Practitioner: Caroline Luckham and colleague (who wishes to remain anonymous)
Client: Edwin Whymark is 86
Case history: Edwin has been living in a basement flat for 40 years – a home he shared with his wife until her death 20 years ago. The landlord has blocked off access to the upstairs bathroom. All he has downstairs is a toilet but no bath or shower. The “kitchen”, which leaks, comprises a cooker and a sink. There is no hot water and very minimal natural light. Edwin, since his wife’s death, simply sits in his chair all day reading and sleeps in it at night. The only heat comes from a two-bar electric fire. The landlord has wanted to move Edwin out for many years but because he has a secure tenancy he hasn’t been able to achieve this. As a consequence the landlord let the property tumble into disrepair. Edwin’s only contact with the outside world is provided by a couple of friends, both of whom are opposed to any social services involvement.
Dilemma: Despite the atrocious conditions at his home, Edwin expresses a strong wish to remain where he is.
Risk factor: If Edwin remains it is likely that his health will deteriorate. However, if he is moves out, there is an equal danger that change will be mentally overwhelming and adversely affect his health also.
Outcome: Edwin moved into a nearby flat, as a result of which his health and mental well-being are improving.
If ever a maxim lumped itself uncomfortably upon the shoulders of social work it must be: “damned if you do and damned if you don’t”. You take a child off their parents and you’re breaking up the family. You leave the child with their family and you’re accused of neglecting your duty.
The case of Edwin Whymark presented social worker Caroline Luckham and her colleague, who was the main worker, but who wishes to remain anonymous, with a conundrum that challenged their own perceptions of acceptability and what constituted a client’s best interests.
The conditions that Whymark lived in would be unacceptable for nearly all of us. Not something we would call “home”. Damp, with no hot water, natural light, bath or shower, it was, nonetheless, exactly that for Whymark: home. And it had been for 40 years. Further, it was where he wished to continue to stay.
“The interesting thing about working with this case,” says Luckham, “was that it wasn’t a question of just working with the client to achieve what he wanted, but the whole issue of acting in the client’s best interests, which were contrary to what he actually wanted.” And Edwin, who believed in the guidance of spirits and felt duty-bound to remain in the place where his wife died, wanted to stay.
Luckham’s colleague agrees with the conundrum they faced: “If we left him alone in those appalling conditions and he died, the department would be criticised for allowing this to happen. And yet we had to respect his wishes. As a person I had to come to terms with how someone would choose to live in such a condition: what might not be acceptable to me was clearly acceptable for him.”
The workers questioned how informed Whymark’s choice to stay was. A psycho-geriatrician confirmed that he was mentally sound. However, they considered it might be the case, given his isolation, that he simply didn’t know or understand possible alternatives. “Perhaps if he could taste the difference of being in another environment and not have to live in such conditions, what would he then think?” says Luckham.
At this point the workers joined forces with housing officers. Section 604 of the Housing Act 1985 (as amended) lists nine criteria that a dwelling house must meet to be considered fit for human habitation. Whymark’s home failed on all counts.
One option was to have the building repaired. The landlord refused.
The other option was to close the property. “Such a closure could be delayed for up to two years. But it was clear to us that if we waited two years, we would be presented with the same situation: he would still not want to move and would be two years older,” says Luckham. The one glimmer of hope was that he said that he had visited a flat across the road many years ago – and if that became available would consider moving there. Luckham’s colleague says they had to weigh up the mental consequence of moving Whymark. “Would we be saving the body but destroying the soul? There was a strong risk that this could happen because Edwin stated clearly that he was happy,” he says.
At a multi-disciplinary risk assessment meeting it was decided to close the property. Coincidentally, the flat that Whymark said he would move into also became available, following its tenant’s death. His friends, now more accepting, facilitated Whymark’s move into the flat. “Although Edwin was quite able, we put in a maximum care package. However, we didn’t want to disable him with the move so the care package gradually decreased over time. Now he has a carer visit twice a day to prepare food, check things are all right and to provide company,” says Luckham.
At a recent visit Luckham’s colleague reports that “Edwin is now appreciating nature. He was saying how much he enjoys sitting outside watching the birds and squirrels and how wonderful the blossom was on the tree outside his window. I got the sense that he had been released from an existence he had endured for 40 years. His legs, which have been problematic for over 20 years, appear to be healing now. He is thriving.”
He concludes: “The difficulty in the whole case has been an over-riding of the client’s wishes, not in a disrespectful way. We heard them but did not act on them. There appeared to be no morally sound solution. We took what constituted good or at least reliable practice. Even so, we were all fortunate. Humans, like social work, have no exact answers.”
Arguments for risk
- Change can be scary, especially when you’ve known no different way of living. However, the law was clear that Whymark’s home was unfit for human habitation.
- In the end it boiled down to making a decision about what was in Whymark’s best interests. As Luckham’s colleague observes: “Although we did know that he wanted to stay, he did say that if he had to go he would, but ideally would like to remain. His friends, who strongly advocated on his behalf, were also the cause of much anxiety through regularly complaining about their perceptions of our intentions.”
- His GP said that Whymark should be moved because he appeared to have a varicose eczema, where the eczema concentrates around the damaged veins. Whymark often scratched his legs until they bled. In spite of this, the district nurses had withdrawn as he proved unco-operative and they could not treat him. The GP said Whymark’s legs would only heal if he moved out.
Arguments against risk
- While we might not choose to live in such conditions, Whymark, with sound mind, did. His attachment to the property was strong. He had coped for 40 years. His wife died there – and as he is a man who believes in being guided by spirits, perhaps he felt his wife’s spirit around him.
- Any move of home for an older person can be traumatic. While recognising that his living conditions might be physically detrimental any such move might damage his mental health and even cause his death.
- Perhaps more pressure might have been brought to bear on the landlord to improve the physical surroundings. Indeed, if the building was done up Whymark could have moved out during the refurbishment but have been secure in the knowledge that he could return upon completion. However, he had lost a previous tenancy in this same way, so the workers might have had difficulty in winning his trust for any such proposal.
Caroline Luckham and her colleague are too hard on themselves; they should take a great deal of credit for their handling of a difficult situation, writes Jef Smith.
The self-critical judgement that “the whole case has been an over-riding of the client’s wishes” ignores the complexity of human aspirations. Whymark’s expectations for what he could get out of life were desperately depressed, the result of a lifetime of deprivation. To try to widen his horizons was not patronising but a genuine attempt to persuade him that a more fulfilling lifestyle was really possible. That final picture of a healthy, thriving old man, taking delight in wildlife and blossom, is proof of how worthwhile was their patience.
Social work is often about presenting clients with the reality of their position. An element of Edwin’s reality was that society cannot tolerate extremely poor levels of housing; he needed to be confronted with that fact. The issue was that the situation he wanted to maintain was unsustainable. Helping him recognise that involved many lengthy discussions and tactful contact with his friends.
Even the “luck” of the acceptable tenancy becoming vacant conceals calm and thoughtful work. Without close liaison with the housing department the social workers would not have been able to know about this opportunity; without having gained Whymark’s confidence they would not have known that it provided the perfect way out of his dilemma.
Jef Smith is a writer, trainer and consultant specialising in the care of older people.