Personalised Care or Caring Communities: Challenges to Social Work in the time of change

Vito Flaker University of Ljubljana, Slovenia

Community work
The duality of working with individual and community has been intrinsic to social work (e.g. Mary Richmond and Jane Adams) it has to observe social dimension of personal distress or a person within the community Casework (clinical social work) has however become a dominant form of practice in 50s. Community work: community organisation, development, mobilisation was prominent in Europe in seventies In nineties community care was a dominant issue. In the dilemma of just care in the community or care by the community. Former somehow prevailed.

Move from institutions

Collective Therapeutic communities, Cooperatives Group homes Users and advocacy associations Individual Case management Care planning and management Independent service brokerage Personalised care

Long-term care as new pillar of social security

coordinated

Plural and polivocal

Long term care

continuous

Holistic

personalised

Long-term care innovations

Old paradigm New paradigm Provision Entitlement Health and social care Status and diagnosis Special long-term care Needs

Quantity of resources
Payment Relationship to helpers/ professionals Position of user

Based on employment
Indirect - providers receive funding Dependence Patronising Segregation Devalued roles

Based on services needed

Direct - users receive funding Independence Partnership Community participation Valued roles

Innovations in methods and organisation

Organisation of care Drama of institutionalisation Continuity of care Methods of care planning and implementation Standard services Passive recipient Tailor made Users choice and desire

Knowledge

Professional Axiomatic
Overburdened or excluded Helpless, dependent

Users Experiential
Supported Links to community Productive consumer

Informal helpers

Image of the user

Services received Finance

Service led Sometimes unnecessary Not clear

User led Gets precisely needed Transparent

5 intensities of personal service

Action Talk Support Arc of help Coordination (care management) Level Representation Deeds Power Organisation

Residence

Dislocation

Institutional world

coordination

Life world

help

support

Care planning
Virtual - desires

approval

Providing Planning

Actual - deeds

Common effort
Plan is persons will To be approved by the state (if funded) and accepted by the participants Approval and acceptance transform individual will into common action Provision is a concerted effort of formal and informal helpers conducted by the user Appropriation of public resources and mobilisation of the personal and common good

Ownershipp of resources
Resources Alienated Own

Public Private

State Market

Movements Networks

Resources provided example of mental health

Market pills State hospital, or any other services Networks tolerated, or even cared for in safety and well-being. Movements join with other people dissatisfied by the position, and the way people with mental health distress are treated, and try to find ways to feel better and recover from the distress.

Knowledge
Market commoditised knowledge (pills) Networks territorial knowledge (recipes). State territorialising knowledge (panopticion, labels) Movements critical knowledge of change.

What does the deinstitutionalisation change?

Deinstitutionalisation impossible without Movements (of users, relatives and professionals). decrease in institutional space : smaller parking space more traffic. state provides services at home:
transforming private space into public or its agents (professionals) into friends, acquaintances or visitors. a new home to the residents or a mini-institution.

intermediate residential structures : Direct funding is money public or by persons own. Way out:
quasi)markets of services, living in the community is a right

Markets thus developed are only a means of privatisation of public funds home, community is in principle private. return of the people who have lost their networks (community, relatives, etc.).
buy services in the market Caring friends however cannot be bought.

Community can be provided only by a Movement. Sublime community!

Perils for social work

Withering of Welfare State Bureaucratisation Controlism Gate keepers antiwelfare watchdogs Labelling and confinement Economisation and medicalisation of everyday life (loneliness, commercialisation of distress,

Direct Social Work Action (bailing out people not banks)

Conservation of social state Self-defence of the people Recreating the communities Joining the movements of today Direct democracy and common fare Imperative of non exclusion

Bailing out the people not the banks

Stable social security (universal income, access to service for good quality of life, right to live in the community, long-term care insurance, direct payments, minimal bureaucratisation of social care) Protection and defence against debto-cleptocracy (protection and insurance in loosing work due too redundancies and bankruptcies, evictions, debts, advocacy, crisis interventions) Strengthening communities (enabling communities, strengthening capacities for self-providing, selforganisation and self management and self government; establishing cooperatives, mutual help groups, time banks, self help clubs; reclaiming the social ownership of the public sector, shifting care into community).

Conclusion
Welfare is undergoing big and irreversible changes Not only threats but also challenges Common-fare is a personal appropriation of public good and public expression of personal desire Social Work has to adapt and contribute to the changes It has to find new alliances with people,movements, unions and reformulate the relationship to the state and market Social work has to continue to be practical synthesis of freedom and care it has to continue with personal approach to the services and re-create communities that would be able to sustain systemic shocks Social work has to resurge and a assert itself as a independent actor and profession connecting people to create common good and humane communities