Barbara* is an 81-year-old woman who has lived alone in a privately rented house for many years. She has no family but for the past four years has relied heavily on the help of two dear friends (A and B) and neighbours. I also know Barbara as a friend and have witnessed her severe decline in functioning over the last year due to her dementia.
Barbara came out of hospital in 2012 and was given a care package of two visits a day which was, until a few weeks ago, reduced to only one morning call, despite her dementia worsening.
Friends and neighbours
This care was intended to take some of the load off her two close friends, both older women with their own health and/or family issues.
Shopping, laundering, bill paying and general love and care continued to be provided by A and B. Other neighbours helped with practical tasks and their time. Three friends held keys to her home as she would not answer the door.
The state of her house can be seen in this news report by BBC London. Her incontinence and wariness meant that one care visit a day was simply not enough to help Barbara live in dignity. She accepted some level of personal care from A and B but the increasingly soiled clothing and furniture could not be their responsibility. They complained to the care agency over many months as that was their only point of contact with the care system.
Giving up caring responsibilities
Just before the BBC piece went to air the care was increased to four visits a day. Immediately afterwards Barbara took ill and was hospitalised. A and B said then that they wished to give up all care responsibility and relate to Barbara as her friends only. They explained they were simply not able to provide the intensive levels of care which Barbara needed.
They felt she needed a placement in a residential setting with 24-hour supervision. Barbara goes to bed at 6pm and consequently is up in the early morning hours. When she falls she does not use her alarm pendant. It is A and B who find her in the morning if she has fallen.
The Care Act and the Mental Capacity Act govern how Barbara’s needs are to be met. One of the duties of the social workers in these cases is to promote Barbara’s wellbeing and, as part of this, consider her personal relationships.
Demanded keys be returned
For Barbara, who has no family, that means A and B and her other caring neighbours. Yet when A and B stated their intention to withdraw from being unpaid carers, a social worker demanded that they return the house keys to them.
They declined as they wish to remain good friends and continue visiting Barbara and to do this they need keys to gain access. The council then changed Barbara’s locks and refused to give keys to A, B and another neighbour.
When challenged, the council said they had the right to restrict their access in Barbara’s best interests.
The council holds a different view of Barbara’s capacity to that of A and B. They state that she does have the capacity to decide to return home, which is what she wants, and so they will provide care at home to her.
It is clear that under section 47 of the Care Act social workers may protect the person’s moveable property. But any action they take must be with her consent, unless she lacks capacity and they are acting in her best interests.
Would she consent to lock her only friends out of her life? It’s hard to imagine the answer is yes.
In which case the council must believe that “there is a danger of loss or damage” to her property. They have to believe therefore that her friends and neighbours present a danger to her property and this must be stopped by a change of locks. The implication therefore is that Barbara’s friends are likely to be criminals.
Is there evidence her friends are criminals? Given they have been helping to clean up Barbara’s faeces and soiled bedding for many, many months this would be surprising and certainly no such evidence has been presented by the council.
In this case it is hard not to feel a service user is being punished for her friends’ concerns and actions in taking her story to the BBC. They are shattering working relationships with the people closest to Barbara irrespective of the effect it might have on her already deteriorating mental health.
It reduces the client to an object of state-only intervention, where her only relationships are with professionals. It effectively divorces Barbara from her community.
Because she is old and powerless social work is enabled to do this but we must constantly be wary that social work does not become a tool of oppression simply because others are worried about ‘damage control’ to the reputation of an organisation.
*Not her real name