Dementia and guardianship: challenges in social work practice in a health care setting

Abstract

This thesis critically examines social work practice in complex and disputed situations where an alternative legal decision-maker is perceived as necessary for a person with dementia. Australia has unique adult guardianship legislation and social workers are actively engaged in the process in a variety of ways, such as weighing the benefits against the possible harm and lodging applications. Yet within the profession this is an area where there is very little research. The purpose of this study is therefore to enable social workers to better understand the dynamics involved in adult guardianship proceedings for a person with dementia and provide knowledge that can be used for more effective practice. The theoretical approach is to use perspectives from social constructionism, with the links which can be made to modernism and postmodernism being taken into account. Five research case studies were investigated drawing from the caseload of social workers in an aged care service at a large metropolitan hospital in Australia. A thematic network analysis of the findings showed that the research case studies are constantly evolving, where different players participate by bringing their own perspectives, and in this process alliances are formed which reflect underlying dynamics of power. There are many diverse and contested issues, such as varied understandings of dementia and capacity and differing constructions of the notions of risk, protection and responsibility. The implications for social work practice are that in a contemporary health and welfare context social work is well placed to make an important contribution through its traditional roles of negotiation, interpretation and mediation between those who have discursive rights and those who do not.