22 | Nursing in Practice | Summer 2022
COLUMNIST
It’ s about what we say,
as much as what we do
The language used in social care is important. It takes a different approach to that used in the NHS but has a valuable contribution to make to the wider care sector, says George Coxon
George Coxon Care home owner
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As a former senior mental health clinical nurse specialist with numerous subsequent NHS roles, I feel I have been indoctrinated with medical model language. I’ m now a staunch care home activist and have become uneasy about jargon, labelling and words that could alienate and disempower people in my care homes.
I’ ve got into trouble with the occasional mild criticism of our beloved and revered NHS but I do wish to put the case for how we talk in social care land. There’ s a growing determination to speak up about progressive, elevated social care work, where what matters to those we care for is more important than what is the matter with them.
I am now challenging a lot of disease- and treatment-oriented terminology in my care homes, partly to embed a more relational care ethos as much as a personcentred one. Mere semantics? Perhaps, but I do believe we humble, often maligned care home people need to speak up about what makes our work attractive – to create a new narrative with a glossary that illustrates what we offer the healthcare world.
In practice, this means outlawing language such as‘ challenging behaviour’, or‘ doing’ things to people, such as feeding or dressing. As to terms like‘ aggressive’ – I contend that no person living with dementia is ever aggressive, since aggression requires premeditated malicious intent. Even the word‘ admission’, when someone moves into a care home, is one I’ m keen to ban. We are not hospitals, we have‘ arrivals’ and we offer homely life, not life in a clinical setting.
So, with that provocative stuff out of the way, I want to share some words that do really matter in my care homes, and to ask what key words matter to you and your work?
Before the pandemic, I did a TED-style talk at the South West Academic Health Science Network. It was entitled‘ It’ s bout time’ – a play on words that set out to ask about the most important word in care home life. I asked the
Care home people need to speak up about what makes our work so attractive
audience for their views and my conclusion was that the word is‘ time’, and how we use time well. My glossary has now expanded; I’ m also talking about‘ atmosphere’ and how this is shaped by‘ culture’, which in turn is very much driven by‘ language’.
Can we take this further? I’ m eager to hear from others how we can build inspiration, insight and respect across our health and care divide. I think this must include a recognition of difference.
I wrote a piece for the British Geriatric Society about‘ fun-guarding’ being as important as safeguarding, and have said – perhaps contentiously – that the word fun very much differentiates the values and themes of NHS and care home life. Fun is something we encourage hugely in a care home, but is a lesser priority in a busy emergency department! I also wrote an article entitled‘ It’ s only words’ for the Institute of Health and Social Care Management’ s The Loop( issue 4, January 2022). Do have a look: talk to colleagues, and let me know what you think.
Social care and care home work have a lot of things to be positive and confident about, and we need to show why we are worthy of parity with our NHS colleagues.