘vulnerable old people’ throughout the pandemic – treating individuals as a collective with an increasingly diminished ability to see them as individuals and able to make decisions and exercise risk on their own terms.

I mentioned above that as well as a concern for the mis-use of the word vulnerable that I would also want us to embrace a positive dimension to vulnerability. Perhaps the person who has advanced this more than anyone else has been the researcher and speaker Brene Brown. She has in her writings and speeches cogently articulated the need to recognise vulnerability as intrinsic to our humanity.

Brene Brown argues that vulnerability is essential to enable us to live a life which is connected and authentic. She believes that it is those who live fully open to their vulnerability, who ‘spend their life showing up’, who are happiest in their own self and in relationship with others.

In our rush into situations of strength and protection, in our avoidance of risk and emotion, perhaps especially in pandemic times, we are in danger of on the one hand diminishing some people by labelling them as vulnerable and on the other hand totally falling to see that vulnerability is a real strength, and an  essential asset and characteristic of our humanity.

Throughout my working and personal life, I have continually discovered that it is those who are vulnerable, who are wounded, (the word ‘vulnerable’ indeed comes from the Latin word ‘to wound’),  those who live fully raw and honest lives, it is they that evidence to us a strength, reality and maturity which is beyond price and value.

To live a life open to the dynamic of change and circumstance, to be courageous to the point that we can allow others into the space which is our inner self, to be able to stand against easy stereotype and hatred, to speak against the noise of expectation, strikes me as a wound of vulnerability we should all be seeking.

The English poet David Whyte has written a beautiful narrative poem which captures the intrinsic value and necessity of vulnerability:

‘Vulnerability is not a weakness, a passing indisposition, or something we can arrange to do without, vulnerability is not a choice, vulnerability is the underlying, ever present and abiding undercurrent of our natural state. To run from vulnerability is to run from the essence of our nature, the attempt to be invulnerable is the vain attempt to become something we are not and most especially, to close off our understanding of the grief of others. More seriously, in refusing our vulnerability we refuse the help needed at every turn of our existence and immobilize the essential, tidal and conversational foundations of our identity.

To have a temporary, isolated sense of power over all events and circumstances, is a lovely illusionary privilege and perhaps the prime and most beautifully constructed conceit of being human and especially of being youthfully human, but it is a privilege that must be surrendered with that same youth, with ill health, with accident, with the loss of loved ones who do not share our untouchable powers; powers eventually and most emphatically given up, as we approach our last breath.

The only choice we have as we mature is how we inhabit our vulnerability, how we become larger and more courageous and more compassionate through our intimacy with disappearance, our choice is to inhabit vulnerability as generous citizens of loss, robustly and fully, or conversely, as misers and complainers, reluctant and fearful, always at the gates of existence, but never bravely and completely attempting to enter, never wanting to risk ourselves, never walking fully through the door.’

Donald Macaskill

Grief is the cost of loving: care and Covid trauma.

The distinguished writer on bereavement, Colin Murray Parkes once wrote that ‘grief is the price we pay for love.’ It is a price which many have had to pay in deep measure in the 15 months that have passed, and which thousands are still paying. In this piece I want to reflect on the issue of bereavement and what we may have to do as a society to properly support those who have experienced death during the pandemic.

There are three groups I want to give particular focus to but that in no way should be seen as suggesting either their higher priority or indeed that there are not others impacted in an equal way by bereavement during Covid. The three are staff who work in care homes; the residents of care homes and lastly family members of those who have died in hospital, care home and community.

There is already an emerging literature and research focus on the experience of death, dying, grief and bereavement during the pandemic. At the launch of the UK Commission on Bereavement on which I am honoured to be serving, I heard a detailed description of the excellent research which is being carried out by Drs Emily Harrop and Lucy Selman. Their study has highlighted the difficulties and distress people experienced when trying to get support after the death of a loved one during the pandemic, with more than half of people (51 per cent) experiencing high or severe vulnerability in their grief and those seeking support facing long waiting lists or being told they were ineligible. The study also showed that of bereaved people demonstrating high or severe levels of vulnerability, three quarters (74 per cent) were not accessing formal bereavement services or mental health support. These are very worrying and challenging initial findings.

Internationally there has been an emerging recognition of unique pandemic grief responses and a growing acceptance that there is a strong likelihood that we will witness a significant growth in people presenting with what is termed ‘prolonged grief syndrome’.

Prolonged grief syndrome.

Grief is normal and natural. It is part of the rhythm of our living. When we experience the death of someone we know or someone close to us it is as if the earth beneath our feet quakes with their absence, we lose our footing and take time to steady ourselves. Grieving is a journey onwards into a new way of being in the world and with others in the absence of the loved one. Over time, we learn to live without that familiar voice, without their smell, presence, and touch. But grieving is invariably lonely, painful, and sore deep inside our very being. We slowly re-orientate our journey of life and our steps take on a different pattern and shape, as we travel to a new destination without the person who has died.

But for some people this adjustment and change does not happen. Their grief is blocked, their hurt simply overwhelming. They may end up experiencing what has become known as prolonged grief disorder or syndrome (PGS). Psychological experts have stated their belief that up to 10% of all who experience death will be impacted at some stage by PGS. The World Health Organisation describes it as ‘a pervasive yearning for the deceased or a persistent preoccupation, accompanied by intense emotional pain. In addition, individuals with PGD have difficulties enjoying social activities, experience a reduced capacity to feel positivity and possess a general inability to accept the death of a loved one.’

In a helpful paper, Lise Johns and others, describe the risk factors which may make PGS more likely:

  • experiencing more than one death within a short period of time;
  • a strong dependency on the person who died;
  • the death was shocking, premature and unexpected;
  • the death could be perceived as preventable;
  • witnessing the death, or suffering alongside the deceased person if they died following a protracted illness;
  • previous history of mental illness, especially post-traumatic stress disorder (PTSD) or depression.

Numerous scholars and clinicians are now suggesting that one of the legacies of Covid19 will be a significant increase in the number of people suffering from PGS. Indeed, the sudden and swift nature of Covid death for so many means that Covid deaths are often shocking and surprising. There is equally a lot of emerging commentary on ‘Covid guilt’, self-critical behaviours characterised by a belief that you could have done more to prevent the person becoming infected, as well as evidence that many of those who have died from Covid have experienced ‘hard’ and ‘traumatic’ deaths. All of these fit a definition of PGS.

Care home experience

We know that right across the world aged-care facilities or as we describe them in the Scotland, nursing and residential care homes, have been disproportionately impacted by high numbers of deaths because of the Coronavirus pandemic. Speaking to both frontline staff in Scotland and to colleagues across Europe I am very aware of the profound impact that this experience has had upon staff. I would argue that this is a unique grief experience in the sense that it is unlike any other equivalent experience and that not only will it result in prolonged grief syndrome but that there are factors as well as those noted above which may well benefit from academic colleagues undertaking further research and clinical investigation, in order to categorise the experiences and response as a distinct Covid grief syndrome and to thereafter identify specific and bespoke psychological and trauma therapy responses.

A care home resident in Scotland on average spends between 18 months to two years in a care home but in many instances, especially in residential care, this can be a much longer period, potentially up to 8-10 years. It is inevitable, therefore, that over that time a resident gets to know their fellow residents and staff extremely well. Whilst staff come and go and continuity of care has always been an issue in the sector, it is equally true that there are many thousands of care staff who have worked in the one care home or organisation for a long number of years. This results in the formation of deep, close personal relationships – not in divergence from but complementary to the relationships a resident has with their family. Perhaps this is especially the case for the estimated 1 in 10 residents who have no close family proximate to them and for those who live with dementia for whom figures of recognition become so important.

It is a sad reality that for many hundreds of care home staff that outbreaks resulted in the deaths of a large number of individuals over a brief period of time and that the nature of these deaths has been especially upsetting. That in itself is traumatic and is something shared with colleagues in emergency and acute medicine. What is markedly different, however, are the often intense and long-held relationships which care staff have formed with those who die compared to even staff working in intensive and emergency environments in the acute sector.

I know from my conversations that staff have been left traumatised and deeply shocked by what they have experienced and witnessed. Just a couple of days ago a senior palliative colleague expressed concern at the impact the multiple sudden deaths of residents was having on the young staff team in a particular care home.

Staff, I have been told have supported each other and have where necessary had additional psychological support and there is no shortage of virtual support. But I remain unconvinced that there has been an appropriate recognition of the distinctive grief trauma which care home staff have experienced and are still enduring. I profoundly believe more work needs to be undertaken in this area. What we are witnessing is that staff have struggled through the first wave, have been determined not to give up but to keep people safe and have worked through the second wave. But when they have had the opportunity to take a break, to switch off then they have frequently either not returned to work or have returned only to leave after a brief time. The workers whom I have spoken to in these situations are frequently manifesting behaviours and responses which have at their core an inability to process and deal with what they have lived through and the grief which has resulted. We need to do more for this amazing cohort of professionals. In passing, I would also comment that concern is being raised for those who have ‘got on with the job’, those who have returned and have not wanted to or are unable to open up, to talk and share their experiences. For some this might be a coping mechanism but the inability or lack of willingness to talk through such hard experiences is well recognised as a challenge.

The second group who I feel have often been ignored or forgotten about in our support for the bereaved have been care home residents themselves. Just picture the scenario. You are living in a community with others who help to make your life meaningful and purposeful, who are your friends and acquaintances. Together you have formed groups of interest and affection. Then the pandemic hits and the chilling exclusions of isolation together with the loss of familiar activity and exchange; the removal of the rituals of routine and predictability leave you very much alone but for the care and compassion of staff. Add to all that unreality the lack of contact with family, friends, and acquaintances unable to come into the care home for a very prolonged period. Then you may experience living in a care home where there is an outbreak. What do you feel like when not one but maybe a dozen of your friends, people with whom you have spent time and relationship, die within days?

The experience of residents during lockdown is increasingly being explored but the impact of the deaths of friends and fellow residents has not received much attention. It needs to. Whilst a renewed focus on the physiological impacts of the pandemic on residents is imperative, I am concerned that we are not sufficiently focussing on the emotional and psychological impact of the pandemic especially the grief of our care home residents.

Some have suggested to me that my concerns are misplaced and that because so many people are living with dementias and cognitive impairment that their memories of contact and their sense of loss and grief is less significant and troubling. I find such attitudes to be offensive and totally inaccurate. They are equivalent to the attitudes I encountered years ago when professionals suggested that those living with profound and multiple learning disabilities did not experience grief. People even in advanced stage dementia evidence behaviours which are clear grief responses, sometimes evidencing behaviour which challenges. These are manifested in many ways but it is clear that for some the fear and inner anxiety of not knowing what is happening, of losing the pattern of predictability and the comfort of routine, of being unable to be consoled by touch, of masks worn which have distanced empathy and the absence of families, have all had a profound impact.

We owe it to the dignity of their humanity to make sure that appropriate grief and bereavement support is in place so that the Covid grief care home residents have lived through and are still experiencing is addressed.

The third group I believe that is deserving of greater focus are those who have had to endure the absence and separation from loved ones as they have spent the last weeks and days of their lives. This has been hell for so many, moments that will never be re-captured, days that will never be had again. Whether it has been in hospital or in care home, despite all the efforts of many staff, the effect has been an absence of consolation from the hands of those who matter the most. I know from email and conversation that this aching inability to be present has cut deep into the hearts of many, it is a sore which seems incapable of healing.

We cannot turn the clock back, much as many of us would wish but we can not only learn the lessons so as never to repeat them, but equally important we must ensure that we are present and there in word and deed to support those who are left bereaved and grieving. As the world rushes to re-frame its normality, there is a danger that the fractured lives of those who grieve will be forgotten and ignored. They cannot be. We must strive to not only talk about but to actively support in practical ways the needs of the Covid bereaved. The Harrop and Selman research shows just how far short we are failing in this regard.

Covid19 has left its scars on our humanity, it cannot be allowed to continue to wound that humanity still further. Whether it is recognising the distinctive psychological and practical needs of care home staff, the necessity to adequately address the grieving of care home residents, or to bring solace to the suffering of the bereaved relatives and friends, there is an urgent task which cannot be delayed.

Speaking at the launch of the UK Commission on Bereavement and as chair of the group, the Bishop of London and former Chief Nursing Officer, Sarah Mullally said:

“To have to choose a very small number of people to be present at a loved one’s funeral, not to be able to hug and to hold one another, to be unable to gather with a large group of family and friends in someone’s home or a restaurant or pub afterwards is another series of losses, heaped on top of the raw grief. In some cases, this has included the additional trauma of having been physically separated from the person we love as they have died.

“In the wake of so much loss, we now risk a post-pandemic bereavement crisis.

Donald Macaskill

Unconquered Care: the human right to independent living

This week’s blog is an adaptation from an address I gave at the Scottish Care Homecare Festival a couple of days ago.

It has been said on several occasions – that we are at a key point – as a nation – at a crossroads as a society – perhaps that is inevitable given the trauma and the pain of the pandemic

There are two major legislative proposals which are likely to come before the Scottish Parliament in this coming term – the first are the plans for a National Care Service and the second are the proposals for Scotland to have a new Human Rights Act. I want to talk about both.

I’ll take the latter first – we all know that human rights are often mentioned and there are few who perceive the broad concept of human rights in our culture in a negative sense – but it is one thing to make constant reference to human rights it is quite another to really embed rights but if they are to be more than a fob to liberal conscience they need to be rooted in practice and in reality, and critically in legislation.

I am today calling for the new human rights legislation to have on its face – a right to social care and specifically a right to independent living. I have written a lot about why social care should be seen as a distinctive human right and not just subsumed into the right to health. Social care as we all know is much broader than a narrowly defined acute physiological or even psychological health definition – it is about the enabling of wellbeing, it is holistic, it is about relationship, connection and citizenship.

If we are creating a new Human Rights Act – then I would hope as a nation we can be adventurous enough not just to take the easy parts from the Convention on the Rights of Persons with Disabilities and the Covenant of Economic, Social and Cultural Rights – but to seek to push these to their ultimate and to be progressive and visionary.

The CRPD has a famous section which is Article 19 which recognises

‘the equal rights of all persons with disabilities to live in the community, with choices equal to others’.

The CRPD is the first legally binding instrument to give explicit recognition to the right to live and participate in the community. While the recognition of this right is an important step, having it in legislation is not sufficient. Successive governments have been criticised for their failures under the CRPD whether through the bedroom tax at UK level or other measures such as the failure to fully implement Self-directed Support in Scotland. They have been criticised for failing to live up to the requirements of the Convention. Bringing it into national law would be a huge first step for Scotland but it cannot be the last one.

Article 19 of the CRPD provides a clear vision for the future – that people with disabilities can live in the community as equal citizens. But simply being present is not enough – presence requires support for it to become belonging.

It is also important that older person groups and advocates see themselves within the scope of this legislation and come increasingly to recognise that these provisions if incorporated into national law give them added recourse and opportunity. We might argue till the cows come home about whether for instance ’dementia’ is a disability but that nicety should not be at the cost of empowering our older people communities.

And in passing I hope our political leadership will finally have the courage to create a Commissioner for Older Persons like Wales and Northern Ireland have and critically support the United Nations in its work in developing a Convention on the Rights of Older Persons.

But more than that I want to see a right to social care and a human right to independent living on the face of any new legislation brought forward to create a National Care Service. Unless it is there – unless it is enshrined in statute then the ability to achieve what Feeley hopes for which is a real re-orientation of power and influence away from the system to the supported person, a re-design which puts the individual rather than commissioner at the centre, will not be fully achieved.

We have had plenty legislation in the past – and it has been effort wasted in large part – Feeley made clear the extent of the implementation gap – I think it is a chasm not just a gap between aspiration and real life. It would be unforgiveable if we fail to achieve the vision of Feeley because there is not sufficient legislative intent to give citizens the ability to challenge and where necessary have recourse when things go wrong or do not meet what they consider to be their human rights.

This is not just a semantic suggestion. Incorporating a human right to social care in both pieces of legislation would show that our politicians are serious and not just playing to the crowd. It would bring with it a set of duties and accountabilities on a range of stakeholders and the ability to seek redress and to ensure all duty-bearers live up to their responsibilities.

So, what about this right to independent living – why is this so important? Why is it so important that people can be who they are in a place they call home, in a community they know and love, with people they wrap around themselves with familiar grasp and touch?

One of the first roles I had in social care was working alongside people with learning disabilities who were living in long term institutions or hospitals. My job was to support them to become more independent but also to support the staff they would work with to help them in the journey from closed hospital ward to open community.

It was hard but also such a rewarding experience. One person I remember well and who I go to know so well – summed it all up for me when I asked him why it was so important that he was moving into his own home. He turned to me and said: “Donald – I now have a name – for the first time in my life I have a name and a place I can call home. Now in his seventies he had entered that institution in his teens decades before. He was probably someone who we would now describe as having emotional and behavioural challenges. But for that he spent decades institutionalised. And of course, he was there in a time when quite literally we gave people numbers not names, categorised them by diagnosis, and really failed to see rehabilitation or recovery as in any sense necessary approaches. Because he had been there for so long, he had remembered the days when he was just a number on a patient file, a reputation, a diagnosis…now he had a place to call home.

For most of us being able to be who we are; to be with those we want to be with; to be able to create our own pattern and time; our own rhythm, and moment – is the essence of what independence is.

It is all about life and living on our own terms – a life free to find its own fulfilment

But it does not just happen. For so many who need support whether because of age or disability, condition or disease, circumstance or event,  independence must be resourced and supported – planned and prepared.

That is the real essence of social care at its best – not a system or process, but the developing and nurturing of a support relationship that transforms a life – that gives it a name like no other name.

Social care support allows us to belong – to be a vital vibrant citizen in our community; to have our words heard and to make us feel we matter; we have something to say that should be heard and which can make another love us or even to change society. Paradoxically true independence is not separation from another but closer connection to others.

That is why a human right to independent living is so important.

For a party of Government that prizes the goal of independence for the country – the Scottish Government should commit to embedding in legislation the right to independence for each citizen regardless of disability, age, or circumstance. You cannot foster an independent nation without nurturing an independent people.

And if we created a social care system, a National Care Service, rooted in the human right to independent living – then we might be able to work together to build a homecare sector which was founded on the principle of enabling independence to the fullest and what a change that would be…

It would give people the ability to question the obscenity of commissioned care visits which are task oriented and functional in nature; it would enable a citizen to challenge the presumption that their worth and value can be calculated in 15-minute timeslots.

It would help the whole sector – both the health and social care system – to revert to a preventative, relationship based, dignity infused model of dynamic care delivery rather than the embarrassment of indignity that we now too often are forced to deliver.

It would really help to empower people to be the directors of their care support rather than passive consumers of a take-it off the shelf care package, pre-determined by commissioners and delivered by providers with little scope for change. It would put real muscle and meaning to the talk of person-led rather person-centred care support.

It would help to foster and encourage innovation, which was able to be delivered because all providers, across all sectors were treated with equality and all citizens regardless of diagnosis or age were treated with fairness and equity.

When Nelson Mandela was imprisoned on Robben Island, he often recited a poem to his fellow prisoners. That poem was written by the Victorian William Henley and followed the loss of the lower half of his left leg: he was determined to remain ‘unbowed’ and ‘unconquered’ by this physical setback. The poem is called Invictus – and inspired not only a film by Clint Eastwood, gave its name to a male cologne but a new movement for injured veterans in the form of the Invictus Games. Invictus is the Latin for unconquered. It was a poem which for Henley made sure that he would remain independent, the master of his own fate, the director of his own life-story.

It was also a poem which my friend had in a frame over his bed in the first place he could call home – it described his own determination to be independent and not to be bowed or overcome – in a place where he was not a diagnosis, a number or reputation but a man with a name and a story – at last.

‘Out of the night that covers me,

Black as the pit from pole to pole,

I thank whatever gods may be

For my unconquerable soul.

 

Beyond this place of wrath and tears

Looms but the Horror of the shade,

And yet the menace of the years

Finds and shall find me unafraid.

 

It matters not how strait the gate,

How charged with punishments the scroll,

I am the master of my fate,

I am the captain of my soul.’

The prize of a reformed, reshaped, and re-invigorated care at home and housing support sector in Scotland are transformed lives in a transformed community. That is why the human right to independent living matters and why it needs to be at the heart of any new legislation for Scotland’s human rights and social care future. We need through independent living to give every person who requires support a name they can call their own.

Donald Macaskill

Home First: re-enabling homecare.

Next week Scottish Care will be holding our Homecare Festival. This is the second such event which explores and examines the major issues, challenges and potential facing the care at home and housing support sector in Scotland. It is once again a virtual event because of the continuing pandemic which we are all experiencing.

The theme of this year’s event is Home First and each of the days from the 15th to the 17th will have a specific focus. The first will Home First: issues of vision, sustainability and practice; followed by Workforce First: the critical role of homecare workforce and ending on Thursday 17th with Independence First: homecare and personal independence.

The phrase ‘Home First’ has become ever more commonplace in the last year. It describes a desire on the part of most individuals that the place where they would want to be supported and cared for is their own home. The emphasis upon the increased use of homecare is an important if subtle change in both social messaging and political commentary. But what lies beneath the catchphrase?

Homecare has undergone some dramatic change in Scotland over the last couple of decades and not all of it for the best. We have seen the gradual stripping away of non-personal, preventative and relational care and its replacement by a transactional, functionalist and reactive approach to care and support in one’s own home. The numbers simply do not lie.

Since the introduction of Free Personal Care we have witnessed a dramatic change in the way in which home care has been delivered in Scotland. This is evidenced in Scottish Care’s 2015 report, ‘Home Delivery’, which was premised on independent research on the home care sector in Scotland. It outlined that:

  • In 2002, clients receiving Free Personal Care accounted for 56.9% of all care at home clients aged over 65
  • By 2013, those receiving Free Personal Care accounted for 93.6% of all care at home clients over 65

A later report Bringing Home Care said of this:

“In 2004/5 there were 16,440 clients who received home care provision out-with the Free Personal Care criteria. By 2014/5, this figure had fallen to 3,410. We can therefore deduce that a dramatic reduction has taken place in relation to the number of clients receiving publicly funded support for areas outwith the definition of ‘personal care’, such as ‘mopping and shopping.’ Instead, those who access services are narrowed significantly to those with high level personal care needs and often, those with lower-level needs are left without support.”

What this effectively meant is that non-personal care has been squeezed out from prioritisation, eligibility and therefore public funding. This change in dynamic and delivery has had real consequences not just for the nature of the care but for its impact upon the individuals being supported.

The same Scottish Care report summarised this well in stating that:

“Care at home services have tended to be developed almost accidentally; in part as a reaction to the market, whether that be a shaping in response to social care commissioning or a reaction to health and wellbeing policy development.

This has caused many problems; a lack of commissioning for innovation and new developments, a stereotypical assumption of the contribution of care at home and housing support and more worryingly, a diminution of its central importance and the effective marginalisation of the capacities and skills of the care at home workforce.” (page 4)

Undoubtedly one of the casualties in the re-orientation of homecare has been the loss of an emphasis upon preventative care and support. The Christie Commission and more recently the Feeley Report articulated just how critical such an approach was not solely on fiscal grounds but for improving personal outcomes for individuals and for the wider wellbeing of community and Scottish society.

Nowadays preventative homecare is virtually non-existent because we have stripped out from the system the ability for frontline workers to form natural and meaningful relationships with those who they support. The ability to spend time with someone, to consistently get to know the needs of an individual cannot happen within the constraints of a functionalist approach to a task and time-oriented form of care. You cannot build a preventative model of care which fosters wellbeing within the constraints of what is commissioned as homecare today. Indeed, the last few months have witnessed the obscene rise of commissioned 15-minute visits – and given it takes 7 minutes to don and doff PPE – what chance is there for care and support delivered in a manner which affirms human dignity and individual autonomy, and which can embed a preventative approach to care?

If we are serious about enabling people to be independent and autonomous for as long as possible then we need to invest in that reality. Ultimately that involves significant fiscal prioritisation. It means that we invest in creating and retaining a talented workforce who are more autonomous, professionalised and enabled to do what they are best at, caring through relationship. It means that we in this Carer’s Week need to put our money where our mouths are and actually make the task of caring for a loved one less onerous and demanding, by properly funding carers, both paid and unpaid, and by developing meaningful respite supports and maximising the commitments we already have.

I attended a European meeting a couple of weeks ago which had as its focus ‘re-ablement’. It described a growing movement in Europe which we have seen here, which is all about less dependency upon long-term support and a shorter focus on enabling people to re-discover or develop skills of self-reliance and self-management that they may have lost. Now no-one can be in disagreement, I would suggest with such reablement approaches. Indeed, there is a lot of academic and research evidence to show both the fiscal, personal and societal benefits of such an approach. However, as I sat and listened to the growing reablement movement in Europe I could not help but reflect on the reality of care at home and support in our own country. Yes, reablement is the essence – not fostering dependency but encouraging independence, not doing for but enabling someone to do for themselves, autonomously, free and self-directed. But that is not what we have.

For in truth what we have in Scotland are not true reablement models but an elastoplast approach to enabling independence. We constrain reablement to within a defined time period, often twelve weeks, rather than moulding the support offered to the needs of the individual.

Homecare at its best is always about relationship. Reablement should be a process without time constraint but one which involves a multi-disciplinary team with diverse skills and mutual respect for each other’s competences. Such teams should include practitioners such as a homecare worker, community nurse, GP, community geriatrician, AHPs and others. They should be allocated a case load of individuals whose journey to reablement is not limited by the constraint of time or resource, or commissioned models, but is flexible and relational in nature. Workers regardless of role should be autonomous and trusted to make appropriate local, person-led decisions. Such a model has a built-in rhythm where the person is followed up at regular intervals and where real preventative care ensues to the benefit of society and the individual alike.

We need to be adventurous enough in Scotland to embed a re-visioned model of care at home which fosters independence, breaks down the barriers between professionals and different parts of the health and care system. We see some of this in the hospital to home model, but it is much wider and more holistic than that especially when it focuses as much of psychological, emotional and relational wellbeing as it does on physiological needs and frailty.

There is a real opportunity in the talk of a National Care Service for us to re-imagine homecare in a way that fosters independence through continuous personal care and care accompaniment. Preventative care at its best doesn’t create dependency but enables independence.

The concluding words of the report mentioned above still ring true:

“Preventative care is the only way in which social care can deliver – for current and future demand, for constrained budgets but most importantly, for people’s lives. Preventative care is not the opposite to greater self-management but a natural ally and requirement. And preventative care can only be enabled through the valuing and prioritisation of relationships, time and home care services.” (page 36)

 

Donald Macaskill

Details of the Home First event this coming week can be found here 

 

 

 

 

Fulfilling the promise: the potential of a National Care Service

My colleagues Dr Tara French and Imogen Caird have launched the fruit of over a year’s work which they had undertaken with another colleague Becca Young. ‘Coileanadh’ is the output of phase two of the Scottish Care ‘Collective Care Future’ programme. It presents a vision of care and support in Scotland created in collaboration with Andthen, a design strategy studio. The visual landscape embodies the contributions of a diverse range of expertise and experiences from providers, staff, people supported, families and wider partners in care and support in Scotland. The findings include eight concepts and three priority areas of focus relating to the overarching philosophy and culture, the policy and partnership enablers, and the way in which change can be enacted in social care practice.  The work also includes 39 practical steps for action across these themes.

I will let you have a read of the change landscape envisaged by the work, but I just want to focus on a couple of the themes raised.

This last week has seen the formal commitment in Parliament by the new Cabinet Secretary for Health and Social Care, Humza Yousaf, to the creation of a National Care Service. It is a bold vision – albeit one at the moment with little detail, but it represents a real opportunity to create a better way of providing and receiving support and care in Scotland. The authors of Coileanadh believe the actions identified in their work are both complementary and distinct to the recommendations of the Independent Review of Adult Social Care which first formulated the idea of the National Care Service. Coileanadh explores the synergies and areas of opportunity that can help to overcome the implementation gap and articulate the key requirements of a National Care Service, what it refers to as a National Care Framework. In doing so, they aim to offer a more holistic perspective on the creation of a National Care Framework and the resulting implications for how work in this context could be taken forward.

I have already reflected in this blog on a number of occasions on some elements of the National Care Service not least the positive image of a social care covenant, but today I want to take a couple of Coileanadh themes to underline why I think it is important that the distinctiveness of social care is continuously affirmed and why we need to adopt a life-course approach.

The distinctive integrity of social care.

Coileanadh starts with a call to ‘put the foot down’ in order to harness the moment and wider climate that currently exists to make significant change. There is a wide acceptance, accentuated by the experiences of the pandemic, that the model of social care support we have in Scotland is not working. Recognising the problem as the Feeley Report did so eloquently is a critical first step in addressing the challenge. It is, as many have said, not that we have the wrong legislation or the wrong vision, it is because we have failed to implement what we promised. Overcoming the barriers to implementation will be the major challenge of any new models or systems seeking to change the current landscape.

A critical part of creating a national care service is as Coileanadh argues the need to ‘develop a commonly accepted ‘hallmark’ of non-negotiable ‘conditions’ so that everyone is held to account for upholding these and working to ensure that these are supported. This would give assurance and confidence to all people involved, both in terms of quality and recognition.

Part of that is adopting a social care mindset which creates and establishes a more supportive approach to understanding people’s experiences, needs and preferences. This cannot be a functionalist and transactional model but one which is relational in essence, and which starts from a wellbeing perspective that emphasises individuality. We have to get beyond the accounting of value by commissioned timeslots, where care and its outcomes are measured by the length of a visit, with all the negative impacts such casual care arithmetic has upon supported person and worker alike.

A social care mind-set involves shifting the balance of power that clinical models are believed to hold in relation to decision-making and recognising the unique contribution of social care. In all the talk of a national service there is a risk that we try to ape and mirror the NHS. Social care is not health care. It demands and involves a different vision and perspective, one rooted in autonomy and control, personal independence and choice. The National Care Service cannot simply be the National Health Service for social care. Social care has value and importance in its own right not just as an adjunct to acute health care. As Coileandah states: ‘At the moment value is largely from a system-oriented perspective e.g., relieving pressure on hospitals, prioritising settings of support such as the drive for people to remain in their own home and a focus on ‘beds’, ‘placements’ and ‘packages’ as forms of measurement.’

Any model of social care has to be rooted and focussed on the needs of the person and not rescuing the fractures of the system. There is an opportunity in the consultation in the next few months to articulate and substantiate the vision of a distinctive social care mindset. One that moves us from talking about people being ‘treated’ to ‘supported’ and not saying ‘putting’ someone in a care home or ‘maintaining’ someone at home.

A life-course approach

Part of that re-envisioning of both the debate and the foundations of a new way of doing things is the necessity to adopt a ‘life-course approach.’ As Coileanadh argues we need to ensure that any model of social care is not rooted in a discriminatory and broken approach to personal life and wellbeing, not least in terms of age. Instilling a life course approach means normalising the ageing experience in order to view this as a natural journey.

Empowering people to have choice as they age and preparing society with information and awareness of support available should be critical elements of any national commitment. Coileanadh puts it well:

‘A focus on opportunities within the education system and enabling earlier conversations about the value of age and the celebration of wisdom, experiences and richness that comes with the journey of life would foster open and transparent conversations when reflecting on the life course and personal growth. Instilling a value for ‘levelling up’ will support the profile of older people and social care to the extent that people feel privileged to make choices, have options, and encourage people to work in a sector that is rewarding and with opportunity. All stages of life should be viewed with equal importance, e.g., later stages as important as birth, and people should be equipped with the knowledge to prepare for and navigate each stage and life event positively.’

Coileanadh is the Gaelic word which means to fulfil and accomplish. The conversations have been held, the words heard, the desires expressed. Now is the time to make the change happen. Now is the time to put aside vested interest and partisan position, and to adopt the holistic shared common purpose of creating something new and better. This is a task not just undertaken for those who use care support, who work and manage, who provide and regulate, who commission and finance today– but for everyone who follows. There really is an opportunity to fulfil the promise.

It is time to push the boat out, to seek a better horizon than the limitations of our sight, to dream bigger than our imagination, and to do better than our skills permit. And in the brilliant words of Edwin Morgan the unknown is always the best even in older age:

At Eighty

Push the boat out, compañeros,

push the boat out, whatever the sea.

Who says we cannot guide ourselves

through the boiling reefs, black as they are,

the enemy of us all makes sure of it!

Mariners, keep good watch always

for that last passage of blue water

we have heard of and long to reach

(no matter if we cannot, no matter!)

in our eighty-year-old timbers

leaky and patched as they are but sweet

well seasoned with the scent of woods

long perished, serviceable still

in unarrested pungency

of salt and blistering sunlight. Out,

push it all out into the unknown!

Unknown is best, it beckons best,

like distant ships in mist, or bells

clanging ruthless from stormy buoys.

From https://www.scottishpoetrylibrary.org.uk/poem/eighty-0/

Donald Macaskill

 

 

 

 

 

 

Donald Macaskill