Debate on whether it is acceptable to use affectionate names with service users

We asked if it was acceptable for care workers to use
affectionate names for services users.

To read a recent article from Community Care magazine on the
click here

These are the comments we received:

Having been brought up in Yorkshire and now
working here for a number of years, the practice of saying “love”
to everyone and anyone is endemic. However, using pet names that
are colloquial to any particular area with service users is
unacceptable. It’s a battle I sometimes have with colleagues – even
though we are called “love” or “chuck” by service users it doesn’t
mean we have to reciprocate.

Darron Stone

As with the French ‘tutoyer’, where to use it
to an adult whom one does not know is to put that person in an
inferior position, so with English terms such as ‘dear’. Fine for
children, or people with whom one has established a relationship:
insulting to others. Patients have to fume in silence, since to
protest angrily ‘I’m not your dear’ is to invite neglect or ill
treatment. At best it is thoughtless; generally it betrays a
condescending attitude, whether conscious or not, to people
dependent on NHS treatment.


I did not mind the kindly nurse holding my
hand during labour and telling me ‘you will be alright lovey’. 
However, if the doctor spoke to me in a similar way I would be
alarmed. I think if the professional knows the person well enough
that they can usually tell how a certain term would be viewed, but
they should still ask if the patient minds. If the professional is
unknown to the patient its probably best to keep a respectful


I am a care manager working, for the most
part, with older people. 
I don’t think it is ever acceptable to address any service users by
familiar terms. I always use their title plus surname.  Sometimes I
am asked to use the first or christian name so then I do. The other
problem, which I as a woman worker regularly experience is being
addressed by service users or their families (almost always male
service users etc) by familiar terms. My standing as a professional
woman and even as an adult is undermined by this kind of

So I do know how service users feel about


At first contact, the people we work with
should be asked how they wish to be addressed, this should be
recorded in the care plan and staff should then follow that
request. After a period of time, it is clear the relationship will
develop especially with key workers, and at that time both the
worker and service user may well use more intimate terms to each
other that properly reflect their increased mutual respect.
Use of such words as a means of hiding the fact that you don’t know
or remember the person’s name is abhorrent and should never

Nick Johnson
Deputy Chief Executive
Social Care Association

Referring to an older person from certain
ethnic minority communities as ‘darling’, ‘sweetie’, ‘dear’, ‘love’
can be wrongly interpreted as a sexual address, and often men from
these communities have made sexual advances towards female care
staff who have been using such terms. (especially in cases of
people with dementia) This has then caused problems as staff have
accused the user of sexual harrassment when if they had been
addressed appropriately this would never have occurred.

I have long found it offensive and patronising how our older
generation in care are addressed. I have a background of working in
homes and have been an inspector, but I am also a relative and now
field worker. Some of the ‘terms of endearment’ are so ingrained
that I find myself on the receiving end. I have several times been
referred to as ‘dear’ or ‘darling’, but I know to challenge this
will cause offence, and I will be regarded as ‘difficult’. However,
there is of course good and bad practice, and it is certainly not
all bad!


Surely it is more about respecting
people’s wishes as individuals rather than being
“politically correct” calling people by their own
names. If this sort of thing causes conflict, then it does not say
much about the care provided in the first

Michael D. Ryan

I have worked with a range of different client
groups for a number of years now and I don’t think I have ever
called anyone ‘pet’, ‘hen’ or ‘dear’. Such terms aren’t what I
would use in my private life, so maybe I’m less likely to use them
at work. I’m more likely to cause offence by shortening or
lengthening people’s names (eg. Matthew rather than Matt) as that
is more ‘my style’. However, I am sensitive to the preferences of
the people I visit. Recently I asked an elderly lady if she
preferred to be called ‘Mrs X’ and she said she likes to be called
by her middle name.

In terms of other people using terms of endearment, I think it
can be offensive, inappropriate or overly familiar. I don’t like
people I meet (eg. bus drivers) calling me love, so I should
imagine there are plenty of other people who feel the same way.
People with learning difficulties can have trouble with boundaries
and see staff as friends.Using ‘mate’ or ‘dear’ certainly can
infantalise or confuse. However, style can be a factor. I have
worked with some very good staff members who seem to use the term
‘mate’ without it seeming inappropriate, and I can imagine ‘hen’ or
‘pet’ being of great comfort to some in certain situations.

As usual, it’s one of those areas that isn’t clearcut and the
best remedy would be for guidance such as ‘check what the service
user prefers to be called when you first meet’, and such
preferences being noted and respected.
That’s my opinion anyway.

Madeline Stephens
Tenancy Support Worker

Personally I think using words such as ‘cock’,
‘love’ etc is totally unacceptable. I remember when I was a young
girl being totally confused when the shopkeeper always called me
love, I’d tell myself how can she love me she doesn’t know


Reading your article “Sounds Familiar”
regarding using affectionate words within the workplace may in many
circumstances be classed as being demeaning to many individuals. In
many situations however these terms of endearment can make a great
deal of difference to those who are in need of help, reassurance or
support.  Working within the community as an emergency response for
the elderly, there are also circumstances where trust must be
gained immediately from the clients we attend to. Terms of
familiarity help to build a firm foundation and put those in need
of emergency intervention at ease. No harm is ever meant by a nice


Asking people how they prefer to be addressed
is central; the use of terms used in local speech can also be
acceptable provided there is no objection from the person. However,
what needles me is the now almost normal use of the terms “lady”
and “gentleman” in the written assessment, and other written
materials by social workers, health professionals etc. 

Is this a middle class thing? Do workers use these terms in more
urban settings characterised by poverty? Are these terms used in
reference to people from ethnic minority groups?  I’ve wondered
whether it is an attempt by the worker to lend a greater sense of
respectful objectivity to the written assessment, dispassionate and
impersonal. For me it doesn’t work because the assessment is
personal, and should refer to the person by their preferred

Stephen Caffrey
Professional Officer
Joint Elderly Mental Health Service

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