Compassionate Ageism: A Curse Within Social Care: Speech given at Hertfordshire Social care Festival 12th November 2019

Recently, I spoke at the Adult Social Care festival of Practice organised by Hertfordshire (ASC, Development Centre in Stevenage, Tuesday 12th November 2019). I was privileged to share the platform with Mr Justice Mumby and professor Bob Hudson. It was a daunting experience given their prestigious national profiles. My subject was listed as 'Compassionate ageism in Care Services', though I had at the outset to reclaim the original title which I had proposed, namely "Compassionate Ageism - a curse within Social Care". 

Whilst I did not write a paper, using only notes and headings, this blog is basically my speech written from those fairly chaotic scribblings which I now hope reflect more or less the performance! 


A TRINITY OF SOURCES


One of the best analyses I have read on the existing social care narrative was recently published by Social Care Futures' (Talking about a Brighter Social Care Future, 2018), written by Neil Crowther.

The second source was the late feminist writer and gerontologist, Betty Friedan, from North America, The Fountain of Age (1993), which, for me, is one of the most influential books on my shelves, introducing me to the concept of Compassionate Ageism and in particular, its pernicious effects on  how we think about age and ageing, and hence the practice of social care.

Finally, a book published only a few months ago, edited by four amazing individuals and with contributions from a number of writers (Rob Mitchell, Elane James, Hannah Morgan, Ian Burgess and Mark Harvey). I was privileged to speak at the London book launch at what I consider a publishing social work sensation (Social Work, Cats and Rocket Science, 2019). It has been said of this book that it has 'been written by social workers who dearly love their work, powerful, hopeful, funny and informative'.

I, therefore, wish to apply the Neil Crowther narrative about social care's injustices in how we think about and communicate compassionate ageism; the challenge of Betty Friedan in understanding the destructiveness of this form of ageism with the inspirational, practical application of what social work is, can be and ought to be in Social Work, Cats and Rocket Science.


REFRAMING THE SOCIAL CARE NARRATIVE AND MESSAGING


We understand, and it is a given, that in general terms, social care lacks adequate financial investment. We accept, too, that there are structural and systemic issues in how it is delivered and carried out and 'the gap between those requiring good support and those accessing it'. In Crowther's view, this is set to get wider.

Both policy and certainly campaigners and the media in highlighting the social care deficit and shortfalls focus on presentations and a narrative of decline, deficit and othering of older adults seeking support. We, and here I speak as an ageing baby boomer, are 'somebody else'. By seeking to appeal to the public and politicians' hearts and minds, existing narratives and messaging is about the plight, negativity, rescue, pity and fatalism. Older adults are a burden, a drain on limited resources, lonely, increasingly living with the risk of dementia, frail and long-term care, whether in the community or institutions, evidence a demographic time bomb, which is at the tipping point of an explosion. What is argued is that we need beds, more beds, and even MORE beds. Let us resource the provision of beds, more nursing and residential care, more home care, more clubs, and all will be well.

This is a pernicious narrative, one that, in my view, has and remains at the heart of present-day social care, third sector effort, and political ambivalence. It is one that blames older adults for the 'care crises', one that rigs our responses to primarily outdated so-called 'responses'. Responses that patronise older adults, infantilises them, and others them. In addition, it too frequently disempowers, removes real choice and control from many social care workers, and ALL older adults. We collude with the plight, negativity, rescue, pity and fatalism, rather than the hope and optimism of citizenship, human rights, ownership, control and, above all, the radicalisation of social care.

Compassion and empathy are important. Even Compassionate Ageism, coined by Robert Binstock (1984) was originally one that led to policies and politics on ageing that benefited older adults through its 'collective concern.' Indeed the very construction of 'an old age welfare state' was facilitated by it. But, over the past half-century, it has arguably become corrupted, which was the Friedan view and social care policy and practice, in this context, is potentially destructive.

Returning to Crowther, the values we hold today and how they are framed need to inspire hope and possibility, but also need to be regarded as a certainty. We need a more collaborative and cooperative social care model. The ethics and values of social care/work that underpin practice has to communicate a set of different values, a different vision, a different underpinning in the context of age and ageing, and a narrative adopted professionally of social care and by the public. 'The messaging of organisations campaigning for reform and spending on social care and the consequent impact on public thinking is at the heart of the problem concludes Crowther.

My questions to all of us engaged in some way in adult social care is: where is the power, ownership and benefit held? Where are the voices of discontent, indeed who are the social care professionals that silence the voices of those wanting to reshape the narrative? Crowther has articulated the story we want to tell and the dominant framing that has allowed Westminster to dither and delay and put off the Social Care Green Paper. What is worse is my fear that, if that consultation paper ever sees the light of day, it will be based on the very negative framing of which Crowther warns!


A CURSE ON ALL OUR SOCIAL CARE HOUSES


Compassion is biased and tends to tilt assessments and subsequent actions and outcomes that benefit the agency's commissioning and provision of services. It is about feeling good about ourselves as financial managers or gatekeepers, charity trustees, elected politicians, practitioners, volunteers. God help us! We think celebrity endorsement of our third sector objectives/purpose is a cherry atop a cake of stale ingredients, which is consumed with gratitude, as little alternatives are on the menu.

"Ageism in broad terms is 'complicated'. Ageism is not equivalent to sexism and racism; there is no one group discriminatory against another. Younger people can be discriminated against, as can older adults. Indeed we are all, throughout our lives, oppressed by ageism, by dominant expectations about age, expectations that dictate how we behave and relate to each other"  writes Bill Bytheway ( Ageism in Age and Ageing Ed. Malcolm Johnson 2005) 

Little, however, is mentioned about Compassionate Ageism, though we are increasingly becoming familiar with the Decline System of New Ageism. The economic drain of older adults on society, time bombs, demographic tsunamis, the boomers robbing of generations x/millennials, the innocent absorption of cultural signals, youthful age anxiety, and so-called 'middle ageism' dominates ageing narratives (Gullett, M, 2013). Where is the notion of how compassion compromises human rights, wellbeing, belonging, citizenship and hope? We are blinded to the potentially pernicious consequences of our social care actions and responses. All of us in this room is at risk of colluding with the pretence that our practice is without prejudice, myths and stereotypes about older adult users - nay, older adults generally. Eligibility criteria, resource constraints, case demands and our internalised cultural attitudes to and about older adults shape our responses. Compassionate Ageism demonises and commodifies ageing, leading to a belief that we are doing what is in their best interests. It leads to systemic stereotyping and discrimination against people we deem older. It is the offensive exercise of social care power in reference to age. It oppresses. It is a social construct. All evidenced by and through both our behaviour and language-imaging, negative narratives and communications which dehumanise and depersonalise. It sees our older adult 'users' as victims and vulnerable, and it pathologises and others. Older adults become somebody else! Evidence? Look at case notes, care plans and minutes.

Compassionate Ageism is a curse dressed up as concern and as sympathy. As a professor of Social Gerontology Tom Scharf (Newcastle University) coined, 'benevolent patronage'. Compassion exists and here's the rub - it exists in the minds and attitudes of older adults themselves. Older adults 50yrs plus are essentially the same and worthy of government assistance. The notion of  "silver or grey" power is a myth. We see older adults as goodies or baddies (deserving or undeserving, needy and desperate, requiring special policies). It is a time of loss and decline. Ageing celebrity endorsements have in my view, distorted the narrative around loneliness, dementia, social isolation and poverty.

Compassionate Ageism sees:

- Older adults as a problem = they are somebody else
- Dependency, sickness and deficit = plight
- Imaging = negativity (decline) eg images of wrinkly hands
- We must do something = rescue
- Age has to be avoided = pity

Plight, pity, decline and rescue - beware! A rescuer can easily become the persecutor, and good intentions, risk assessments, safeguarding policies, care homes, day centres, eligibility criteria, home care, budgets, financial management, and adult social care generally, become, in reality, oppression.


FROM OPPRESSION TO "LIBERTY" - THE ANTIDOTE


The third and final source on which I have drawn for this presentation is the recent publication Social Work, Cats and Rocket Science (1919). The authors reflect in my view a different pathway and value base, which moves the narrative from hopelessness to hope. It is a narrative of ambition and a belief in a better social care future for adults - especially older adults. It is a narrative of opportunity and freedom. We move from the rhetoric of  'personalisation and co-production' and professional/political grandstanding to the reality of outcomes that people actually want.

Earlier we explored Neil Crowther's analysis of the importance of language, messaging and communication. We now look at the importance of upholding respect for the inherent dignity, equality, and worth of all people. Upholding social justice and human rights and, quoting judge James Mumby, 'being a servant, not a master'. To this I would add: not being a jailor to a prisoner of social care or work bondage.

Much is said and written these days about loneliness epidemics, dementia tsunamis, mental incapacity and frailty. I urge you to read chapter one of Social Work, Cats and Rocket Science. In fact, I urge you to read all the chapters. Read Mavis's story. It is a familiar one, one that was evident in the late 1960s when I first started my social work career. And it is evident in November 2019, as I stand behind this lectern. To quote two sentences, 'We are guests in people's lives, and it is not always benign or good.' And 'social care is about standing up for peoples' rights, to have a right to a home and a private family life'. To Liberty!

Mavis died in her sleep, waiting to return to her home, with her lifelong partner. Her husband was the eighth person to be informed of her death.

The years, months or days remaining to an older adult is of value: everyone is capable of exercising choice and everyone has a right to participate in society. So what is the nature of wellbeing, of social justice, of choice and control? On what grounds are they denied? What are the existing protections in place? I leave these provocations with you.

I have, over the years, given and heard eulogies at funerals, and frequently thought that they provide more information on the deceased than ever obtained on the living through social care assessments and processes. Knowing the person, not the labels, of loneliness, dementia and frailty is written large. It's not rocket science!