Caroline started her PhD at King’s in January 2016 with Dr Shereen Hussein supervising her work. Her second supervisor is Dr Annette Rid in the Department of Social Science, Health and Medicine. Caroline holds a Law degree from the University of Edinburgh and a Master of Science in Human Rights from the London School of Economics and Political Science. She is particularly interested in the rights of the elderly, especially within care settings. Her PhD thesis will be focusing on the role of human rights in framing standards of care in a comparative perspective between England and Germany. Before commencing her studies at King’s, Caroline undertook a qualitative study at the Catholic University of Applied Sciences, exploring the knowledge and understanding of caregivers in German care homes. She taught a course module to students of nursing on human rights in care standards and on social work with the elderly.
Hello, I am Nigel Warburton and joining me today is Caroline Green, a PhD student at the Department of Social Health and Global Medicine at King’s College London. The topic we are going to focus on is human rights and care homes. We are focusing on care homes for the elderly. How does the issue of human rights come in there at all?
That is a really good question. I think it is one that first of all relates to the dignity of people living in care homes and it is a big issue which has been out there, we have been talking about in society. It’s an important one for all of us and we can see it in the media, we can see it in politics, we can see it in public authorities working on this issue in policy papers. So it is all around us and it is an important one for the ageing society that we live in.
And your discipline, your intellectual discipline is discourse analysis. So you are particularly interested in the way people talk about these sorts of issues.
Yes, I would say so. Well discourse analysis to me is, well I am going to be looking at how we use language but particularly also what meaning we ascribe to human rights and to dignity in care homes. And, because I believe the way we talk about it, the way we write it down, the way we see it in policy papers influences the way in the end we will work. So, I want to actually see how human rights are being conceptualized and have been helping people to work in care homes on human rights and how it could also maybe be used differently, the concept of human rights.
In one sense human rights are just legal rights that we have that are given by international law. Is that the sense you are interested in?
Well, I am interested more in human rights not in the legalistic sense but actually in the normative sense, in the ethical sense namely that we have human rights not because law gives them to us but because we are human beings. And, I am coming from a social justice perspective where human rights are seen as instruments in certain social justice theories that I am going to be looking at in my PhD as the analytical framework for in the end using my data and analysing my data.
And you are contrasting two different countries here, the UK and Germany.
Exactly. Because human rights is also in the way we talk about it and use it I believe is also very specific tot he context you are working with. So the context I mean the law, the culture, you know also the history of the places and it is different in Germany and in England. In England you have got the Human Rights Act, for example in Germany you dont, you have the Human Rights within the constitution and that already has really big influence on how people talk and use human rights, how it is perceived. But the issue of care homes and human rights is just as important in both settings. I want to use those two settings and compare them to see whether they can learn from each other or whether they can work together with each other. So I am interested in looking at that.
I think the term human rights for me would be most likely to turn up in the context when something terrible has happened. You know, a violation of human rights, people would say.
Exactly, yes, and this is actually exactly why I became so interested in it. Because I did a Masters of Human Rights at the LSE before I came to King’s and what I saw living in Germany, you know I would look into the newspapers and every other week you would see the headline another human rights violation in a care home. And I’d find that really interesting and I was like ‚Oh OK, so because what is really happening here is that the careworkers, who you know working in care homes may feel like they are perpetrators of human rights violations but I also felt like well that is an interesting idea; Human Rights first of all of residents of care homes is a really important issue, on the other hand how can care workers actually be empowered to work with human rights so that they can actually provide human rights oriented and human rights based care? So that they, you know, can answer to when people say you have been a violator of human rights.
And how would someone make the connection between human rights and day to day practice within a care home?
I think people nowadays have to because it is out there in the media so much that people are starting to think about it more but of course I think that within the care, in the curricula of nursing students, in Germany it would be nursing students, here in England it would be social care workers. But there you would already be learning about dignity, about person centred care, which in the end is also a human rights issue. So I think that in the end there are being exposed to human rights in different ways and would now be good is to see and actually bring everything together, the curricula together, the policy papers together, the media reports together, so that people actually know what we are talking about,
So is what you are saying that there is a certain vagueness what we mean with human rights in this context? It is obviously important, we understand there is a need for dignity of anybody who is in a care home and that there is a legal obligation, there is a moral obligation as well but people get confused when they talk about human rights?
I think so. I think there are some issues that for example abuse, there you are able to say, OK a person has a right not to be treated in an undignified manner and abuse would definitely fall underneath that. But then there are other rights, for example, the right to privacy or the right to family life, what does that mean within a setting of a care home? How do people, you know, what framework conditions do their need to be, does a person have to live in their own room, or is it OK that they share a room, how do care workers have to treat people so that they do not violate the right to privacy. And some, you know, may be quite clear and other issues are not, so I think it is actually important to put flesh to the bone.
And presumably distinguish what is required by law and what is good for how you treat another human being because you could within the framework of the law still presumably not violate someone’s human rights legally but still treat them quite badly.
Exactly, yes, I think that is also a gap I want to adress within my PhD research and this is why I am also doing the discourse analysis and I will be including, I mean discourse is a very broad concept with different definitions, but the one I will be using will definetely also include how the law works around this issue and then try to see the normative statements we are making outside the law, what should be but maybe the law doesnt say there has to be. So there may well be a gap here, but I dont know yet because I have not researched it yet.
I suppose what is underlying all of this is a question of social justice, how you treat people, within our society. People who might be vulnerable.
Exactly. And who we are talking about here are older people. Older people living in care homes. Now in England the people living in care homes – older people – are the average is 85 years plus. An often they have multiborbidity, so that means they cant look after themselves anymore. Many of them are dementia sufferers. So they are vulnerable people, a lot of them. And this issue of human rights and older people in care homes is really about social justice for these people and how do we perceive them in our society, what lives do we want them to have and what lifes do we want to lead when we are older. So this is really the issue what this is for me about is social justice for older people living in care homes. And here I would like to add that I am concentrating on care homes but most care is actually provided residentially in their own homes. So this is just as an important an issue and human rights talking in relation to care at home is a very different issue again and it is just as important but it is an issue that I cant look at at the moment because that would just be too much.
Do you have a specific set of human rights that you are focusing on in your research?
Well I will have one case study on the right to physical freedom and the issue of restraint because this is an issue that is well spoken about, there is a lot of policy papers, both in England and in Germany. So this is one that I will be looking at but otherwise I will be generally considering how is human rights discourse being used in order to shape the idea of dignified care and what we want for older people in care homes.
It is very difficult because presumably there is a lot of paternalism that goes on for the sake of the individual. They have to be restrained because otherwise they would damage themselves or other people and there must be lots of grey areas whether somebody is actually competent to take care of their environment and negotiate it undaided or need to be kept in a room, kept in a chair until someone is available to help them.
The big issue with freedom and restraint is the issue of duty of care, that care workers still do have the duty of care. So they may well be legally liable if a person falls and they could have done something to prevent that fall. On the other hand if someone says, I dont want to sit in this chair and I want to freely roam around and walk around then they should have a right to do so. So how do you actually balance this out? How do you balance out the duty of care on one hand and the right not to be physically restrained on the other. And this is actually a really big issue for care workers. I have been doing some interviews previously in Germany and they have said just balancing this out and knowing what is right is really difficult for them and this is where we need more clarity.
I could imagine in many situations in a care home, this kind of ease of your work, it is simpler to keep people in a room, to keep them at the table while they are finishing their meal or whatever, not to give them that kind of freedom. It may actually be difficult operationally if you are running a care home to give people the kind of autonomy you might expect to somebody who isnt in a care home.
That is a really important issue you are touching on here, are the framework conditions. This is what I mean by framework conditions: If you have a care home, which is quite usual in Germany for example, of a 120 people. Many of them have dementia. Dementia is something for a 24-hour job because people with dementia often also wake up at night, they will walk around at night. If you then only have 2 or 3 care workers, and sometimes you even only have 1 care worker looking after different people at the same time, this is making it really difficult for them. And then again, they have the duty of care. So how do you make sure that one person doesnt get lost, another person falls and then on the other hand you dont restrict their freedom. So it is a really difficult issue. But, there are people who are coming up with solutions, so there are many different ways of dealing with this now and products on the market to be making people safer so that they can still do what they want to do.
When you talk about technology, what strikes me is that surveillance technology has reached a stage where relatives of people in care homes can plant cameras and observe how relatives are treated and there have been cases where people have been able to provide evidence that their human rights have been violated.
Yeah, I actually think this may be an effect of the human rights discourse that we have been seeing. People are also more worried about issues and probably of course rightly so. Of course everyone is worried about their relative, you know everyone wants their relative to be safe and happy wherever their are living. But I wonder whether that really is the best way for dealing with the issue and I think that the issue of human rights violations gives such negative connotation to the word. But I truly believe it can be a positive instrument you know you can use it to come up with a human rights oriented framework and approach for care which can be positive rather than a strain on care workers.
So you are just beginning your research in this area. What would be your ideal outcome? Your ideal scenario at the end?
For me this is really an issue of social justice. Because old age and care in the end touches us all. We are becoming older, we may have relatives who are in care homes or not who need care. So I am really passionate about this issue and I want to make a contribution to how we perceive older people, what we want them to have at that stage of their lifes and also what I want old age to be perceived for myself.
Caroline Green, thank you very much.