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The second part of the report concentrates on to understand process of ageing. It will then assess the role and function of social work within wider socio-political policy context especially in terms of poverty and inequalities. Finally it will be demonstrated how the identified issues may inform the policy and organisational context and the points raised will be summarised in the conclusion.
According to World Health Organisation, most developed world countries have accepted the age of 65 years as a definition of “elderly” or older person. (WHO: 2012) However, in the United Kingdom the Friendly Societies Act 1972 S7(1)(e) defines old age as, “any age after fifty”, where pension schemes mostly are used age 60 or 65 years for eligibility. (Scottish Government: 1972) Ageism can be defined as process of discrimination and stereotyping against people because of their age. It affects many institutions in society and has a number of dimensions such as job discrimination, loss of status, stereotyping and dehumanization. Ageism is about assuming that all older people are the same despite different life histories, needs and expectation. (Phillipson: 2011) According to Erikson (1995) psychosocial stages of life older age has been defined as the period of integrity versus despair. This stage involves the acceptance and reflection on one’s life.
The authors describe older people as a group of marginal concern that has moved to one of central importance in social work profession (Phillipson: 2011) This is caused by the speed of demographical change that is most remarkable in its expand. The number of older people is increasing both in absolute numbers and as a proportion of the total population. The ageing of the population indicates two main factors such as the downward trend in the birth rate and improvements in life expectancy. (Phillipson: 2011) In Scotland in 2010 there were an estimated 1.047 million older people age over 60, where older people are one fifth of Scottish population. (Age Scotland: 2012) In the last hundred years Scotland’s life expectancy has doubled from 40 in 1900, to just over 74 for males and just over 79 for females in 2004. By 2031 the number of people aged 50+ is projected to rise by 28% and the number aged 75+ is projected to increase by 75% (All our future: 2007) It has been estimated that in the UK in 2005, 683,597 people suffered from dementia, the number is expected to triple by 2051 to 1,735,087 people. (Alzheimer’s research trust: 2010)The issue require to be deeply analysed in terms of how society will be able to respond effectively to the complex needs of older people.
“Look beneath the surface” the needs and issues of older people
The policy All our future (Scottish Government: 2007) indicates the age over fifty as a stage where life circumstances start to change in ways that can be significant for the future. An example of this can be; children leave home, change in working patterns, people have less work and more time for themselves and perhaps more money. It is worth pointing out that caring responsibilities for elderly relatives at this stage can also increase. The time fifty upwards is a time when physical health can deteriorate causing possible health problems such as osteoporosis, osteoarthritis or coronary heart disease. What is more, the state of health after that time decrease substantially and become greater in its extend. People must face changes in appearance such as wrinkles, hair lost or change of hair colour to grey. In addition, they physical state deteriorates and they are not as fit as they used to be. Form psychological point of view this must be difficult to accept it. However, ageing can also concerns some psychological effects such as changes in memory function, decline in intellectual abilities or even memory loss. As a result of a degenerative condition of brain’s nerve cells or brain disorders many people may suffer dementia, Alzheimer or Parkinson disease. Wilson et al. (2008) who draws attention to physical, biological and psychological effects of the ageing, pointing out that ageing is not itself a disease but some specific diseases may be associated with this process. (Wilson: 2008)
Social work underwent fundamental changes from the 1960s following broader ideological, political and economic developments. To understand the current role of social work within society and wider policy framework, particularly with older people, it is important to analyse the past socio-political and economic trends that have reflected on contemporary practice. By the 1960s, more attention was beginning to be paid to the social consequences of capitalism that started to be seen as the economic order of an unequal and unfair society. The strong critique of that system is known as radical social work that grew on the ideology of Marxism. (Howe: 2008) The publication of the Kilbrandon (1964) consequently led to introduction of Social Work (Scotland) Act 1968, which embedded social work firmly within state sector with the voluntary sector as complementary. (Ferguson & Woodward) Social work wanted to be seen as unified profession that offered generic services, to overcome earlier fragmentation and overspecialisation of services. Social workers were obligated by law to assess needs and promote social welfare by providing services. However, the government of Margaret Thatcher began to weaken state welfare responsibilities to help people in need leading to the major ideological shift in 1980s called neoliberalism. As a result Barclay Report (1982) intended to clarify the role and task of social workers employed within statutory or voluntary sector, the later Griffiths Report (1988) were similar to Barclay Report in terms of promoting greater choice, participation and independence of service user and carers. However, neoliberalism undermines the role of welfare professionals, allow the rich become richer and marginalise the poorest and most vulnerable individuals. Woodward and Ferguson (2011) argue that neoliberal trend has been continued under New labour government, leading to managerialism and bureaucratisation. Therefore, contemporary practice is drawn by extreme pressure through the forces of marketisation, managerialism and consumerism, that led to profession dominated by stress, frustration and strongly focus on meeting deadlines. The labour government has also been driven by the development associated with consumerists ideas such as personalisation that place service user at the centre of service design and delivery or direct payments that emphasise independence and individual choice through giving service user their own money to buy own services. For a long time neoliberal economic and social policies in the UK speculated a very different concept of what social work should be about. The Changing Lives report of the 21st Century Social Work Review (Scottish Government: 2006) has brought significant shift within social work polices through an expression of dissatisfaction of social work that was mainly caused by lack of opportunity for relationship based work with service user.
The policy has reshaped social work practice towards providing social workers with additional space to develop good social work practice. There have been initiatives to improve recruitment and increase professionalism and standards within workforce as well as improve integration in the planning and provision of social work services. Integration has been developed through Modernising Community Care: An Action Plan (1998) and Community Care Joint Future (2000) that introduce Single Shared Assessment (SSA). In Scotland Joint Future is the driving policy on joint working between local authorities and the NHS. The other key policy themes are personalisation, self-directed support, early intervention and prevention as well as mixed economy of care on the grounds of more effective partnership. (Scottish Parliament: 2008) Another significant report that brought about change in policy and later in Scottish legislation is the Sutherland Report (1999) that provided free personal and nursing care on the basis of assessed needs. (Petch: 2008) The above review of social work policy framework is a good illustration of constantly changing role and function of social work. Social work operates within socio-political framework of constantly developing policies and legislation of health and social care. The reality and ideology constantly has changed people and society faceing new challenges. Social work makes a key contribution to tackle these issues by working with other agencies to deliver coordinated support and to increase the wellbeing of older people.
The critical analyse of needs of older people and current issues in the delivery of social work services.
The first issues when working with older people is partnership of health and social care within four main areas: assessment, care management, intermediate care and hospital discharge. (Wilson: 2008) The main problem is tight budget this is in particular importance especially in statutory setting. (Wilson: 2008) The problem increases when local authority must, as normally is a case, work in collaboration with other bodies. This raises an external question who are going to pay for services? That causes unnecessary delays and constraints. One might expect that new Integration of Adult Health and Social Care Bill (Scottish Government: 2012) will resolve problem by the joint budget and equal responsibilities of Health Boards and Local Authorities. Wilson et al. stresses the importance of rationing services in social work due to low budget that lead to delays in provision of services and lack of time to develop more creative forms of practice.
The next issue is the assessment process that is seen as balance between needs and resources. A major element during assessment is the relationship with service user and appropriate methods of communication to understand and be understood. Practitioner must take the time to get know the older person and resist pressure from other professional to do a quick assessment. (Mackay: 2008) The problem of autonomy and protection is the other one in relation to work with older people. This raises the question of capacity, consent and the deprivation of liberty of older people. This group of service users is often a subject of legislation that deprives their rights and liberty, this is because they are likely to be affected by cognitive disorder such as dementia. The term dementia include Alzheimer’s disease, vascular and unspecified dementia, as well as dementia in other diseases such as Parkinson’s. It has been estimated that in the UK the number of patients diagnosed is 821,884, representing 1.3% of the UK population. (Alzheimer’s research trust: 2010) The assessment of incapacity or mental disorder is not straightforward and ethically and morally difficult for both service user and social worker. Social workers have to manage the balance between acting in accordance with the wishes of the individual and their best interest. It has been suggested by policy and legislation that the views and wishes of people expressed through self-assessment would remain at the heart of intervention. (Department of Health: 2005)
The another issue is abuse of older that may have many forms and can be very severe in its extend. Older people are vulnerable to abuse or to not having their rights fully respected and protected. The problem came to public awareness not as long as few years ago. Despite the fact that legislation came into force through Adult Support and Protection (Scotland) Act 2007 it is estimated that elder abuse affects 22,700 people in the Scotland each year. (Age Scotland: 2012) Older people are a subject of physical, psychological abuse, neglect, sexual or financial harm, that normally takes place at home, in hospital, residential care or day centre.
Age discrimination is next issue to consider around 24 per cent of older adults in the UK report experiencing age discrimination. (Age Scotland: 2012) The new NHS policy that came to force 1st of October this year, states that it is unlawful for service providers, policy makers and commissioners to discriminate, victimise, or harass a person because of age. A person will be protected when requesting and being provided with services. If anybody will be treated less favourably because of their age, they will be able to take organisations or individuals to court and may be awarded compensation. This mainly relates to health boards individual clinicians such as consultants, GPs or other health professionals. (Department of Health: 2012)
Older people are disadvantaged based on the relatively low socio-political and cultural status in contemporary society. They are repeatedly presents as a drain on resources as they no longer actively contribute to grow of society. They do not work and do not pay taxes anymore. Older people are systematically disadvantaged by the place they occupy within society. Wilson et al. (2008: p. 620) rightly suggests that old age is “socially constructed”. A good example of this is retirement that makes people officially old and unavailable to work, despite factual physical and emotional state of the individual. Other forms of social construction that significantly affect the experience of old age is class, gender, race and ethnicity. (Wilson: 2008) An illustration of this can be statement that older people have much more in common with younger people from their class then they do with older people from other classes. (Philipson: 2011) Disadvantages and inequalities experiences during life can magnified the process of ageing through differences in access to health facilities, health status and lifestyle that may influence life expectancy. There is no doubt that experience of ageing is subjective and depends on many factors but it seems to be a matter to consider class, gender and race at first place. When discussing poverty and inequalities the things that have to be in mind are issues of discrimination of older women who are less likely to have as a great pension as male due to the fact many women are paid a lower wage then men. Moreover, women tend to live longer than men so they are more vulnerable to live alone and in poverty. (Age UK: 2012) There are many forms of disadvantage associated with older people in poverty such as; low income, low wealth and pension, debts or financial difficulties, feel worse off, financial exclusion, material deprivation and cold home. The first three are experiences by around 20% of older people, half of older people experienced at least one of the nine forms of poverty described above, and 25% had two or more. A minority 3% suffered from three or more forms of poverty. (Age UK: 2012) In terms of ethnicity and race there are significant inequalities in the process of ageing. An illustration of this can be the black community of older people who are more likely to face greater level of poverty, live in poorer housing. In addition, they are more susceptible to physical and mental illness due to often heavy manual work, racism and cultural pressures. (Phillipson: 2011)
Most of older people want to say at home as long as possible this is supported by policy All Our Future (Scottish Government: 2007) that helps people through services such as free personal care, telecare development programme, care and repairs services or travel scheme free bus passes. The policy aims to improve opportunities for older people, foster better understanding towards this group of service user, create better links between generation to work together and exchange experiences, to improve health and quality of life: promote well being and active life within community, improve care support and protection, housing and transport as well as promote lifelong learning.
The role of social work in working with older people is described by Marshall’s text (1990) and cited by Scottish Government (2005) It has been suggested that a key issues are: communication, including sensitive listening and awareness of non-verbal communication, taking time to assess needs always in the presence of service user. Supporting people in managing crises that arise through loss or change such as bereavement, mental health issues or physical constrains like illness or disability. Offer practical help and organise resources. Working with other professionals and people involve in the process of intervention and together combat ageism.
Ageing can be defined as discrimination against older people m
The current trends in adults social care have began through Green paper Independence, Well-being and Choice (Department of Health: 2005) and the subsequent White Paper , Our Health, Our Care, Our Say (Department of Health: 2006) these documents set out the agenda for future. This is based on the principle that service users should be able to have greater control over their own lives, with strategies that services deliver will be more personalised than uniform, this is referred to as personalisation. Personalisation enables the individual to participate and to be actively involved in the delivery of services. Personalisation also means that people become more involved in how services are designed by shaping and selecting services to receive to support that is most suited to them (Scottish Government: 2009) Personalisation is a wide term covering a range of approaches to providing individualised services, choice and control. The programme directly response to wants and wishes of service user regarding service provision. Personalisation consists of person centre approach, early intervention and prevention, is based on an empowering philosophy of choice and control. It shifts power from professionals to people who use services. (Department of Health: 2010) However, it could be argued that approaches extending service user control in realty can be seen as transferring risk and responsibilities form the local authority to the individual service user (Ferguson: 2007)
Another option recently promoting by government is Self Directed Support (SDS), a Bill has been introduced into the Scottish Parliament last year and recently has passed stage three. The bill seeks to introduce legislative provision for SDS and the personalisation of services and to extend the provisions relating to direct payments. (Scottish Parliament: 2012) The SDS approach before has been brought into Parliament were reflected in many reports and policy initiatives such as: Changing Lives, Reshaping Care for Older People. SDS let people to make informed choices about the way support is provided, they can have greater control over how their needs are met, and by whom. Social worker working on behalf of local authority will have a duty to offer SDS if the individual met eligibility criteria. The four options to consider are: direct payment to the individual in order that that person will arrange own support, the person chooses the available support and local authority will make arrangement for services on behalf of that person, social worker will select support and make arrangement for provision, the last option is a mix of the above options. (IRISS: 2012) There is no doubt that the ideas of SDS are glorious because express a great opportunity for service user to expand their control over services provided. However, this raises a question of how many people will be ready to utilise option one of SDS, if a ordinary person who use services will have skills and knowledge to take responsibility for own care such as to employ own carers or personal assistance and to buy own services. One could envisage that it could be possible if the role of social worker will change from care management to brokerage and advocacy. The new model of care requires also to support communication, have experience in employment practice, manage record keeping and pay roll services. A potential care broker will provide assistance to obtain and manage a support package, drawing on individualised funding. It can be questioned if social workers who are mostly employed by local authority and accountable to statutory agencies are reliable to perform this task working across three sectors.
Service User Involvement
Dalrymple and Burke (2006) discuss issues that influence contemporary social work such as social justice, empowerment, partnership and minimal intervention. The service user participation has began in 1990 through NHS and Community Care Act. (Ray, 2012) There is still increasing acceptance that people who receive services should be seen as own experts in defining their own needs. This is in accordance with exchange model of assessment presented by Smile and Tuson et al. (1993), where social worker view the individuals as experts of own problems. The role of practitioner is to help service user to organise resources in order to reach goals that are define by the service user. Government policy addressing to older people highlights the importance of developing services that focus on maintaining independence, encouraging choice and promoting autonomy such as Independent living in Scotland (2011), Reshaping Care for Older People (2011), All our Future(2007). The policies highlights the importance of user participation in risk management and risk taking within independent community living for older adults. One of the action enhance independent living is direct payments. This has been seen as a way of improving choice and autonomy of older people. Social workers have a moral obligation to ensure that direct payment, when offered, do in fact provide better opportunity for this group of service user to meet their needs in creative way. (Ray: 2009) One may expect that active involvement and participation in service provision will have a crucial role not only in exercise more control and choice but also in challenging social exclusion. Shaping our lives is a notional independent user network that aims to make sure the voice of older people are heard so they have equal chance in defining outcomes in social care. (Crawford & Walker: 2008)
It could be argued that one of the main needs of older people is the importance of active listening of this group of service user, who are often because of age ignored or disregard. This is supported by Kydd (2009) who highlights how important it is for older people to feel that they are being listened too.
In social work there is constant need to evidence based practice on the grounds of empirical knowledge that guide decision making process. An example of this can be three stages of theory cycle presented by Collinwood and Davies. (2011) There is no doubt evidence based practice is important but the view undermine relationship based practice that is equally important. Rightly Wilson (2008) refers to relationship-based as a main feature of social work practice that shape the nature and purpose of the intervention. It is a unique interaction between the service user and the practitioner that help to obtain more information and define the best way of intervention.
A fundamental part of working with older people is to recognise and respond to the way in which they may be marginalized. An example can be the role of social worker as advocate that seek; to provide accurate information in relation to the services the individual is entitled and to enable the person to live where she/he wants to live. (Dalrymple & Burke: 2006)
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