Good social work practices with disabled adults and elders who live at home: more than provisions’ delivery

Background and purpose In Italy, three main factors set the scene of social work practices with disabled people. (1) Population is aging even more than that in other European countries, with an increasing number of elderly people with high care needs. (2) Italian social policies for elderly and adult disabled people are community- care oriented, but, within this framework, two different directions are followed. At local level, social services units are engaged in planning and providing personal care. But they struggle because of welfare funding cuts, which particularly affect local authorities. At a state level, dependent persons are eligible for economic benefits, without restrictions on how they can use that money. (3) This, combined with wider international dynamics, encourages private recruitments of unqualified paid caregivers, usually from Eastern Countries. So, the problems that social workers are daily coping with are progressively changing, and so should the practices needed to address them. The study explored these changes. Our hypothesis was that, in addition to traditional social work practice for standard provisions delivery, social workers are making other important and delicate contributions to maintain and improve the life quality of disabled elderly people. The purpose of this research was to identify these changing practice areas. Method The research was carried out in a district of Northern Italy of 72.000 inhabitants. Semi-structured interviews were conducted with the five district social workers assigned to assist people with disability: each one was asked to describe some cases which s/he thought are examples of good practice. 32 case stories were collected, transcribed and processed through a thematic analysis. In a second step, 10 cases were chosen and 10 group interviews were conducted for each one of them, with the participation of the main people involved (for example: the service user, his/her caregiver, other family’s members, health and social care professionals). So, various points of view about each case were also collected and analyzed. Findings Results show that ‘good case’ does not mean ‘simple case’. Most people who asked for help from social workers had both physical and cognitive or psychiatric disorders. Many people were alone, or with their families and caregivers in severe life difficulties. According to these case stories, social workers navigate bureaucracy and act as case managers (albeit not formally recognized) to combine, in a difficult puzzle, public provisions, voluntary services and private resources of the disabled person. At the same time, they consider the needs of other family members, to preserve or to improve relationships that play an important role for people wellbeing. Interviewed social workers felt, and were viewed, like they are a key person for their clients, with a direct personal supporting role. This is in tune with an approach that goes beyond the applying of proceedings for standard provisions delivery. Such an approach considers relationships, collaboration, trust, respect of self- determination and promotion of interpersonal ties as pivotal elements for building an effective helping process.