Ageing, ethics and social welfare: contemporary social work and social care practices with older people

The ageing of societies around the world is frequently portrayed negatively and the perception that an ageing society represents a burden is entrenched in policy-making. This has generated enormous challenges for practitioners in social work and social care services. There are important differences between countries in terms of the economic contexts of practice and the histories of social welfare provision. In general, however, predictions of future needs for care, based on demographic changes, provide the backdrop to a policy imperative to reduce demand for support and cut the cost of provision. Intergenerational relations have been severely tested by the characterisation of older people as a drain on societal resources, with the post-war baby-boomers singled out as particularly responsible for the impoverishment of younger people because they have benefited throughout their lives from the welfare services established after World War II. There are, therefore, particular challenges to growing older at this point in time. The global phenomenon of societal ageing has coincided with the marketisation of welfare, in some countries under conditions of economic austerity, and there is an emphasis on cost control in provision. At the same time, demographic developments have generated changes in levels and types of need for support for social work and social care, while professional values emphasise the promotion of the rights of service-users to person-centred, care and on maximising their self-determination and control. Consequently, practitioners face a range of ethical and professional dilemmas and challenges in negotiating their way through these competing priorities. Inequalities between older people are of particular relevance to the provision of social care services because of the needs of those who are socioeconomically disadvantaged. In the UK, the trend is towards higher levels of inequality and rising levels of poverty among the least well-off (Centre for Ageing Better 2017). The value of pensions makes a crucial difference to the risk of poverty in later life, a point that highlights the importance of a life-course perspective on understanding conditions of later life, but if people are required to pay out of pocket for social services, the likelihood of falling into poverty increases as their needs increase and those who have been on low wages throughout their lives are further disadvantaged in old age. This raises questions not only about the level of support but also about individuals’ entitlement to it and fairness in access. At the same time, older people’s organisations in different parts of the world call for improvements in support, an increase in the level of support and changes to the way services are provided. For example, in the UK, after years of austerity budgets, a state of crisis exists in social care provision with no evident sign of abating. A 2017 policy briefing by Age UK points out that at present around 1 in 8 of people aged 65 and over do not receive the social services that they need, which represents a 48% increase since 2010 (Age UK 2017). Nevertheless, where services are better funded, they still may be flawed in terms of accessibility, equity, quality and organisation. In Australia for example, there are calls for better quality services as well as greater choice for service users and transparency in funding of residential care services. This points to an evident flaw in the market system in residential care, which is that it often fails to produce