Happy or “appropriate”?

When I think back to my time working as a care assistant in a residential home, the word “appropriate” come s to mind. I was reminded of this by this post on the very well-used Foundation for People with Learning Disabilities “Choice Forum” (http://www.learningdisabilities.org.uk). Here’s an extract:

 “The care provider has enforced a no touch / hug policy into the house as my daughter can become over huggy on occasions – Staff take the line if we avoid all touch, the issues will be minimised. This does not seem to be the case – quite the reverse – When told not to hug or touch a staff member she will become very distressed and angry and an episode of conflict follows where she is extremely confused and out of control. She is very strong and staff have been forced to use breakaway techniques at times. The whole episode results in her feeling rejected upset and confused. The relationship between staff members and service users (and indeed family members) is complex and can be confusing. Staff have suggested that she greets and says bye to staff leaving shift by shaking hands – I find this totally unacceptable because it is not a normal way of interaction between people that know each other well. At other times they are told to say very firmly ‘no! we cannot do that, I am a staff member- it is not appropriate’ I see her actions as very normal and human.”

Who gets to define what is appropriate and what is not? When I was a care assistant, I took it for granted that staff defined what was appropriate. It seemed self-evident that hugs weren’t appropriate to professional/client interaction, particularly as they could lead to escalating physical contact and in some cases aggression with one or two individuals. It never occurred to me that the people we worked with did not have an “ordinary” home life, so ideas of appropriateness based on the difference between home and professional life perhaps weren’t as clear-cut as we believed.

Some of the people I worked with were deemed to be very challenging. There was a nod to the idea that it was us, the staff, finding those individuals challenging to our role, but little room for radical changes in our approach within the boundaries and risk assessments of residential care at the time.

A Shared Lives manager described one man’s transition from residential care to a Shared Lives household to me recently. There had been a big battle about the move, because many professionals involved did not think it would be safe or manageable for the man to live in an ordinary household. He was considered challenging and spent most of his time standing outside his care home, in all weathers. Since he moved in with them, the Shared Lives carer and partner have had a baby, which provoked further anxiety about the individual’s ability to cope with the upheaval and change. The manager describes him coming into the living room, putting on his slippers, kissing the baby and settling down in his favourite chair in his living room – utterly at home.

We can all be “challenging” when we’re unhappy. It’s time for services and professionals to spend at least as much time thinking about people’s happiness as they spend working out what’s appropriate.