Care plans – Now and Future Me.

This morning I read a post by Mark Neary (whose blog I highly recommend) which highlights the hypocrisy and inaccessibility of the language of social care. I am used to jargon. I have been working in health and social care since 1993 so a lot of the language comes easy to me and I can almost forget what is jargon and what is usable by ‘normal’ people. It is posts like Marks that remind me of where our sector has lost its humanity. When we talk about ‘accessing the community’ rather than being a part of it as a part of a personal budget, we seem to have lost the idea of what community actually is.

 

Mark’s post got me thinking about how my life would be in the care and support plans I used to write so I’m going to imagine and put myself in that situation and see what my care plan would say. It’s not quite going to be ‘me me’. It’s going to be the me who, in 30/40 years time is living with a dementia which has affected my cognition. I’m in my 80s. I’m living alone and have no children. I’m a bit of a loner because I always have been and don’t have many friends living nearby.

Because someone in an office decides I may not be able to make decisions about what care I need, those decisions are made for me. I have a personal budget, of course, because everyone does. It isn’t a snazzy flexible one because I get confused by money and finances and am not sure I’d be able to make decisions about money management. I get my £5 and my £50 mixed up and that’s got me into all sorts of trouble at the local supermarkets. Sometimes some of the local lads offer to clear my garden. I give them £100 for an hour’s work because it seems fair to me and they are such nice lads. They always smile and they come every week. So my ‘personal budget’ is managed by the local authority.

 

Between 7.30am – 8am I have a carer to come and give me a shower or strip wash. The carer often doesn’t turn up until past 8.30am. I’ve always been an early riser so sometimes I try and get up and dressed within her help. I don’t like waiting till 8.30am when I’ve been up since 5am. I can’t manage the shower though and she thinks it’s a shame to change me after I’m already dressed.  “Carer to help with shower or strip wash”. Sometimes I’d like a bath. There isn’t enough money for that. That’s a shame. I last had a bath four years ago. I remember it sometimes.

 

I sit in the lounge. The carer sometimes puts the television on before she leaves. I don’t pay much attention to it. Because I’m over 65 now, I don’t get any ‘day opportunities’. The day centres have closed and I don’t have any family to visit. I sit and watch TV. It’s ok. I don’t want enforced company so I’m not so lonely. I miss going out to the shops though. Accessing the community? That would take too long and cost too much so I just have a carer come once every fortnight to do my shopping. I write out my shopping list in advance. Mostly it’s the same from week to week. I don’t do spontaneity anymore.

The carer comes at 12pm to make my lunch. Lunch is a tuna sandwich. Lunch is always a sandwich because there isn’t time to cook. It’s always tuna because I once mentioned I liked tuna 2 years ago. Now I have tuna sandwiches every day.

“carer to prepare light lunch and cup of tea. Clean up afterwards”. Sometimes I miss coffee.

 

It’s Thursday which is shopping day. Shopping day is only once a fortnight. So shopping is lots of instant meals which don’t need to be prepared. I wish I could go out sometimes and potter around in the supermarket. But that would take too long. You see, my allocated hour wouldn’t be enough because I’m a bit slower on my feet. It’s tins of spaghetti hoops. Bread for the freezer. Milk for the freezer. Chocolate hobnobs. Some cheese. Lots of tuna. I like all these things but sometimes I miss sushi.  “fortnightly local shop. Collect list. Leave change”.

 

It’s nice when it’s shopping day because it means something different happens. Mostly I just sit and watch TV. That’s my meaningful activity.  I have a personal budget. Look how well self-directed support works for people like me. What do you mean it’s no different? This is innovation. I know how much my care package costs now. That’s changed my world.

 

I can’t wait until dinner. At 5.30pm my carer comes and makes me something ‘light’. But this time it’s a hot meal. Spaghetti hoops on toast. I like that. Sometimes I put some cheese on the top but have to be careful with the toaster. I can’t manage it on my own. At least I get another cup of tea and help to the toilet. Sometimes I miss coffee.

“5.30pm – 6.15pm Prepare dinner – leave with cup of tea. Help to toilet if necessary”.

After dinner I watch TV for a while. Usually I fall asleep.

The carer wakes me up when she comes at 9pm to assist me to bed.

 

So that’s what the day looks like. I get up later at the weekend. That’s nice. But I like getting up early.

 

Now coming back to my present self, I wonder how my own care plan would look in the language of, as Mark calls it, ‘Carespeak’.

So snapping out of reality, this is my current ‘care plan’. I wake at about 5.30am and interact constructively with other household members, which is problematic to those who don’t want to be awake at 5.30am. This is evidence of my self-centred nature and need to mind my anti-social behaviours around waking early. Sometimes I don’t have breakfast. This presents a risk to my nutrition and hydration. Occasionally I might eat an unhealthy breakfast, like a croissant. This is high in fat and could lead to unhealthy habits and putting on weight which could affect my health.

I have a shower and this means that my needs related to hygiene are met. I ensure that I wear clean clothes which are appropriate to the season. Although sometimes I judge poorly before leaving the house and this means that I may not be protected from the risk of inclement weather. I don’t own an umbrella. This is a risk as it often rains in London. I am able to meet my personal care needs.

I go to work. Now, I’m accessing the community and engaging in a meaningful activity because I have economic worth. Although sometimes it isn’t meaningful. Sometimes it’s sitting in front of a screen staring at spreadsheets. It has economic value and therefore it is meaningful. Daytime activities, I have them, you see. All is good.

I might go out after work. This means I am socially active. I am engaging with my informal support network i.e people who are not paid to be with me. I can tick off my ‘social network’ tab on my care plan. I have friends.

When I get home, I should really clean the house a bit. But I sit on the sofa and fall asleep in front of the TV. This is a risk. This means that I have not been able to meet my domestic care needs. The washing up is in the sink. I am, therefore, in a house, where there is a concern that I am not managing domestic care sufficiently. This worries those people who write care plans. All is not well.

I go to bed at a reasonable time. I don’t have any problems with sleeping and am not worried or concerned by my lack of sleep. All is well.

 

So why is it worth considering? These two care plans say different things but in the same way. We can look at aspirational documentation and what we should strive for. I always want to strive for better. But those who are striving, don’t forget the people like me or the future me. Don’t get carried away with the language that can actually mean less than it should. A personal budget does not mean choice. Choice does not mean choice as often as not. If we want to solve problems, we have to know the problems and how they would affect us.

 

It’s worth considering how are lives are and how they would be in the context of ‘care planning’. Would we plan care for others, the way we would want it planned ourselves? And if not, why not?  Food for thought.

Burnout and Avoiding it.

I attended an event recently for newly qualified and student social workers. There were a number of speakers of which I was privileged to be one. Although it wasn’t a part of my ‘talk’, some of those speaking began by talking about how long they’d been in ‘social work’ and how they had managed to ‘stay fresh’ and counter burnout. It’s something I have appreciated more since I moved out of my social work job and moved into less intense, less stressful role. I don’t think I ‘burnt out’ but I do think I left at the right time. Things had been getting increasingly stressful at work due to the cuts and the increased workloads and a couple of incidents in the lead up to my applying for other roles made me realise it was probably a good time to take a step back.

While I can’t make the claims that some at the event did of having 20/30 years in social work ‘frontline’ practice and remaining fresh, I think there were a number of things that helped me in the 12 years that I did. I probably wasn’t helped by my having had a particularly difficult last few months at university. I sailed through the exams and modules but struggled with (and eventually failed) my MA dissertation. That meant I qualified with a PGDipSW rather than an MA in Social Work and although it made absolutely no difference to my career in the sense that I could work as a qualified social worker, it did give my ego quite a knock. In retrospect, although I’d never have said it at the time, it set off a chain of events which actually made me far more competent and able to deal with challenges, it made me realise I could fail and yet, succeed at the same time. It made me realise that intellectual achievement isn’t defined by qualifications or what particular tutors think. I did go back and retake the dissertation eventually (actually it was 5 years later) so I do have my Masters now, but at the point that I failed my dissertation, I had never failed any academic test which had been thrown in my direction, indeed, I’d pretty much sailed through without much effort.

On qualifying, I went into a fast paced adult social work team in inner city London. I thrived and was both excited and terrified as my caseload went from the six I  had on placement to around an average of 45. I’ve written about these experiences previously so won’t go into details. The things that got me through weren’t so much the management because, as I’ve realised since, my first manager was the least competent manager I’ve had through my professional career. It was my colleagues. I was extremely lucky to work in a team with very experienced, very kind practitioners who were patient with me as a newly qualified, agency social work – earning more than many of them, but they helped and guided me without anything but generosity and kindness in the absence of structured managerial support, in fact, sometimes in the context of an organisation where there was bullying from ‘above’.

I won’t list all my professional experiences and teams but it did get better. I had moments, not in my first or second year of practice, but in my third, fourth, fifth year when I wondered how long I’d last. When I first qualified, I didn’t have time to stop and think – it was doing and learning, doing and learning without any space to grow. By the time I settled into a good team, with a firm but fair manager who had a strong ethical focus, I looked around me and wondered if I would ever be as ‘good’ at my job as the person who sat next to me. The key that got me ‘on track’ was taking the old PQ1. I don’t think PQ1s exist anymore – this makes me feel old – but it was the first stage in the post-qualifying process. This was before (this is where I really DO feel old!) the NQSW/AYSE-type schemes. We were expected to practise on the ‘front-line’ and then think about post-qualifying practice awards. So it was I started the PQ1 in Social Work Practice at Brunel University which was a part of a London consortium. At that time, as well, it was a generic first step. I did the PQ1 alongside social workers in children and families and mental health. We had slightly different tinges to our work as I’m sure can be imagined, but we came together to share our learning.

The PQ1 gave me an absolutely amazing mentor, who was a very experienced social work manager in the same borough as me, but in a different team. She was someone I wanted to be like. I wanted to know as much as her and exude as much kindness, thoughtfulness, generosity and competence as she did. Most importantly though, I learnt what ‘reflection’ really was about. Of course, like any social work student, I’d studied, learnt and thought I understood ‘reflection’ when I was at university. I’d studiously completed reflective diaries and written reams of essays about reflection through my course – but it was at the post-qualifying stage, when I’d worked for a few years and held a fairly hefty caseload, that I grew to understand reflection far better. I have no doubt whatsoever that the PQ1 saved my career and saved me from burnout. Having a mentor who ‘got’ it and helped me create time and strategies to ‘remain fresh’ saved me.

It was this reflection process through the PQ1 and the encouragement of my mentor, that pushed me back to university to retake my failed MA dissertation. It also pushed me to apply for a different job and that, in turn, led me into the move to Mental Health services – so it really did change my life.

‘Getting’ reflection saved me and helped me to grow. The other part of that came a few years later when I started to write this blog. This writing process, and I did ‘force’ myself to write daily over a number of years – gave me the space to consider how my work fit into a wider health and social care system. It gave me a voice that even though inconsequential on the larger scale of things, meant I didn’t take my frustrations with work, into work. It pushed me into directions I had not considered, for example, a desire to learn more about current research and policy documents. It meant I read far more about health and social care and understood my part in it. I became more active and more vocal at work in areas and became involved in BASW and later, the College of Social Work as a result, realising that influence doesn’t always necessarily need to link itself to management or leadership.

So what would I advise to a newly qualified social worker to avoid burnout? Well, it wouldn’t be the newly qualified social worker I’d be most worried about for a start. It would be the social worker 2/3/4 years into their career where I think the difference can be made. While I don’t think I’m necessarily in a position to ‘advise’, I would say, rather, what worked for me.

 

Asking for help. I didn’t ‘ask’ for my mentor to turn up. She was ‘assigned’ to me but she was one of the key people who had a significant influence on my career and my life. I have never told her that. We can’t always have that handed on a plate though and hopefully there are different sources for mentorship other than people turning up at your desk saying ‘I’m here to help you’. Maybe it’s something that experienced practitioners have a responsibility for. I am no longer a practice educator, but I was, and I miss having students but I think having an oversight or interest in the careers of ‘younger’ (not through age but through work experience) professionals is something we can all do.

 

However well you think you ‘get’ reflection, you can always ‘get it’ better. I’m learning massive amounts about  how to develop skills to reflect on my practice and the effect that I have on other people’s lives. I had some skills which started to grow at university and through various experiences of supervision but different environments and different experiences need new skills to learn and grow all the time. I’m absolutely convinced that it is reflection that leads to good and caring practice so we need to create space and learn from ourselves in different ways. Sometimes we don’t have mentors. Sometimes we work alone. Sometimes we don’t get the supervision we should. Sometimes we don’t have environments which allow us space. So we create this for ourselves, in our own way, often in our own time to learn. It might be writing things down, it might be unpicking things internally, but it is necessary to all aspects of work with other people that affects their lives.

 

Being interested in broader issues. I got involved in BASW and when BASW imploded in pique of rage, I got involved in the College of Social Work. I was and am just a ‘lowly’ social worker without any managerial responsibilities but I decided that didn’t mean I didn’t have a useful perspective to bring to the table. Indeed, in some ways, it was more useful than all the managerial perspectives put together. I found that reading and trying to understand policy issues and papers as they were published meant I could relate some of my day to day work to broader social justice agenda goals – which it didn’t always feel like on a micro level.

 

Support each other. I didn’t have much management support when I first started but was pulled along through my first year by colleagues. I hope, in turn, I’ve been supportive to those I’ve worked with over the years. Sometimes it’s hard to explain the work to anyone who doesn’t do it. While work/life balance is essential of course, sometimes you need to speak and share with other people who ‘get it’ and can support from a non-managerial viewpoint.

 

Work/life balance Say it often. There need to be some boundaries between work and life. I know it’s not always easy, I’m not always great at it myself but doing things that are ‘not work’ really does help!

 

– Knowing when to go and when to return Although it may not be for me to judge, I don’t think I ‘burnt out’ but I could feel myself getting more frayed around the edges before I left my last job. I increasingly had begun to feel I wasn’t necessarily being a ‘good’ change in the lives of the people I worked with as my work became more about telling and less about asking. As I felt I was taking away more than I was giving. I never stopped caring, I don’t think, but I felt increasingly frustrated with the amount of change I could affect and my role in the system. I became more frustrated – not with my immediate managers – who were always incredibly supportive, but of the organisations I worked in and the lack of my voice within them. I think I left at the right time. Now, I miss my old job. I think, in the back of my mind, I hope to return to ‘frontline’ practice someway, in some capacity. When I do, I expect I’ll be enthusiastic and re-energised in a way that was very necessary.

 

So those are some of the things that helped me. I am in another job now but the same tools help me through. I try to take time to reflect and whilst I don’t write here as regularly, I have other ways to ponder and learn from the ways I affect people’s lives.  It would be interesting to know other people’s tips for not burning out.. especially if you’ve been in the job for a few years.