‘Who’s helping who?’ Is there a role for reciprocity in self directed support for older

people?

Nick Andrews, Swansea UniversitySarah Taylor, Edinburgh Council

Personalisation - do you want to buy a friend or be a friend?

• Are we Homo economicus or Homo reciprocans? (Bowles and Gintis 2013)

Personalisation – what matters most?

• ‘When I lost my legs, it was “right, what can we all still do together?” Still play football and rugby with my friends, sitting on the floor as a goalkeeper, scooting myself around with a rugby ball in my hands’ Nathan Stephens, Paralympics athlete, Barry Island, Wales

What do we mean by Independent Living?

• ‘There has always been a distinction between what we mean by IL in Britain and what they mean in the States. IL in America is organized around self-empowerment, individual rights and the idea that in the land of the free and the home of the brave – all that crap – individuals, if they are given access under the law and the constitution, can be independent. In contrast, in Britain . . .IL entailed collective responsibilities for each other and a collective organization. It wasn’t about individual self-empowerment; it was about individuals helping one another. Once you accept that notion, it seems to me, you are beginning to question the foundations of the society in which we live’. (Campbell & Oliver, 1996, p. 204)

‘A life on equal terms’ - who is helping who?

And an early lesson from a bicycle repair book

• ‘I am struck by how sharing our weakness and difficulties is more nourishing to others than sharing our qualities and successes’ Jean Vanier

Recognising the importance of reciprocity

• ‘The world of helping others in need is now built around one-way transactions…. and with the best of intentions, one-way transactions often send two messages unintentionally. They say: “We have something you need – but you have nothing we need or want or value.” And they also say: “The way to get more help is by coming back with more problems.”’ (Cahn, 2002)

• Mental well-being: ‘Over-benefitted’ and ‘under-benefitted’ relationships (Fyrand 2010)

But there is a problem in ‘care’ services

• ‘3.1 Becoming the friend of a person who uses our services is an inappropriate relationship that focuses on the needs of both people. A professional relationship should focus solely on the needs of the person who uses our service. Becoming a friend of that person is inappropriate’, Professional Boundaries Policy, Gwalia Care

‘Simple but not simplistic – developing evidence enriched practice’ project

What does good care looks like?

‘A man or woman could be given the most accurate diagnosis, subjected to the most thorough assessment, provided with a highly detailed care plan and given a place in the most pleasant surroundings – without any meeting of the I-Thou kind ever having taken place’ (Kitwood 2007)

What does good care looks like?

‘The most important finding was that it is possible to provide residents with reasons to live, period. Even residents with dementia so severe that they had lost the ability to grasp much of what was going on could experience a life with greater meaning and pleasure and satisfaction’ (Atul Gawande)

Beautiful moments

Beautiful moments

Beautiful moments“We used a company called Living Eggs to have chickens hatch at the care home. The company provide an incubator with eggs. Whoever sees the egg hatch, gets to name the chick. The handyman built a chicken run for the chicks once they were hatched. Staff brought their children and residents’ grandchildren came to see the chicks”

Beautiful Moments

“I had grown up in Royston and took a resident who also grew up in Royston on a walk around the area to reminisce and talk about the changes that had taken place in the area and what used to be there before”

How Beautiful Moments Feel for Staff

It doesn’t feel like working…it’s

relaxed…everyone kens you

It’s like an extended family…you really become friends

with the residents and their families too

I learn something new every single day

You pick up interesting pieces of wisdom, little nuggets of wisdom. They have some amazing stories you know.

In spite of, not because of

Personalisation

Tension What Staff Say

Building meaningful connections vs restrictive professional Boundaries

“We get a row for getting too close”“It could look like favouritism”

A way of being vs a task focus “We have to get the practical stuff done first”

“As domestics, we can get told to get back to work when talking to residents”

Empowering staff vs a rules focus “It’s about a mindset – coming up with your own ideas and encouraging residents to too”

“We sense things and use our own judgements about how a resident is that day because we know them. But we can’t always act on this”

Normalising experience vs rigid risk management

“It’s hard to be personalised when there is so much red tape”

“I wanted to take a resident to the local hairdressers but it wasn’t permitted”

Caring as human vs bureaucratising care

“If its not in the care plan, you can’t do it”“everything has to have an action plan and an outcome”

Where do we go from here?• Celebrate “ordinary heroes”

(Barry Schwartz)• Be mindful of tensions and

contradictions….and have good conversations about them!

• Redefine approach to professional boundaries - towards sharing lives

• Take positive and rights based approaches to risk management

• Focus on things that really matter, which can often be ‘little things’

References

• Bowes, S. and Gintis, H. (2013) A Co-operative Species: Human reciprocity and its evolution, Woodstock, Princeton University Press

• Cahn, E. (2004) No More Throw Away People (2nd Edition), Washington, Essential Books

• Campbell, J. and Oliver, M. (1996) Disability Politics: Understanding our past, changing our future, London, Routedge

• Fyrand, L. (2010) ‘Reciprocity: A predictor of mental health and continuity in elderly people’s relationships?’ Current Gerontology and Geriatric Research, 1-14

• Gwande, A (2014) Being Mortal, London, Profile Books