New Care Normal: Choice and Connections in Social Care

Social care is frequently literal, as carers maintain and support their service users ability to remain a part of our society. It is incredibly common for carers to develop deep personal connections with their service users through this process as well. The coronavirus pandemic has disrupted these connections, shattering many and compounding the isolation this virus necessitates. Rebuilding these connections as we slowly reduce lockdown measures will define the future of social care, and what will become the ‘new care normal’. We spoke to Scottish Care CEO Dr Donald Macaskill about social care’s present crisis, and what it means for the future.

Dr Macaskill, like so many others in social care, has been barely stopped in the past two months. “I think for anybody involved in the care sector this has been an intense period of time,” he says. “As the head of a representative body, especially around care homes and care at home and particularly because of the fact our members support older people, the impact of COVID has been immense.”

Along with the immense pressure, there has been increased public interest in social care. The specifics of what social care providers do and the realities on its frontlines have become daily news stories. Though this long-sought publicity has not necessarily come in the form the sector would have liked. Especially considering the evidence indicating social care is yet to pass its own infection peak.  However, as the ever enterprising Phineas T. Barnum would say: ‘there is no such thing as bad publicity.’ The empathy, dignity and commitment of care workers during the pandemic has writ their cause large in the British consciousness. Dr Mackaskill says: “There has been an astonishing degree of interest from the media on the care sector. Some of it informed and intelligent, others sensationalist and ignorant. The vast majority of the general public have limited experience of social care. I think what this virus has done is to help people understand that social care is intrinsically important to health, wellbeing and [has a] societal benefit.”

This is something we have heard expressed by many other industry figures such as Dr Townson of UKHCA and Karolina Gerlich of the Care Workers Charity. Social care is not something everyone will experience as frequently as they would the NHS. As a result of this virus, and social care’s response, attention and awareness have massively increased over the last two months. “The optimist hopes [the increased attention] will carry through into a continued collective awareness,” Macaskill says. “While the pessimist might suggest that people might fall back into their usual ruts of ignorance or disinterest which has been the problem in years past.”

This increased focus on social care has led to some calling for a centralised body to be created. The idea being that if social care ran more like the NHS it wouldn’t suffer from as many funding or organisational issues. However, ensuring that choice, control and social connections remain for service users would be paramount. As Dr Macaskill points out, ‘we’re not an emergency service: social care is about life, potential choice, and the exercising of that choice.’

The coronavirus has already severely restricted the choice available to social care recipients. Not to mention the life those choices provide.  “[Coronavirus] has virtually removed the independence of people in care homes. The whole process of social distancing [and] self-isolation has basically removed it. The sense of independence, freedom, choice and control,” says Dr Macaskill. “That’s one of my main concerns at the moment. How do we reconnect people? Because people are being given life and being sustained in living. But there is a difference between existence and living. Living is about relationships, it’s about connections, it’s about purpose and value. I think that’s what we’ve lost significantly and that’s what we urgently need to start to rebuild.”

Technology has played a huge role in keeping society connected during this pandemic. Whether for business or personal needs technology has been almost exclusively keeping us in contact with each other for nearly two months. It has the potential, when applied correctly, to do something similar for social care.

“Technology can [rebuild that bridge],” Macaskill says. “We set up in Scottish Care a project called the Tech Devices Network. It is about people donating tablets and devices and then giving them out to care homes and individuals who are living in isolated circumstances. That’s growing in success, so technology has kept people in contact, through tablets, through Skype, through Facetime, through Zoom.”

“But we have to remember that a significant number of the care home population are individuals who have lost the cognitive ability to either independently, or indeed even with assistance, use such devices. There are limitations of technology; there are benefits as well. 

We are using tech creatively and purposefully but it can never replace touch and presence.”

Touch and presence are crucial factors for providing social care. However, they are also the primary methods of spreading Coronavirus. With uncertainty around PPE supplies and changes to the PPE requirements, touch and presence can be very hazardous to provide right now. 

“I am pretty convinced that we need to start moving towards that new care normal. France, have begun to make sure that people were reconnecting to families, still staying safe but with a degree of PPE being used,” says Dr Macaskill.

“I was in a conversation yesterday and they had a 103-year-old resident [who doesn’t have] weeks and weeks of life left in order not to be connected,” Macaskill says. “I think they have the right to decide whether or not being in touch, being in contact, having the presence of their families is more important than extending the clock of life. For all of us in the older care environment, whether Australia, Canada or the US, are beginning to ask these questions. How do we exit in a manner which preserves life, treats people as individuals and doesn’t discriminate simply on the basis of age or characteristics and reconnects communities?

How do we rebuild the broken connections? Can we provide choice while still preserving everyone’s safety? How do we prevent this from happening again? What will that cost in personal freedom of choice?

These are huge questions and ones that will shape the ‘new care normal’ we are heading towards. They are daunting to engage with and at times seemingly impossible to resolve. However, deciding to address them honestly, and with real purpose, is not a choice we can delay.