Making the invisible visible – social work in care homes

As a social worker committed to social justice, I am troubled by how ageism shapes society – according to the World Health Organisation it is one of the most tolerated forms of discrimination.
The way we talk about ageing and older people regularly emphasises stereotypes of dependency, failure and burden. This is especially true for care homes.
Well-resourced care services staffed by a respected, valued workforce are fundamental to our society. Yet many people are still scared of ‘ending up’ in a care home – perhaps this is a defence against the fear of growing old, intensified by media-driven worries about the quality of care they might receive.
The perception of care homes as a ‘last resort’ is further reinforced by health and social care policies which position staying at home as best for everyone. Independence is of course important, but this narrative can make moving to a care home seem like a failure.
What I find striking is that this is at odds with strengths-based practice, which underpins adult social care in England, under the Care Act 2014, and focuses on supporting people to live well in ways that reflect their strengths and what matters to them.
Many care homes have really strong community connections, linking with local schools, groups and businesses, whereas others are less visible and not always acknowledged as part of the community.
This lack of visibility may contribute to negative assumptions, particularly as research conducted by Ipsos in 2020 suggests that people with direct experience of care homes tend to view them more positively than those without.
All this matters, because how society and the media talk about care homes influences how social workers think about them, and about the people living and working there.
Social workers often have limited involvement with older people once they have moved to a care home. As a result they may not understand the care home environment or feel confident navigating it or appreciate the important contribution their involvement could make.
Yet my PhD research, and that of others on the social work with older people research project, suggests that social workers have a vital role to play. With their focus on rights, relationships and advocacy, social workers should have a greater role in care homes, making older people more visible and supporting older people and care home staff in meaningful ways.
Of course, this is not always easy in the current context of adult social care. Social workers often work in systems that reduce what they do to a set of tasks. One participant in my research said: “We are allocated, we do the review, we give our recommendation and then generally the case is closed.”
Social workers also spoke about the tension between their values and the demands of the system: “It's workload pressure, isn't it?" said one. "You're being asked to take more work. You don't have time to build that relationship. You don't have time necessary to make those connections. Maybe you don't even have training.”
Care homes often came low down the priority list.
One social worker told me: “If you've got time to visit one person, it's going to be that person who’s at risk at home. It's not going to be the person safely tucked up in a care home”
But participants in the study also described drawing on both personal and professional experience to stay grounded in what matters: rights and relationships, which ultimately leads to better outcomes for people living in care homes.
This aligns with My Home Life England’s approach, founded in 2006 by a group of organisations including Age UK, to promote quality of life for people who live, work in and visit care homes.
I joined My Home Life England at the start of this year through a part-time fellowship with the North Thames Applied Research Collaboration.
It has turned out to be the perfect match. The focus is on promoting the importance of relationships and a shift from simply providing care to creating environments where people feel valued, respected, and empowered. It speaks to the importance of connection, partnership, and seeing the person, not just the process.
I have quickly come to see how closely this aligns with the values of social work.
In the second part of the series Sally Nieman uses transactional analysis to put relationships between social workers and care homes under the spotlight. Look out for it in PSW magazine delivered only to BASW members
Sally Nieman is co-chair of BASW’s special interest group on ageing and social work [add link from website] and has a part time research fellowship through the North Thames ARC Social Care Learning Network