For the past 18 months I have befriended Martha*, a woman in her 70s who has dementia, through a befriending scheme run by Camden Age UK. One of my recent visits made me think a lot about how we practice social work.
As soon as I arrived at the care home where Martha had been staying for three months, she thrust an envelope at me. She said with tears in her eyes, “look at what they’ve written about me.” She trembled as she took out a sheaf of reports to pass to me; an assessment, a capacity assessment and a report from an Independent Mental Capacity Advocate.
I read silently for a few minutes. The reports told of a woman who posed a high risk to herself and others, with few redeeming character traits or strengths. She was challenging to staff, hostile to her family and a flight risk. As I read, I realised I didn’t recognise the woman described. This experience gave me a jolt and forced me to reflect on how we write reports in adult social work. How can we emphasise the risks involved in a person’s situation, without losing sight of who that person is?
To give a little more background, Martha was placed at the home due to increased health risks, limited insight and her refusal to accept support at home. I couldn’t disagree with any of the judgements in the reports or the decision to place her in a care home. If I was Martha’s social worker, there’s no doubt I would have made the same recommendations.
However, I did question why none of Martha’s strengths were listed in the reports. Martha is a warm, independent woman who has made friends in her former sheltered housing block and in her current care home. She remains physically very active and is extremely nurturing. She used to be a foster carer; prior to placement she cared for a pet and even in the care home she has taken vulnerable residents under her wing. She has also maintained a very good relationship with myself.
Despite turbulent life events and cognitive changes over the last 18 months, she never fails to greet me with a smile and is the perfect host. As a befriender I have come to know and admire these traits well; as a social worker would I have the time or inclination to?
When I first met Martha I was a social work student. Now I am a fully-fledged social worker. I appreciate fully the difference of a befriending role, which allows the luxury and satisfaction of getting time to know a person more fully. This can be a stark contrast to the fleeting one or two visits that can characterise assessments in adult social care.
The danger of churning out reports
In children’s services, there remains I believe, a need to balance strengths and risks in reports. Within adult services (at least in my experience) the onus can be to emphasise or flag risks to secure scare resources. Sometimes as adult social workers it can feel like a battle just to keep on top of assessments. The danger is that churning out reports becomes a mechanised process and we forget that we are describing real people and real lives in our reports; or perhaps, failing to.
Few of us may witness the moment people read the assessments we write and their reactions. My experience with Martha made me consider and reflect before submitting reports and assessments. Who is this person? What is their personality? What are their strengths (alongside risks)? Would the individual recognise themselves when reading this report?
I would know these things as a befriender. Though time is scare in adult social worker, these questions can bring some humanity to the social work process. It can hopefully restore some dignity to the person reading the report, even if they may not agree with all recommendations.
This is a person, not a ‘case’
This is something many social workers already do, but sometimes we can cut corners, and I know I do when I’m tired or pushed for time. Since this experience I try to reflect-in-action more as I assess and try to consider who the person I am assessing is; as a person not as a case, list of medical diagnosis or risk factors. I did this previously but Martha has made me more aware of why this is crucial.
I am more conscious to ask individuals what they enjoy doing, what they used to work as and their life histories. I look for clues in their home as to what interests and motivates them.
One client with advanced dementia who I just assessed this week had lots of pictures and statues of Native Americans in her home. This prompted a lively conversation of her love of Westerns and showed me her fun personality and sense of humour which could easily get lost in a conversation about fall risks and personal care.
A shift of mindset
She hates romance films or any of that ‘dolly bird nonsense’, and instead likes to pretend she is in the middle of an action film. This conversation helped to build rapport but I will also mention this in my report. It may just be a few sentences but it demonstrates my interest in her as an individual, not just as ‘a case’.
I can’t unfortunately spend all the time I would like to get to know service users well or reduce my workload. However, this shift of mindset at least keeps me focused on why I entered this profession: to provide the individuals with the dignity and respect which we all deserve.
*Names have been changed. The author has asked to remain anonymous.
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