‘This is Still All about Love’: Practitioners’ Perspectives of Working with Family Carers Affected by the Harmful Behaviour of the Older Person for Whom They Care

Abstract

This article explores a hidden and under-acknowledged dimension of caring in family life: when older people with care needs act in a harmful, abusive or violent way towards the family member(s) who cares for them. Thirty-eight health and social care professionals, working in the UK, took part in five focus groups to explore their experience of working with families in this situation. The group discussions were stimulated by vignettes developed from interviews with carers affected by harmful behaviour, and the data generated using this method were analysed using a thematic approach. There were two principal findings: (i) ‘carer harm’ is a serious and under-acknowledged problem, which practitioners have extensive experiential knowledge of and (ii) practitioners face considerable practical and ethical challenges working with affected families. Drawing on Miranda Fricker’s concept of epistemic injustice, we discuss how contemporary social, legal and policy systems can make it difficult for practitioners to identify and meet the needs of affected families. Finally, we explore the role of social workers—and the support they need as a professional group—to work alongside a ‘hidden’ group of families seeking to manage the intersection of care, harm and intimacy in later life.

Using text-based vignettes in qualitative social work research

“…The vignette scenario can be generated in different ways. It can be based on literature (Schoenberg and Ravdal, 2000), interviews with people with lived experience (Pwle) (Isham et al, 2021; Roets et al, 2016) or professionals (Bradbury-Jones et al, 2014), analysis of case records (Engwall et al, 2019; Kristensen, 2011; Stevens et al, 2010) or serious case reviews (Wilkins, 2015), media reported incidents (Aujla, 2020), practice knowledge (Bain, 2008) or a combination of these. Zeijlmans et al (2019: 402), for example, observed professionals in two organisations and analysed case files from a third organisation.…”

“…Responses to vignettes give insights into people’s norms and beliefs whilst taking into account contextual factors (Grootegoed and Smith, 2018). Vignettes allow an insight into social work practice, decision-making and service user experiences without the need for examples from social workers’ practice that would potentially include sensitive data or breach confidentiality (Isham et al, 2021: 3196). Vignettes can be used to address sensitive topics that are otherwise difficult to talk about (Grootegoed and Smith, 2018; Wilks, 2004).…”

“…Participants respond to a scenario whose characteristics are controlled by the researcher creating forced inference which is especially powerful if combined with reasoning and justification of the response to the vignette (Schnurr, 2003: 397). Text-based vignettes within semi-structured interviews and focus groups with social workers and related professionals have been successfully used in• Europe (Åkerlind et al, 2019; Callegari et al, 2022; Enroos et al, 2017; Falconer and Shardlow, 2018; Ghanem et al, 2018; Grootegoed and Smith, 2018; Hetherington, 1998; Isham et al, 2021; Käkelä, 2020; Kristensen, 2011; Liljegren, 2012; Nygren et al, 2021; Sanfelici, 2021; Walsh et al, 2019),• North America (Aujla, 2020; Schoenberg and Ravdal, 2000; Taylor et al, 2021),• Latin America (Nygren and Oltedal, 2015),• Africa (Nygren and Oltedal, 2015),• Asia (Taylor et al, 2021) and• Australia (Darlington et al, 2010; Drury-Hudson, 1999)…”

“…• Europe (Åkerlind et al, 2019; Callegari et al, 2022; Enroos et al, 2017; Falconer and Shardlow, 2018; Ghanem et al, 2018; Grootegoed and Smith, 2018; Hetherington, 1998; Isham et al, 2021; Käkelä, 2020; Kristensen, 2011; Liljegren, 2012; Nygren et al, 2021; Sanfelici, 2021; Walsh et al, 2019),…”

Understanding Gender-Based Violence

“…Older women report that feelings of shame and anticipatory stigma inhibit them from disclosing sexual and IPV particularly when carried out by a life-long partner or family member [20]. The complex dynamics of love, care and inter-dependency in older age create additional challenges for older women seeking help in relation to a taboo expression of violence and abuse-that perpetrated by people who need and who 'give' care [21,22]. Help-seeking is further hampered by a lack of specialist, age-sensitive services in most countries.…”