A view from social work practice

Ethical dilemmas: balancing choice and risk with a duty of care in extending personalisation into the care home

“…However, rather than erecting yet another boundary (Barnes, 2012), in relating our findings to the wider personalisation literature, we found that familiar tensions generated by the fundamental flaws of choice-based models of personalisation were thrown into sharp relief in the care home context. Specifically, questions posed in community settings about the nature and content of choices and the conditions in which they are offered assume a new saliency, and the overblown attention to pre-set menu options chimes with Hart's (2014) concerns about offering older people the choice between 'two baths a week or a shower every day'.…”

“…They are compelled to demonstrate advocacy of a consumerist model presented as synonymous with person-centred quality care, despite their own knowledge of the inconsistencies entailed, including over-emphasis on the autonomous individual (O'Dwyer, 2013). Hart (2014) compares the gains that she has seen for working-age adults fully engaged in the process of organising their own care with the lack of change for older adults with cognitive impairments. Questioning the vastly different ways in which the 'personalisation box is ticked', she contrasts the 'shiny brochures all about user choicelocal leisure centres versus day centres' with her own experience which often came down to 'one shower a day or two baths a week' and highlights that '[i]t is the dishonesty that is difficult to manage as a practitioner' (Hart, 2014: 114-115).…”