A Few Words about Words

A word about words or maybe a brief discourse on discourse, how language is used is important in society and we have a debate now on how Dementia is referred to (see the excellent D4Dementia Blog).

Despite Shakespeare’s words, “a rose by any other name would smell as sweet”, if a rose was called a manure fed weed, chances are that you would not even bother trying to smell it in the first place!

Sometimes the changes to words we use to label something are good, we only have to look at the term learning disability, previously known as mentally handicapped, mentally retarded (mental retardation is still used in the U.S.A.), feeble mindedness etc. and we have the evolution of the label lunatic to mental health issues. In such instances re-labelling the terms we use reduce the stigma attached to the old ones and can help toward promoting a more positive image of individuality.

Many times labels are used by those in power to delineate ‘us from them’, the classic example being a terrorist in one state can easily be called a freedom fighter in another. Governments re-label in different ways constantly, usually as way of marking out their difference from the previous one – for example the Department for Children, Schools and Families was quickly relabelled the Department of Education when the current Government came to power, the functions are largely the same but the idea is to display the current ideology in the Ministerial office.

Labels also change as a form of aggrandisement, for example in job titles where those who collect our rubbish are now waste management technicians or those trying to sell us insurance become Financial Security Consultants, equally labels can be used to demonise and stigmatise where they become stereotypes in order to pit one section of society against another.

Whatever the reason for changing labels and the way we talk about things is, ultimately, about changing perceptions of how people in society view something.

What it rarely does is change the reality of what happens. Waste management technicians still collect our rubbish on a regular basis, the violent actions of an individual whether they are a freedom fighter or a terrorist remain the same and Ministers still sit in comfortable offices whatever the name of their department at the time.

So those with dementia or neurocognitive disorder, will suffer the same symptoms, require the same level of care and support and families will live through the same fears no matter what the condition is labelled with. Yet what about further up the social care ladder?

As the cases of dementia continue to grow as the population ages what difference will the label ‘disorder’, rather than disease, make to those holding the purse strings of care and support. It would be interesting to test public perception of the two words and see which is considered more worthy of tax payer money and how politicians in power would change their policies dependent on the word used. Many have campaigned to have dementia recognised as a disease in order to receive proper health funding for those who suffered from it, where does the word disorder leave their efforts?

It is also important to consider the people who actually suffer from it. Throwing new terminology at a person with cognitive decline and probable short term memory problems does seem foolish. One of the keys to personalised care and support is using language which is familiar to the individual and be changing terminology in can confuse and bewilder, especially when the new terminology is particularly vague, after all neurocognitive disorder could easily be interpreted as the result of a head injury, or more connected with mental health issues, something in the realm of psychiatry rather than the physiological needs that can be associated with dementia. In the wider world the public are more aware of dementia than ever before, throwing in new terminology muddies the waters at a time when increasing awareness is needed.

Words are important and the way we use language has an impact on how society as a whole perceives something yet the most vulnerable in society, those with dementia or those with learning disabilities will always have some difficulty in grasping new labels attached to conditions they may have which in turn can further confuse and bewilder them.

Although the possible changing name of dementia has sparked this debate it does not just apply to that, anything we re-label, any terminology we use can cause confusion amongst those who need clear, precise and understandable language to support them in their day to day lives. Whatever the reason for wanting to re-label dementia those who wish to do so should consider how their new terminology will improve lives for individuals and if it does not, why bother?

It's not just about who pays for Social Care but How We Talk About It

                Politicians of all parties have a tendency to view social care as a matter of cost. The endless consultations we have had over the past few years have focused on how social care is paid for and who should pay for it.

Yet it is not just a matter of cost but of how society views its provision care and support for those who need it.

To really improve the social care system society first needs to start changing the discourse of social care. Public views and opinions are always based on the way politicians and the media talk about different issues and social care is no exception. Those who have no contact with the social care system could be forgiven for thinking that social care is delivered in a completely haphazard manner, leaving all those who need it at risk and that care and support is delivered by individuals who are completely incompetent or, worse, evil people who prey on the vulnerable.

This view is very far from the truth yet it is a persistent cloud that covers the areas where social care shines and it is this cloud which needs to be blown away before we can make any real progress in improving social care.

Firstly we need to tackle the image of working in social care.

Social care workers are low paid, work unsociable hours and receive little reward for the work they do – yet they do it. But the entire workforce is often told it needs to ‘professionalise’.

Imagine the effect on any workforce that is constantly bombarded with the implication that they are unprofessional. Think of the impact on staff morale and performance. If you were to hear that phrase used about you, how would you feel?

To add to that there is the constant comparison of social care workers to the retail sector in terms of wages and conditions. Yet how can the two types of work be realistically compared? In truth the closet comparison would be to that of Healthcare Assistants in the NHS but that, perhaps, would raise to many questions in relation to pay and conditions.

The portrayal of social care workers as unprofessional and low paid naturally has an impact on recruitment and retention in the sector. What incentive do younger people have to enter social care other than as a last resort job?

Pay and conditions are not going to change overnight, the way the system works at present means that many care providers are small businesses who do not have the funds to improve wages without making cuts in other areas of care provision or, and lets be blunt, cuts in their profits but it is time to really start talking up social care workers and making realistic comparisons about the work they do.

Politicians also need to tackle the perception of haphazardly delivered care, yes there is a postcode lottery where care and support provision depends on the Local Authority that delivers it but are those services so significantly different from one area to another? If so, then surely we need Government intervention, to discover why and to take action to rectify this and to be seen to do so publicly. Too often, in recent years, there has been a tendency for Government to brush of social care delivery as the responsibility of local authorities yet, in truth, social care is still funded by central government and they should take responsibility for it.

Perhaps the hardest issue to tackle is that of the risk of abuse. We need to be constantly vigilant in the fight against adult abuse but the public also needs to be informed of the reality of vulnerable adults and abuse. Abuse is not limited to social care workers, in fact in home care abuse is far more likely to be committed by family members than by care workers but it is where a care worker has committed abuse that is far more likely to hit the headlines.  In many cases it is the social care worker who identifies and reports abuse committed by others yet such work goes unreported.

How social care is viewed depends on how social care is talked about and it should now be time to start talking about social care openly and honestly, identifying the real issues, talking about them and taking action to deal with them.