Leadership Challenges in Aged Care

Talk by Dr Simon Duffy for ACH Leadership, 3 December 2014 in Adelaide

What are we doing here?

Words are important

• Is it helpful to think of ourselves as consumers?

• Can you consume care?

• Is care the kind of thing you can direct?

• Is it helpful to convert community into a market?

Origin of “Consumer” early 15c., "one who squanders or wastes," agent noun from consume. In economic sense, "one who uses up goods or articles" (opposite of producer) from 1745.

Origin of “Care” Old English caru (noun), carian (verb), of Germanic origin;

related to Old High German chara 'grief, lament',

charon 'grieve', and Old Norse kǫr 'sickbed'.

We make citizenship real by1. Finding our sense of purpose

2. Having the freedom to pursue it

3. Having enough money to be free

4. Having a home where we belong

5. Getting help from other people

6. Making life in community

7. Finding love

This protects our dignity1. Our life is seen to have meaning

2. We are not on someone else’s control

3. We can pay our way - we’re not unduly dependent

4. We have a stake in the community

5. We give others the chance to give

6. We contribute to the community

7. We are building the relationships that sustain community

“My life, my rights”1. I have a right to live independently

2. My budget is my money

3. I can control it, and get good support with decisions

4. I should know my budget and any rules

5. My budget should be able to to be used flexibly

6. I should be able to share what I am learning

7. I should be supported to make a contribution

These innovations were not inspired by consumerism, neo-liberalism or a desire to create a ‘market’. They were inspired by a desire for justice, citizenship and community.

One way forward…

individualise

Social Work

Inclusion Glasgow

Individual Service Fund

Service Coordinator

Lynn & her sister

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My Money

Admin

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Funding from one or more sources

[enables integration]

brokerage unexpected costsoverheads

Coordinator Insurance FundRestricted Funding

Individual Service Fund

People don’t shop for services they build stronger community.

Some questions for ACH going forward

• Can you really plan with people so they can find the very best solution?

• Can you give people some of their own money?

• Can you keep people’s money safe for them (e.g. roll it over to next year)?

• Can you let people use their money flexibly?

• Are you part of the same community as the citizens?

• Are you helping people contribute?

At their best providers are points of wisdom. So how have providers become ‘a problem’?

• Ideological rhetoric around markets?

• Vested-interest of commissioners?

• The increased detachment from community?

• Increased wage differentials and profit?

• Associational with institutional provision?

What roles should you play in order to restore trust and exercise leadership?

• Genuine commitment to partnership with citizens

• Rootedness and commitment to community

• A platform for peer support, family or self-advocacy

• Accountability for meaningful research based in real outcomes

• Sharing what you’re learning

Simone Weil

Christ does not call his benefactors loving or charitable. He calls them just. The Gospel makes no distinction between the love of our neighbour and justice. In the eyes of the Greeks also a respect for Zeus the suppliant was the first duty of justice. We have invented the distinction between justice and charity. It is easy to understand why. Our notion of justice dispenses him who possesses from the obligation of giving. If he gives, all the same, he thinks he has a right to be pleased with himself. He thinks he has done good work. As for him who receives, it depends on the way he interprets this notion whether he is dispensed from all gratitude, or whether it obliges him to offer servile thanks. Only the absolute identification of justice and love makes the co-existence possible of compassion and gratitude on the one hand, and on the other, of respect for the dignity of affliction in the afflicted - a respect felt by the sufferer himself and the others.

Ursula Le Guin

Honour can exist anywhere, love can exist anywhere, but justice can exist only among people who found their relationships upon it.

John Rawls

All social values - liberty and opportunity, income and wealth, and the bases of self-respect - are to be distributed equally unless an unequal distribution of any, or all, of these values is to everyone's advantage.

There are eight degrees of charity, one higher than the other. The highest degree, exceeded by none, is that of the person who assists a poor Jew by providing him with a gift or loan or by accepting him into a business partnership or by helping him find employment - in a word, by putting him where he can dispense with other people's aid. With reference to such aid, it is said, “You shall strengthen him, be he a stranger or a settler, he shall live with you” (Lev. 25:35), which means strengthen him in such manner that his falling into want is prevented. [Maimonides]

1. Don’t look down on people - respect them as your equal

2. Don’t deny people what they really need

3. Don’t wait until someone has to ask

4. Don’t force people to beg

5. Don’t act like you are doing them a favour

6. Don’t expose people to scorn or stigma

7. Don’t distinguish givers or receivers

8. Don’t let people fall into need and out of citizenship

Maimonides’ 8 rules of giving