Hookers, Strippers and Care Homes

Sex, who needs it?

This week it appears that it's residents in a care home in Eastbourne. A News Report in the Metro, claims that a manager in a care home in Eastbourne has been providing the residents with Strippers and Prostitutes and that this practice is still going on.

Now, I'm not sure what's most shocking about this whole event.  Is it, that people in care are like everyone else in their need for sex?  Is it that a care home manager is enabling people in their care to do something about it?  Is it that the media has picked up on the word "primeval" to identify our need for sex?  Is it that old people and disabled people are having sex?  Nope, for me, the shocking thing was that this was happening in Eastbourne!  I was always under the impression the youngest person in Eastbourne was about 85 and therefore I'm wondering how many strip clubs they have?

Is it exploitation of the women?

Well that depends on your point of view and also to some extent who the women are.  If the prostitutes are standing on street corners attempting to get a quick fix and are having to deal with pimps, disease and homelessness then yes.  However, as they are "phoning" for them, we will have to assume that they are not milling around on street corners.  How much are they paying them and how does it work?  Are these women actually expected to have sex, or when they get there can they say no? The question I'd also have to ask is that are people shocked because prostitution exists or that these particular prostitutes are doing what other people won't and having sex with people who are disabled and/or elderly?

Strippers btw rarely stand around on street corners due to lack of music to dance to, also I'm not sure who calls them strippers these days?

What exactly are they investigating and why?

This will be fascinating I feel.  Are East Sussex County Council investigating because they are "supposed to" or because they should?  Are they investigating an illegal act? or an immoral one?  If it is illegal, then I'm assuming the police will be involved, if it's a moral issue, then I'm assuming the investigating panel will all be quizzed about their sexual practices to ensure they stand on the moral high ground? 

Morality be damned

Let's be honest, if you've ever engaged in attending a lap dancing bar, watching porn, having sex in a public place where you might be seen (a criminal offence) hiring a prostitute (and clearly some people do otherwise no one would do it) or engaging in sex which is deemed to be immoral by the general population (swinging, having an affair, group sex etc) then I suspect you're going to struggle to maintain any credibility in giving a negative moral judgement in this particular case.  If you do, then I'd suggest it's not your morality that's offended, it's the fact that the clients are disabled.

My final question

If this was a hotel with businessmen in it or a residential establishment where people could phone and pay for the prostitutes for themselves then would anyone care, would their be an investigation and would the Metro have published an article about it?

My Final Thoughts

1. People have sex (otherwise there would be fewer of us).  
2. People have weird sexual practices compared to our own (which by the way are the only normal ones as far as we're concerned).  
3. People want sex, some more than others.  

Often people who are in care, disabled or otherwise don't have any way of dealing with these three items above and until we can find a way of doing that, then people need to dismount from their moral high horses, suck it up (so to speak) and move on.

Of course, if it turns out that this story doesn't give us the whole truth currently I am willing to revise my opinions!

Ego, Emotions and Creating Change

The Phone Call

As a manager, you get a call from work saying - there's been a problem. 

Your heart sinks, you wonder why you agreed to have a work BlackBerry (probably because you thought it made you look cool to your kids), you think about how to avoid going in immediately or trully wished you were far enough away they had to call your deputy or better still your boss, why tonight, we've got an inspection/family visit/other inconvenient agenda item on Friday.
After this first 20 seconds of thinking, you now start planning. 

1. What do I need to know?
2. Who do I need to tell?
3. What do I need to do?

 At this stage, I should imagine, you're probably also thinking - who's responsible or who might be responsible, or is anyone responsible.  Sadly from a legal point of view the answer to all of these questions is probably, "you".

What we all think we know - perceived knowledge

When we encounter a problem which is work based, or an incident takes place within a professional environment, we'd all like to think that we would respond in a professional manner and be; concrete, creative and rational in our development thinking.
In our minds this rational process would potentially involve

• Identifying what happened
• Identifying all the elements of causation
• Identify systems and process for avoiding the incident in the future
• Putting into place any plans or strategies we have for making sure it doesn't happen again
• Acting on those strategies

The team would be ideally be

• Multidisciplinary, bringing in experts depending on need
• Chaired appropriately
• Have clear objectives
• Make contemporaneous notes
• Reviewed at a later date

Clearly there would be other issues addressed depending on type of incident, type of service and organisational policy.

What often happens (from an experiential point of view)

I am now going to speak of my experiences of  working with dozens of organisations nationally.
As a consultant I often get asked to take part in problem solving sessions with regard to managing people's behaviours.  What I have found through experience is that any significant process of change, will not take place until emotions and egos are taken into account.  If there is no accounting for egos and emotions, then people will generally resent anything they're told to do.

Emotions and Ego

I am not using this phrase in a derogatory way.  We all have an Ego and we all have Emotions.  For example, if you've been brilliant at your job, or even just merely good for the past 5 years and one day it all goes horribly wrong, then naturally, you are going to feel emotionally vulnerable.  Your ego will be dented and you will wonder what's gone wrong in your world (we call this the Why Me? scenario). 
Human nature being what it is, means that we will start with blaming all other factors apart from ourselves.  Our ego, doesn't allow for us to admit that actually, this might have been my fault.  We might find ourselves saying things like

• There's not enough staff, 
• I told the manager about this ages ago
• It just happened out of the blue
• "They" did something wrong
• I did everything I could to stop it

In this initial stage, it's quite common for the person not to have any insight into their role in the process - they are the "innocent" victim, just doing their job and it all went wrong.  At this point, putting together a team meeting to decide how to fix things will be of little value for two main reasons.

1. If you really were the reason for the problem occurring and someone brings that up in the meeting, you are not ready to hear this information so will become defensive and in my experience often hostile to the process - any meeting will now be counterproductive.
2. If you are the key person in the meeting driving it forward, then you will be potentially be looking in the wrong direction, and therefore the process will fail.

Some Examples from our work

These are examples of discussions we have been involved in over the last 19 years of running Timian Training.  Remember we work in the field of challenging behaviour, so some of these incidents may seem to be outside your experience.  However, take away the terminology and I'm sure you'll recognise the events in your own workplace.

• Every time I  sit in the chair in the dining room - the service user sneaks up behind me and pulls my hair.  This happens every day.  This has lead to me losing hair, hurting my back and most recently being hospitalised for a week and off work for three months due to whiplash type injuries.
• Now, it doesn't take a  trained observer to notice that the member of staff has this happen every time they sit in a chair in the dining room.  Most of us would immediately say, don't sit there.  
• However, the problem we have is, that this person has been injured a number of times, once seriously and pointing this out before they are ready, will lead to a long and defensive discussion about why they "have to sit there" and "there's no where else to sit" because they are supporting someone else and it isn't fair to that person that I can't sit down with them at dinner.  Besides there's no room to sit on the other side etc etc. (this is an almost verbatim discussion btw).

• This is from an A&E department.  A staff nurse on turning up to our training on conflict management, had, what could clearly be seen as a  broken nose and bruising around the eyes.  Without asking, she promptly told us this training we were giving would be a waste of time, because when she had her nose broken, it happened "totally out of the blue!"  On further discussion, it turns out that it hadn't quite happened that way.  
• There was a person in the waiting room who was drunk and noisy.  When the staff nurse went over to "talk to him" he punched her out of the blue.  We asked her what she said and how she did it.  
• In demonstrating on me, she leaned forward, stuck her finger in my face and said "sit down right now, your annoying everyone and making yourself look stupid".  
• When she said this, I asked her, if there was anything she could have done that might have caused this person to then punch her.  She said no, and "besides I can't abide drunks!".  What was interesting, was the rest of the groups look of disbelief and one of the other senior nurses, said, "well, perhaps you're working in the wrong place then".
• At this point, it wasn't appropriate to address what she had done wrong as that wouldn't have progressed us any further along the line of solving the problem.  In the end, it turned out that she'd had a physically abusive father who would hit out when drunk.  It pushed all of her buttons and made her both scared and angry at the same time.  

 I could go on about hundreds of other discussion we've had with staff over the years, but the gist is pretty much the same.

So, what does happen then?

What normally happens in these cases, is a manager comes in, tells you what you did wrong (from their point of view in a totally supportive and non-judgemental way).  They then tell you what not to do next time, make a brief note and then expect you to;

• Absorb the information
• Act upon it 
• Feel relieved and grateful for their help.

What you believe happens. They tell you what to do in a patronising way (from your perspective), makes some unhelpful and unrealistic suggestions while quite clearly demonstrating how busy they are by mentioning the reason they're late/have to leave/haven't got long, is all the very important meetings they have to go to.
Your emotional response will then contain the following:

• Typical manager, no idea how difficult my job really is
• Covering their own arse again I see
• None of the stuff they told me to do is going to work, because I haven't got time
• They don't actually care and didn't really listen.

Barriers to personal and organisational development

If the incident or problem has significant consequences - injury, staff being dismissed/disciplined, an investigation or a formal complaint, then there are emotional repercussions.  Sometimes with situations such as these our organisational empathy disappears while we desperately seek the "truth".  This lack of empathy, often means the truth becomes elusive and any findings are counterproductive.

Telling someone what they are doing wrong, almost invariably leads to "close down" of the person where they try to justify their behaviour and you come up against a brick wall opposed to change.

In social care we talk about communication a lot!  In fact, I suspect we spend so much time talking about it, because it means we then don't have to actually do it. That means that when staff tell management about the problems they encounter, they are normally listening, but with an ear out for when is it appropriate to step in and tell them why they've got a problem.  Or, when they're listening, it's clear they are just waiting for their turn to speak.  This isn't listening.  When we listen in these situations, it's important to try to discover what exactly it's like for that member of staff to have to do their job, with their resources and time scale.  Listen in this context.  Rather than tell them what to do, get them to tell you what the best ways of managing further incidents are.  What you might sometimes find, is they have a better plan.

Having said that, sometimes the main barrier is knowledge.  I've sat in on meetings where people use terminology so randomnly out of context, everyone nods and moves on.  When questioned, we realise that all of them are talking about different things!  For example, recently having a discussion about an incident where it becomes clear that the definitions the manager, myself and the member of staff using to discuss restraint (restrictive physical interventions) are all totally different.  This means that fundamentally, one person thought they were doing the correct thing, while another thought it was inappropriate and another didn't see that it was restraint at all and therefore didn't need to be dealt with.

The only real way to overcome these barriers is to create an environment where staff can identify their own mistakes.  This requires a careful balancing act of allowing staff to make mistakes, ensuring managers deal with emotions before they deal with process of change and most of all making sure that the people you are supporting are not left in any danger (physical or emotional).

We generally suggest having an open forum, where people can say how they feel, it's not a right or wrong forum, it's a place to blow off steam.  Once steam has been released, then we are more likely to be able to move forward in a productive way.  This forum shouldn't take hours and is not a process of complaining, it's about how we feel.

So in summary

1. Listen to what people are having to do and deal with
2. Think about what it's like from the staff member's point of view
3. Think about what exactly you're trying to acheive, there is no such thing as an error free environment, accept people make mistakes
4. Make absolutely sure you're all using the same terminology, meaning the same things
5. Let the emotions burn off, address the Ego
6. Pick your time
7. Allow staff to create their own solutions

These are just some of our reflections

Final Point!

What I have always found interesting about this subject, is that, I would suspect that the majority of those reading will identify the egos and emotions in their work colleagues but not always in themselves.  We see ourselves as the rational person in a sea of irrationality.  How can this possibly be true?
If this Blog has made you annoyed because you think that it's patronising, then perhaps I too have not allowed you to offload your emotions?

We all make mistakes at work, 

if we don't, 

we're probably not trying to acheive anything.