This chapter develops the importance of flexibility and creativity as an aspect of practice and explores how techniques drawn from biographical, narrative, and arts therapies can be used to enhance social work practice with older people.

After working through this chapter, readers should be able to:

• Develop creativity in their own practice

• Evaluate the importance of creative work as part of their practice

• Identify ways of incorporating creativity in everyday practice

• Consider ways of using life review as part of their practice

Citizenship practice says that, as citizens, older people are entitled to practitioners’ best efforts. Since every older citizen will have a different life experience and be facing a different social situation, flexibility in our responses to their preferences and interests and those of their informal caregivers is needed. In chapters 3 and 4, I argued that creativity in practice and in the development of services was a crucial element in being able to respond to older people’s preferences for the kinds of services they would prefer and the way in which they would want them provided. In chapter 5, I argued that creativity emerges partly from criticality. If practitioners constantly review their own thinking and the assumptions on which they work, they give themselves opportunities to be more creative in their practice.

The reason why this is an issue in work with older people is the history of seeing practice with this group as concerned with the provision of services, or practical rather than emotional care. Trends over many years have led toward seeing social care practice as a technical task that can be managed through sets of procedures rather than requiring judgment and discretion from practitioners.

The main aim of this chapter is to review the application of critical social work to practice with older people.

After working through this chapter, readers will be able to:

• Understand different areas of critical social work

• Identify how critical social work ideas may be used in practice with older people

• Recognize how critical social work can renew practice with older people

Critical social work is a range of ideas for creating freedom in and through social work practice, for both practitioners and older citizens. The next sections examine in turn two important aspects of critical practice that we can apply to social work with older people:

• Critical thinking—not taking for granted commonplace assumptions about what we are dealing with or how we should work. This helps to free us from limitations created by our own and others’ assumptions about social work with older people.

• Critical practice—using theories that question the existing social order to guide practice actions. Existing care systems are part of a society that limits the opportunities and outcomes of social care for older people. Critical practice helps to free us from those limitations. Our practice aims instead to empower older people’s self-actualization by providing social relationships and services that offer a good quality of life. Critical practice also seeks to create social change that affirms the citizenship of older people in society.

Critical thinking offers three main techniques:

• Critical analysis of language. This involves thinking carefully about how you communicate with an older person or their family members.

Are grandparents as important in a family or community as children? Is caring for them when they need it just as important? If so, we are in solidarity with the older people around us as well as the young. They are citizens in the community traveling along the road through life. That is the principle that lies behind this book.

The first three chapters focus on broader issues about the place of older people and services provided for them in the societies in which they live. Successful social work practice involves individualizing the person you are working with, while at the same time thinking about broader social relationships between younger and older people and between older people as individuals and a wider society in which older people are a significant social group.

The main aim of this first chapter is to introduce general ideas and information about the aging process and social impact of growing older to help social work practitioners understand the experience of the older people who are their clients.

After working through this chapter, readers should have:

• Considered the meaning of a citizenship approach to practice with older people in their social context

• Examined the practice implications of views, assumptions, and theories about aging and the social life of older people, including readers’ own views and assumptions

• Considered the changing social and economic settlement within which policy and practice with older people is framed

• Assessed the implications for policy and practice of biomedical understanding of aging

We all grow old. We experience physical changes as we age, but also we age in a social place; we age within the social relationships and context that have formed our lives.

This chapter explores how practitioners may develop groupwork and community work interventions to benefit older people in the community. After working through this chapter, readers should be able to:

• Evaluate the main aims of groupwork interventions with older people

• Identify the main requirements of carrying out effective groupwork

• Explore reminiscence as an important use of groupwork with older people

• Evaluate the main aims of macro interventions with older people

• Understand useful macro interventions such as creating support groups and integrating older people into community groups

• Develop ways of enabling older people’s participation in decisions that affect their lives and services for them

Groupwork is an important offering in services for older people for many reasons:

• Humans naturally live much of their lives in groups, for example, families and social clubs, so interacting with groups is a necessary part of much social work practice.

• Older people sometimes become socially isolated and the opportunity of taking part in group activities is both a right as citizens and a benefit to psychological and emotional health.

• Care services are often provided in groups, in care homes or in day care, and in addition to working with people as individuals who just happen to be in a group, it enhances services to use the group as an element of practice.

• While groups may be used for psychotherapeutic treatment, a wide variety of other types of group occur in services, and practitioners who focus on the individual excluding the group may be missing the impact of group interactions on their clients.

• Groupwork can be particularly helpful in supporting informal caregivers.

The main aim of this chapter is to place social work practice in the context of the wider range of services and facilities in society that older people use. These include ordinary commercial and public services for the whole population, as well as provision for vulnerable people, including older people. Research and policy development aims to ensure that all social provision for citizens is planned and managed to involve older people positively in community life by organizing services so that they are suitable for older people’s participation.

After working through this chapter, readers should be able to:

• Identify three philosophies of integration in services for older people: integrated care, holistic practice, and mainstreaming and age-proofing

• Evaluate the role of generalized, low-cost services in maintaining independence and dignity for older people

• Explore three approaches to integration practice within social work: community and family integration, partnership practice with services, and macro practice to promote age-proofing and mainstreaming

One of the important ideas about services for older people in recent years has been the policy of integrated care, originating in the U.S. during the 1980s and spreading across the world. It proposes that we should not focus only on specialist areas, such as social or health care. Another aspect of this is to integrate the range of services for a particular group, such as older people, including at least health, social care, housing, transport, social security, education, leisure, and community facilities.

An obvious way to build integrated care is to merge services or aspects of them together.

I recently went to an uncle’s diamond wedding (sixtieth) anniversary party and sat at a table next to the widow of one of his work friends, who was herself in her eighties. We talked about computers and the Internet, and she proclaimed herself a “silver surfer.” “It’s so exciting,” she said. “There are so many things you can learn about. Sometimes I stay up half the night on the Internet.” Her exploration of the world through her computer was giving her a new interest and commitment in life. In writing this book, I want to encourage social work practice to empower that kind of enthusiasm for life and the world among the older people with whom we work.

My main aim in this book is to develop from existing social work practice ideas a citizenship social work with older people. Citizenship social work starts from the idea that older people are equal as citizens of any society, any state, any community, any family; that citizenship confers rights to participation in and responsibilities for older people and everyone else within those social relationships. I argue that we do not always accord older people those rights in the way we think and the way we act. I use “pause and reflect” sections in this book to enable you to think through your own feelings and views on the topics covered.

Think about your own attitudes to older people: are there ways in which you do not quite think of them as equal citizens?

Some people assume that they are not as important as younger people because they are not as in touch with current ideas; they have retired, so they are not making a productive contribution to society; they’ve lived the main part of their life, so they are not as important as younger people who need education and development for the future; they need care, so they are a drain on family, community, and state resources; they have old-fashioned ideas about behavior; they are irritating and slow.

This chapter focuses on three aspects of practice with older people concerned with social exclusion:

• Where aging interacts with inequalities in people’s lives

• Safeguarding older people so that they achieve both psychological and social security

• Responding to end-of-life issues, loss, and bereavement in old age

Two issues about inequalities are likely to affect practitioners with older people: ageism and the impact on older people of wider health inequalities. These are both situations in which the social order—recurring patterns of social relations in society—leads to older people being discriminated against or excluded from their citizenship or ordinary human relationships and social networks.

The Anti-Ageism Taskforce of the (U.S.) International Longevity Center (2006, p. 21) identifies four different aspects of ageism that relate to older people: (1) individuals’ ideas, attitudes, beliefs, and practices; and (2) organizations’ missions, rules, and practices that are (3) biased against persons or groups based on their older age, (4) whether unintentionally (carried out without the perpetrator’s awareness that they are biased) or intentionally (carried out with the knowledge that they are biased, including carrying out practices that take advantage of the vulnerabilities of older people).

Ageism affects people throughout their lives. Younger people may suffer ageism because they are feared as violent, uncontrolled, noisy, immature, and incompetent through lack of experience. People in midlife may be affected by many prejudices about their age. A UK employers’ association gave people at all levels in commercial and industrial organizations a series of scenarios at a time when antidiscrimination legislation was being extended to aging.

This chapter introduces the range of social provision for older people and discusses controversies about the role of social care in the range of public and private sector provision for older people. One of the important characteristics of social work with older people is its role in organizing and providing services, so practitioners need to gain a clear grasp of where social care fits into the services available.

After working through this chapter, readers should be able to:

• Explore and analyze social provision for older people within a range of domains of service

• Understand social care for older people as an aspect of social provision within each of those domains

• Appreciate the role of health care, housing, and social security as crucial domains for quality of life among older people and, therefore, for social work intervention and participation

• Understand the importance of welfare or assistive technology and telecare as part of care for older people

• Examine the role of social work in integrating services for older people, including case management, cash for care, and services for informal caregivers

We have seen in the first two chapters that a range of policy issues affect how services for older people are organized in any society. Walker and Naegele (2009) identify these policy challenges of aging societies in Britain and Germany. First, there is the need to respond to the consequences of demographic change for employment and the labor market; income, poverty and wealth; and in health and health care as they all affect older people. In nursing and social care, important issues are the extent of institutionalization; that is, whether older people should live in special accommodation and the lifestyle in such accommodation.

This chapter discusses the social work skills required in providing services for older people; in the following two chapters we move on to building on these skills to practice critically and creatively.

After working through this chapter, readers should be able to:

• Think through their professional stance in working with older people by looking at “what’s up?” and working in a “can do” way

• Analyze and develop appropriate professional skills in working with older people

• Empower clients’ participation in thinking ahead and thinking aloud about future plans using an advance care planning process

• Incorporate the preferences of older people and their informal caregivers through assessment and care management skills to create and implement tailored packages of care for older people

• Work effectively within caring services

An important starting point for practitioners is to consider their stance toward their clients. We saw in chapter 1 that citizenship social work practice seeks to be holistic (Payne, 2011), including in practice a concern for the body, the mind, and the social. First, practitioners need to know about the older person’s physical and mental capabilities and understand how frailties interfere (or do not interfere) with doing the things they want to do. Second, they need to understand the social context. Part of this is the life story that has led to this point and that explains what in that life is important now, and who is important. Another part is aspirations for the future and plans to achieve those aspirations or find alternatives if they cannot be achieved. The third aspect of a holistic understanding is the caregivers, family, and community who surround the older person and contribute to their capacity to achieve what they want to achieve.