Elder abuse, ethical dilemmas and mul2- agency work What influences and constrains professional decision- making in adult protec2on?

Transcription

1 National Centre for the Protection of Older People Elder abuse, ethical dilemmas and mul2- agency work What influences and constrains professional decision- making in adult protec2on? University College Dublin, 19 October 2011 Dr Angie Ash

2 Research Policy Prac&ce

3 Plan 1. Context Wales, policy, mul&- agency arrangements 2. The research Why? What? How? 3. Findings 4. Joan Tronto s ethic of care 5. Some policy and prac&ce implica&ons

4

5 Wales independent review of In Safe Hands Na&onal inspec&ons of adult protec&on arrangements in the NHS and local authori&es

6 In the offing: Wales Na&onal Safeguarding Board for adults and children Social Services (Wales) Bill New and strengthened du&es of coopera&on & informa&on- sharing between agencies, such as health partners Revised na&onal guidance on safeguarding

7 Why the research? Case review physical assault on older woman Perpetrator had mental health problems, number of criminal convictions Each agency had records over 10 years in some documenting risks

8 Why the research? Adult protec&on procedures were not ins&gated No mul&- agency risk assessments were available Hence the ques4ons

9 Research quesaons What constraints and dilemmas do social workers grapple with when dealing with poten&al elder abuse? What influences social workers deciding whether or not to use adult protec&on procedures?

10 Lipsky s street level bureaucracy

11 Lipsky: dissonance & the street level bureaucrat High ideals of public service Corrupted world of service Agencies conceal lack of service generate appearances of responsiveness perpetuate a myth of altruism

12 Street Level Bureaucracies (to) understand how and why organizations often perform contrary to their own rules and goals, we need to know how the rules are experienced by workers in the organization and to what other pressures they are subject (emphasis added)

13 Street Level Bureaucracies cont the decisions of street level bureaucrats, the routines they establish, and the devices they invent to cope with uncertainties and work pressures, effectively become the public policies they carry out (emphasis in the original) Lipsky, M (1980) Street- level bureaucracy. Dilemmas of the individual in public services. New York: Sage, p xii- xii.

14 Mixed methods case study Methods: interviews; focus groups, observed mee&ngs, documentary analysis; sta&s&cal analysis of POVA data InformaAon sources: social workers, managers, POVA staff, in community care; POVA mee&ng minutes; POVA policy implementa&on plans; POVA ac&vity data

15 Findings Low elder mistreatment referral rates Low awareness of domestic abuse in old age Barely acceptable care homes NHS care and older people Resource shortfalls of services, of certain expertise

16 I don t think for a minute social workers would actually walk away from a situa4on they thought was abusive, but I do think if you said to social workers are you content with where people are placed, is this the sort of quality of care you d want, then probably the answer is no. Manager Real worlds?

17 Tronto s four elements of an ethic of care Attentiveness Noticing needs is a primary human task Not seeing not attending not noticing are moral failings

18 Tronto s four elements of an ethic of care Responsibility - embedded in cultural practices - not rules, obligations, duties

19 Tronto s four elements of an ethic of care. Competence To balance taking-care-of with care-giving Intending to provide care but then failing to provide good care, means that in the end the need for care is not met (Tronto 1993:133)

20 Tronto s four elements of an ethic of care Responsiveness needing care places person in some vulnerability we must stay alert to the possibilities for abuse that arise with vulnerability (Tronto 1993:133)

21 Contexts to pracace Macro: social, economic, cultural Meso: organisa&onal Micro: prac&ce & decision- making

22 Macro Social, economic, cultural levels A]en&veness Responsibility Competence Responsiveness to structural factors and risk of elder abuse cultural prac&ces intolerant of ageism adequately resourced, competent support cultural recogni&on of vulnerability

23 Meso OrganisaAonal level A]en&veness Responsibility Competence Responsiveness healthy organisa&onal cultures systems, structures, processes, prac&ces focused on doing things right for the elder competent support delivered by competent staff rou&ne self- challenge, cri&cal thinking expected, reports of quality shor`all welcomed

24 Micro Individual care- giver, professional level A]en&veness Responsibility Competence alert to human needs; to possibility of mistreatment response to needs or poten&al mistreatment competence and care demonstrated Responsiveness alert to risks that arise with vulnerability

25 Dr Angie Ash ESRC Research Fellow Centre for Innovative Ageing College of Human & Health Sciences Swansea University Swansea SA2 8PP UK Economic & Social Research Council award PTA

26 References Care and Social Services Inspectorate Wales (2010). Na4onal Inspec4on of Adult Protec4on. All Wales Overview. Cardiff: CSSIW, March. Healthcare Inspectorate Wales (2010). Safeguarding and Protec4ng Vulnerable Adults in Wales. A review of the arrangements in place across the Welsh Na4onal Health Service. Caerphilly: HIW, March. Lipsky, M (1980). Street level bureaucracy. Dilemmas of the individual in public services. New York: Sage. Preston- Shoot, M & Wigley, V (2002). Closing the circle: social workers responses to multi- agency procedures on older age abuse. British Journal of Social Work, 32, Prottas, J.M (1979). People processing. The street level bureaucrat in public service. Lexington, Mass: Lexington Books. Tronto, J (1993). Moral Boundaries. A Political Argument for an Ethic of Care. New York: Routledge.