By Gerry Nosowska
“The locality manager is looking at the referrals coming into the team. It is double what it was a year ago. On the screen there are 89 contacts waiting for attention today, the highest it’s been, I’m told.
“The social worker has dealt with 14 people today and said it’s ‘easy to get muddled’. At 3.40pm we take a tea break. The social worker says, ‘I finish at 5pm and it’s demoralising that the workload has not gone down’. At 4.56pm the ‘late work’ (referrals that are late being responded to) stands at 50 cases.”
This extract, from observational research on a local authority older people’s team, is hardly a surprise.
The study – from the Social Work with Older People project – took place in the winter of 2022-23 when social care and the NHS faced exceptional pressures. This winter is no different. This scene will be mirrored in teams across the country.
“Hectic is the life of a social worker”, said one of the participants in the research project. He and ten others, across two local authorities, were observed for six months and interviewed, along with the older people, families and other professionals they worked with.
Social workers making a positive difference
Through the practice that was observed and how people reported their experiences, the research showed the positive difference social work makes to the lives of older people, carers and families.
If there was no social work, Reg* would still be stuck in a box-room, unable to see out of the window and not trusting social care to help him change his life.
Albert and Edna would be struggling on, trying to manage without the benefits they were entitled to and worried that if they asked for support they would lose their independence.
Peggy would still be juggling caring for her 99-year-old mother, her ill daughter and her dying husband.
Fred would be lost if Frida was not supported to visit him, despite the disinhibition that his dementia caused.
And the Sandhu family would be trying to figure out how to get care for their friend, Roy, in their second language from a system they didn’t understand.
‘It’s about being that hopeful person’
In all the situations that our research observed, the social worker brought reassurance, trust, knowledge and practical help.
This was underpinned by a deep belief in older people’s right to dignity.
As one said: “This is somebody with dignity and pride who has run their life, who is now saying, ‘I need a bit of support’.’”
Another summed social work up in this way: “It’s about being that hopeful person.”
Underfunded and undervalued
But the research also showed the pressure on social workers. Older people’s social care is underfunded and undervalued. There is an 11.4% vacancy rate for social workers in adults’ services in England.
The social work participants struggled to find care services and specialist support. Sometimes, in rural areas, there was simply no care available.
There has been chronic underfunding of social care and it cannot adequately meet the needs of an ageing population.
Despite this, social workers carry on.
“I’m the person who has to be the voice of the voiceless. I have to advocate for people. I have to fight for people,” said one
Not sustainable
This is not a sustainable situation.
Social workers do not have infinite capacity to soak up pressure.”
Nor should they or the older people they work with accept this.
It was clear to the experts by experience in our research advisory group that the fundamental problem – the reason why older people’s care is not sufficiently resourced or respected – is ageism.
Fighting ageism
So what do we do? How do we fight ageism?
Well, the good news is that social workers are already doing this every day for the people they work with.
“All of the complexity of human relationships and all of those things don’t stop just because you get older,” according to one practitioner.
And, in the midst of the pressure, social workers are carving out time to think about the ethics of what they do and to support each other with the emotional impact of the work.
In the words of one participant, they are working “to make sure that those support networks are in place to try and make things better, or to try and kind of stop things from escalating”.
But for things to really change and improve for older people, their carers and families, we have to change people’s opinions about later life and the role of social work.
Making social work with older people visible
The Social Work with Older People research project identified three main ways to do this:
- Make visible the way that social work supports people in later life.
- Expect, and call for, the dignity of all older people to be upheld (and for that to happen, it is okay to want dignity for social workers too).
- In the meantime, make the most of the social work expertise we have and keep supporting each other.
We have taken action to help with this:
- We have produced an animation and a leaflet for the public about how a social worker can help older people. This can be shared far and wide to encourage people (who have the vote and can influence what government does in the future) to expect access to social work when they need it.
- Our policy briefing, shared with the Department of Health and Social Care, highlights the problem of ageism and how the context for social work should be improved.
- Our practice resources highlight what the research tells us about how to better support and deploy social workers, so they can do the best possible for older people.
Barriers to good social work
Social workers in our research faced barriers to doing the social work that older people valued.
As well as scarce resources, these included bureaucracy, lack of continuity in their work with older people and IT issues.
Now one of the local authorities we worked with has won funding to implement recommendations from the research to try to free up social workers’ time.
Social work ‘integral to a good later life’
There is so much to build on. And there is so much to fight for. As the population ages, people live longer with more complex situations and the diversity of later life increases, social work with older people will be increasingly important.
We all want a good later life for us and our families. Social work is an integral part of this.
“I think social workers bring that value base of really treating everyone with dignity and respect and listening to their stories. Recognising their history. What is their story, and what is it that they want? What is important to them as an individual?
“And supporting that older person to have some choice and control at a time when they probably feel like they’ve got very little choice and control around what happens to them.”
*All names are pseudonyms
Gerry Nosowska is director of social work consultancy Effective Practice and was co-investigator on the Social Work with Older People research team
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….even the funding process to achieve anything for an older person is discriminatory. Tick the relevant box and for an older adult the budget is wildly different. E.g. 2 older adults, one with learning disabilities & the other perhaps living with Dementia…both identical with their needs, risk and behaviours. Guess which client will be pushed towards a residential setting & which one is living their best life in supported living? One experiencing walks in the park, meals out, perhaps even a seaside break and the other sat in dull room whilst Barbara screams all day and staff with no interest play with their mobile phones. We’re all equal apparently.
Love this research.
I have often found that the people that are really very shocked and upset by the state of older peoples health and social care, are the same people that have voted Conservative and had little to no contact with social care in their working lives. (Blind to what Tories have done to it). And then only in old age have they realised the state of the system – the first time they’ve been vulnerable or not had anybody round them to help.
However I don’t feel the lack of resources and funding is Ageism per se. Rather just cuts and effects of privatisation. Ageism is perhaps more evident in the way that media, press, research and strikes, seem focussed on children’s and mental health social work.
Quote – “In all the situations that our research observed, the social worker brought reassurance, trust, knowledge and practical help.”
– Obviously the situations observed were not a true reflection of the whole picture and the state of social work today.
I have worked with older people most of my working life, from the age of 16 and I am now nearly 57, been a Social worker for 14 years and have seen resources deminish over this time, as noted since the Conservatives have been in power, slowly and deliberately under funding social care. I agree with another comment, Learning Disabilities and older people are treated very differently, LD kept in the community in supported living and an older person put into residential care at very differing costs, some supported living costing over £2k per week, totally unfair and there is ageist attitude. I know this as mainly worked on LD services and Older people’s teams. Also about contributions to the cost of care, many older people have over the capital limit so end up paying privately and some LD income is disregarded, therefore there is an imbalance. Many services are private and cost alot of money and this is passed to local authorities. Also many people who have a Learning disability can access continuing health care funding, yet many with dementia are not eligible despite that being a health condition. Social care is broken and needs more investment and thought about how its funded. As for social workers,the media makes us all out to be evil and dont acknowledge we are agents of a state which at present is happy for us to be demonised. We are part of a system and should not be seen as fully responsible for some horrible acts committed by parents/carers/others. I also point out how social workers are trained, its a hard job and needs those with experience to show students and newly qualified social workers how it should be done before they go up the career
ladder, currently some of those practice educators do it for promotion and show little care about the student, community care you need to do a article about that. In my eyes that is a privilege and yes I have done it, been a mentor as well. As for Health and social care being integrated, chance will be a fine thing, social workers are not respected by health, we are seen as less than, I know. Lastly thank you to all my social work colleagues who strive to support service users and their colleagues to deliver better care and support.