This document discusses the importance of reciprocity in care for older people. It notes that while personalization aims to focus on individual needs and empowerment, true independence also involves collective responsibility and individuals helping one another. Reciprocity is important for mental well-being as both "over-benefitted" and "under-benefitted" relationships can be problematic. However, professional boundaries policies often prohibit care workers from developing meaningful friendships with clients. The document advocates celebrating the relationships between staff and clients, redefining boundaries to allow for sharing lives, and focusing on meaningful interactions and moments that really matter.

1. ‘Who’s helping who?’ Is there a role
for reciprocity in self directed
support for older people?
Nick Andrews, Swansea University
Sarah Taylor, Edinburgh Council

2. Personalisation - do you want to buy
a friend or be a friend?
• Are we Homo
economicus or
Homo
reciprocans?
(Bowles and Gintis
2013)

3. Personalisation – what matters most?
• ‘When I lost my legs, it
was “right, what can we
all still do together?” Still
play football and rugby
with my friends, sitting on
the floor as a goalkeeper,
scooting myself around
with a rugby ball in my
hands’ Nathan Stephens,
Paralympics athlete, Barry
Island, Wales

4. What do we mean by Independent
Living?
• ‘There has always been a distinction between what we mean
by IL in Britain and what they mean in the States. IL in America
is organized around self-empowerment, individual rights and
the idea that in the land of the free and the home of the brave
– all that crap – individuals, if they are given access under the
law and the constitution, can be independent. In contrast, in
Britain . . .IL entailed collective responsibilities for each other
and a collective organization. It wasn’t about individual self-
empowerment; it was about individuals helping one another.
Once you accept that notion, it seems to me, you are
beginning to question the foundations of the society in which
we live’. (Campbell & Oliver, 1996, p. 204)

5. ‘A life on equal terms’ - who is helping
who?

6. And an early lesson from a bicycle
repair book
• ‘I am struck by how
sharing our weakness
and difficulties is more
nourishing to others
than sharing our
qualities and successes’
Jean Vanier

7. Recognising the importance of
reciprocity
• ‘The world of helping others in need
is now built around one-way
transactions…. and with the best of
intentions, one-way transactions
often send two messages
unintentionally. They say: “We have
something you need – but you have
nothing we need or want or value.”
And they also say: “The way to get
more help is by coming back with
more problems.”’ (Cahn, 2002)
• Mental well-being: ‘Over-
benefitted’ and ‘under-benefitted’
relationships (Fyrand 2010)

8. But there is a problem in ‘care’ services
• ‘3.1 Becoming the friend of
a person who uses our
services is an inappropriate
relationship that focuses on
the needs of both people. A
professional relationship
should focus solely on the
needs of the person who
uses our service. Becoming
a friend of that person is
inappropriate’, Professional
Boundaries Policy, Gwalia
Care
‘Simple but not simplistic – developing
evidence enriched practice’ project

9. What does good care looks like?
‘A man or woman could be
given the most accurate
diagnosis, subjected to the
most thorough assessment,
provided with a highly
detailed care plan and given
a place in the most pleasant
surroundings – without any
meeting of the I-Thou kind
ever having taken place’
(Kitwood 2007)

10. What does good care looks like?
‘The most important finding
was that it is possible to
provide residents with
reasons to live, period. Even
residents with dementia so
severe that they had lost the
ability to grasp much of
what was going on could
experience a life with
greater meaning and
pleasure and satisfaction’
(Atul Gawande)

11. Beautiful moments

12. Beautiful moments

13. Beautiful moments
“We used a company called Living
Eggs to have chickens hatch at the
care home. The company provide
an incubator with eggs. Whoever
sees the egg hatch, gets to name
the chick. The handyman built a
chicken run for the chicks once
they were hatched. Staff brought
their children and residents’
grandchildren came to see the
chicks”

14. Beautiful Moments
“I had grown up in
Royston and took a
resident who also grew
up in Royston on a walk
around the area to
reminisce and talk about
the changes that had
taken place in the area
and what used to be
there before”

15. How Beautiful Moments Feel for Staff
It doesn’t feel like
working…it’s
relaxed…everyone
kens you
It’s like an extended
family…you really become
friends with the residents and
their families too
I learn something
new every single day
You pick up interesting
pieces of wisdom, little
nuggets of wisdom. They
have some amazing stories
you know.

16. In spite of, not because of
Personalisation

17. Tension What Staff Say
Building meaningful connections vs
restrictive professional Boundaries
“We get a row for getting too close”
“It could look like favouritism”
A way of being vs a task focus “We have to get the practical stuff done first”
“As domestics, we can get told to get back to work
when talking to residents”
Empowering staff vs a rules focus “It’s about a mindset – coming up with your own ideas
and encouraging residents to too”
“We sense things and use our own judgements about
how a resident is that day because we know them. But
we can’t always act on this”
Normalising experience vs rigid risk
management
“It’s hard to be personalised when there is so much red
tape”
“I wanted to take a resident to the local hairdressers but
it wasn’t permitted”
Caring as human vs bureaucratising
care
“If its not in the care plan, you can’t do it”
“everything has to have an action plan and an
outcome”

18. Where do we go from here?
• Celebrate “ordinary heroes”
(Barry Schwartz)
• Be mindful of tensions and
contradictions….and have
good conversations about
them!
• Redefine approach to
professional boundaries -
towards sharing lives
• Take positive and rights
based approaches to risk
management
• Focus on things that really
matter, which can often be
‘little things’

19. References
• Bowes, S. and Gintis, H. (2013) A Co-operative Species:
Human reciprocity and its evolution, Woodstock,
Princeton University Press
• Cahn, E. (2004) No More Throw Away People (2nd
Edition), Washington, Essential Books
• Campbell, J. and Oliver, M. (1996) Disability Politics:
Understanding our past, changing our future, London,
Routedge
• Fyrand, L. (2010) ‘Reciprocity: A predictor of mental
health and continuity in elderly people’s relationships?’
Current Gerontology and Geriatric Research, 1-14
• Gwande, A (2014) Being Mortal, London, Profile Books