Sounds familiar

Last month, a Lancastrian woman was recovering in hospital after
a panic attack when she took offence at a ward sister’s remark. To
her request for a glass of water, the member of staff replied:
“Right, cock, follow me.” The patient made an official complaint to
the hospital, which wrote an apology to her. And ambulance crews in
Lancashire have also been warned recently to watch how they address
patients after one man complained about being called “mate”.

Words such as “hen”, “pet”, “duck”, “love” and “darling” can seem
affectionate in some instances, but when they are directed at older
people they can be construed rather differently. Overall, says
Annie Stevenson, senior policy adviser at Help the Aged, the way
people address their elders reflects an attitude that we have
entrenched in our society – age discrimination.

The most common example is treating older people like infants when
they have care needs and are in institutions such as care homes and
hospitals.

“It’s clear this sort of attitude is common and that reflects
society’s view of devaluing people once they reach a certain age,”
Stevenson says. “When they become dependent they can be treated in
a disrespectful way as if they have lost their status.”

Although she believes that the tendency of care staff to
infantalise is usually unconscious, it can still be highly
offensive. “The key thing is for staff to ask older people how they
want to be addressed. I think that should be mandatory in all
health and social care training.”

The codes of practice for social care workers, launched in
September 2002, were developed following consultation with staff,
users and carers. Among other things, the codes state that social
care workers must:

• Communicate in an appropriate, open, accurate and
  straightforward way.
• Treat each person as an individual.
• Respect and maintain the dignity and privacy of service
  users.
• Respect diversity and different cultures and values.
• Take service users’ and carers’ complaints seriously and
  respond to them.

The Department of Health involved users, employers, students and
providers of social work education in the development of the
honours degree in social work, which will start in England this
autumn.

According to the General Social Care Council, this should ensure
that service users’ views will be integrated into social work
training even more closely than before. Universities will be
required to involve them at every stage – in developing courses,
selecting students, assessing their academic work and in assessing
their practice placements. The GSCC is also approving the quality
of degree courses offered by universities and colleges. One of the
core subjects students will learn about and be assessed on is
communication skills.

Stevenson says: “Every new care professional that has to introduce
themselves should say who they are and ask how the client would
like to be addressed. Speaking disrespectfully to an older person
should be treated by an organisation as a minor disciplinary
offence.”

However, she would not want the relationship between the older
person and care staff to suffer because staff feel constrained:
“The way they interact with each other on an equal basis is
important. It would be a shame if a natural spontaneity of showing
warmth and familiarity, particularly by using a local colloquial
term such as ‘pet’ in Newcastle upon Tyne, was lost.”

Jean Collins, director of learning difficulties charity Values Into
Action, agrees: “I don’t think we should or could try to legislate
against terms in everyday language in certain areas, like ‘hen’,
because they’re part of normal speech.”

But the only time it might be deemed suitable to use words such as
“dear” or “love” is when people are upset or need to be reassured,
says Collins. Overuse of terms of endearment is “patronising and
belittling and helps to underline the power differential between
professional and client”.

Again, it depends on how the professional views the client. “It’s
unlikely that a professional would address a middle-aged man in a
smart business suit with a term of endearment, so what does it say
about attitudes to someone with learning difficulties?” says
Collins.

Being addressed in this manner is often the experience of people
with learning difficulties and they do not necessarily pick it up
as inappropriate. And, along with many social care clients, they
would not feel confident or comfortable enough to tell somebody
that they do not like the way they are being spoken to.

Collins says it is difficult to challenge somebody in a position of
power when they use diminutives, and even more difficult for those
in a professional-client relationship.

The problem, says Stevenson, is that care staff do not realise how
easy it is for their language to be patronising. Staff should be
aware of the need to treat a client with respect and as an
individual with their own identity, rather than as a homogeneous
group with the same likes and dislikes.

“You need to assess whether it’s appropriate to talk to someone
with a familiar term, because some will love it, others won’t,” she
says.

One of the worst things that care staff can do is talk across an
older person. “This is a heinous crime,” says Stevenson.

Being cut out of the conversation or ignored is also common
treatment for people with learning difficulties. Collins says:”The
biggest discourtesy that people with learning difficulties tend to
face are people not talking to them at all but to their support
worker, care worker or relative, particularly about a health issue.
People should address the person with learning difficulties and
make sure that they understand to the best of their
abilities.”

Over-familiarity is not appropriate in mental health cases because
there have to be boundaries. But mental health charity Mind says
there is no need to be po-faced about it. “It’s important not to
say something that could be misinterpreted when dealing with
clients in this area,” says a spokesperson. “Terms such as ‘love’
and ‘darling’ are not appropriate when the situation might be a
male nurse talking to a woman who has been abused.”

There are often strict patient-professional boundaries laid out by
mental health professionals. For example, psychotherapists are firm
about over familiarity and do not give out any information about
themselves.

All professionals that work within the NHS and those who work
outside providing related services, for example counsellors and
psychotherapists in private practice, should belong to an
overseeing body that provides protocols and guidelines about
professional boundaries and appropriate conduct, such as the
British Psychological Society.

Keith Beach, consultant clinical psychologist and psychotherapist
at West Hampshire NHS Trust, says the difficulty lies with the
range of people with which professionals come into contact. “It’s
possible that in dealing with an older person they may not come
from a culture or era where they feel being called by their first
name is appropriate. But others may not mind being called ‘dear’,”
he says.

The problem is that, although there are strict rules for not using
sexist or racist language which are governed by disciplinary
procedures, guidelines about terms to use are not as clear cut.
“It’s about establishing an appropriate therapeutic relationship,”
Beach says.

The best advice is to talk to clients sensibly and sensitively,
says Mind’s spokesperson. “As a [mental health] professional, you
should take a professional attitude towards your client. It’s a
common sense thing.”