Social workers in community care practice: Ideologies and interactions with older people

Abstract

Since the inception of the NHS and Community Care in 1990, there has been a proliferation of studies examining its implementation at the front line. Considerable attention has been aimed at understanding how it is that social work practitioners, charged with the responsibility to implement community care recommendations for older people, are doing so in a challenging care environment. How a practitioner's ideological frame of reference may impact on his/her practice interactions remains relatively unanswered. However, the course by which professional ideology matures and then directs practice would appear to both complex and multifaceted. The outcome is one that may render the professional both powerful and political, and one that may leave the older care recipient both vulnerable and stigmatized. This paper explores community care practice with older people, emphasizing the ideological underpinnings in practice and their influence on practice interactions. Social work practitioners working on older people's teams in two contrasting communities in England were interviewed to discuss their assessment and care management interactions with older people. Using grounded theory and Goffman's theoretical constructs within frame analysis, a conceptual model for practice emerged, reinforcing that practitioners' understandings of social events, anchored in government and professional discourse and individual perceptions about older people, enabled them to organize and influence the interaction to lead to a professionally determined outcome. The routine work of assessment and care management became very powerful in absence of strategic intention by the practitioner. A move to more strategic behaviour occurred when practice dilemmas required practitioners to intervene, informed by their professionally based values juxtaposed against those supported within official discourse. The findings provide an insight into how social work practitioners manage to deliver community care in a complex environment. The outcomes also reinforce the need for practitioners to develop an understanding of how they construct their social realities, as this may impact on the experience of community care for older people.