Purple Badgers and Social Care

Really try hard not to think about a purple badger

Now having mentioned the purple badger it is probably highly likely that, in an attempt not to think about a purple badger that you have naturally conjured up an image of one so that you can try to not think about it! If I were more conventionally minded I probably would have said try not to think about a pink elephant, but now that I have said it has the pink elephant replaced the purple badger in your mind? Or are the pink elephant and purple badger co-exiting in multi-coloured animal harmony?

Naturally I do have a point about this.

To move to a less abstract level, have you ever witnessed someone saying to someone else, “mind the plate it is hot” and the instant reaction of the other person is to unconsciously actually touch the plate to verify that? Children are usually the best example to see this phenomenon in action – saying “don’t step in that puddle” invariable ends up in wet shoes and muddy clothes!

Language can be a powerful thing and what we say can have an impact on the behaviour of others.

Of course there is nothing new about this. Advertisers, marketers and politicians have been using various language techniques to tempt us, draw us in or deflect us for years. And, obviously, it is not an exact science. How we react to what someone says to us varies according to our own perceptions, views and upbringing. So if I were advertising bacon sandwiches you would have to actually like them before any advertising had any impact, and no amount of suggestion of sweet smelling, succulently crisp bacon being taken from the sizzling pan and being placed on deliciously soft freshly cooked bread would work.

So what does this have to do with social care I hear you ask (with a mouth full of bacon sandwich!)

Social care is intensely people orientated. Care workers work face to face with those who need care services, social care leaders supervise and manage those social care workers and the social care leaders interact with other agencies and in order to achieve the best possible care and support down the line we have to be aware of the power of language and the effect in can have on those we speak to.

Imagine a supervision where the manager tells a staff member that that must stop acting so defensively, the usual reaction is to say “I’m not being defensive” in a very defensive manner. If the manager were to say, “it would be good if you allowed yourself to relax more at work” then the reaction would be different and while the person may not actually relax now they would not have the image of being defensive.

Similarly, if a person with challenging behaviours were told to stop being aggressive they have to think about being aggressive before being able to stop it! This is particularly problematic when the individual does not perceive themselves as being aggressive in the first place. In such instances it is far better to focus on positive words such as relax, calm etc, (although calm down can be an issue – calm down from what?) as these words are better suited to the state you wish the person to achieve.

Even on a minor level we have to be careful what words we use. If I were to say – don’t forget to share this blog with others – the possibility is that you would forget! Yet if I said  REMEMBER to share this blog with others I am far more likely to get a positive result.

If you have read this far the purple badgers have probably slipped from your mind, oops they are back again! But in the future any time pink elephants are mentioned you’ll naturally have an image of purple badgers too!

Language is intensely powerful and it is important that, in social care, we are aware of this power. It is by no means easy to consciously and continuously control what you say to others but we have to be aware that the behaviours of others can be a direct result of what we have said rather than being something totally disconnected from us. Effective communication is the cornerstone of quality care and support and must be one of the key skills that is taught at all levels of social care, if we do not understand the importance of communication and language how can we effectively communicate with those who need care services and those we work with.

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?

Being Gay is Wicked: Language, Leadership & Social Care

"Being Gay is Wicked”

What does that phrase mean? Fifty or sixty years ago it would mean “being happy is sinful” today it would mean “being in a same sex relationship is a really good thing”.

What this illustrates is that the language we use can change meaning quite drastically is a relatively short period of time and while the example above is quite extreme in nature more subtle changes exist that impact on our understanding of everyday things and social care is not immune to this.

Take, for example, the discourse of institutions. The current social care system was created out of a  desire  to get people out of institutions, at that point institutes were the large, impersonal, usually Victorian, buildings that held people with learning disabilities or age related conditions that impacted capacity. These places were notorious for their lack of privacy, dignity and respect where people were treated as objects of pity rather than as individuals with their own personalities, preferences and rights. The people incarcerated in these institutions had no control over their lives, no chances to participate in how their lives were being run and little opportunity for any decision making.

It is no wonder then that the term ‘institution’ developed an extremely negative meaning.

The answer was, of course, to close these institutions and develop smaller care homes for the elderly and frail and those more severely disabled whilst promoting care in the community for the more able.

Yet, just a few decades on, the term ‘institution’ is used to describe those care homes which grew up out of the  desire  to rid the country of those old institutions!

Because of that, and the negative connotations of the word, care homes are seen by the public at large as bad places where the practices of old institutions still take place. Obviously there are bad care homes where institutional practices still take place but, in general, care homes have considerably improved the level of care from the dark days of the institutions.

The principle reasons for painting care homes as bad places is to promote the agenda of more community care and this is a perfectly normal way we operate in language. If we want to show that something is better we contrast it with something that is not as good but there are implications in doing this with social care.

For many there is no alternative to living in a care home. Those with advanced dementia, for example, may need the 24 hour care and support that their families (if they have one) are no longer able to provide. Some, with severe and profound learning disabilities, may benefit from the community setting of a care home rather than the potential isolation of living alone and for other elderly people a care home setting may free them from loneliness.

The negative image of care homes also impacts on the hundreds of thousands of care workers in the country, the majority of who deliver the best possible care they can. Being associated with the impersonal, autocratic staff of the old institutions is hardly a basis for improving moral in the sector!

This is where effective leadership across social care is so important.

To promote social care and to raise the standards those who lead must  present a positive image  of the sector. Being positive does not mean ignoring the deficits and problems of care homes nor does it mean painting a false picture.

Truth and honesty are important traits in leadership as they generate trust as does a recognition that things are not as good as they could be. But the important things is that those deficits are accompanied by visions and goals to show a way to correct those deficits in an achievable way.

Leadership is also about working with what you have got. So there has to be a recognition in social care that care homes are a part of the system, there also has to be a recognition that care homes have changed dramatically over the last few years. The average age of entering a care home has risen and, more often than not, care homes are the final stage of the care process when home care is no longer appropriate for the safety of the individual.

Leadership is about using language that is positive but honest and realising that using stereotypical labels may do more harm than good.

Building Social Care

Social care is full of concepts and the problem with concepts is that there are difficult to get across to the wider population as it is difficult to grasp what something actually means, especially when those espousing the concepts of put different interpretations on what they mean.

Take for instance the Social Care Institute of  Excellence   definition: "Personalisation means thinking about public services and social care in a different way – starting with the person and their individual circumstances rather than the service" 

Compared with the Department of Health version: "every person who receives support, whether provided by statutory services or funded by themselves, will have choice and control over the shape of that support in all care settings" 

Broadly similar but the first takes personalisation as being outside the care service where the latter stresses that personalisation occurs within the care settings.

That is, of course, pure semantics but it serves to illustrate how talking about social care is open to interpretation both by the organisations delivering the message and those listening to it and why listeners may simply switch off if they cannot fully understand the message being delivered.

To add to the general woolliness of social care speak many of the more recent concepts, such as personalisation, are being inserted into a system established 20 odd years ago and may not always be totally compatible without significant change to the system.

To illustrate in more, literally, concrete terms.

Most people agree that personalisation needs to underpin social care (and other public services), it needs to be the foundation on which such services are built. Yet if you can imagine social care as being a house exactly how easy is it to change the foundations without tearing the house down and rebuilding it? But, I hear some people cry, surely personalisation could be used to underpin the subsiding house of social care that is sinking rapidly yet is this a wise move using personalisation to simply prop up a house that is no longer fit for the ever growing family that is needs to accommodate.

We can extend the metaphor to the forthcoming white paper. Will it be an instrument that simply attempts to paper of the cracks in the social care house? One that replaces the odd rotten beam rather than tackle the endemic rot in the system, maybe it will knock through a few walls to allow for more space to accommodate prevention or even add an extension out the back to allow room for the ever growing number of people who will need social care over the next few years.

Or will it be a white paper that recognises that the house is no longer fit for purpose and tear the whole thing down in order to build a bigger   higher   social care house with firm foundations on personalisation and one that has personalisation insulating all the walls. A new,   desirable,   house that has more than enough capacity for social care to grow, has wide corridors making it easier for those who live in it to move from one room to another and, perhaps, even adjoin the Health Services house with a single door through which people can move with ease.

To  engage   the public in the importance of social care and   build   public awareness we need to ensure that the language we use is accessible to all and that the message being sent is consistent, whether we undertake extensive repairs to the social care house or rebuild a shining new ‘des res’ the important thing is to get the planning permission through with the support of the general population and the millions who will need to live in the house in the future.