In-home care : tact and tactics

This article deals with home care for people suffering from mental disorders or cognitive impairments. When caregivers look after these patients, they have to reconcile different requirements, which can sometimes be in tension with each other: winning and retaining the confidence of patients who do not always easily accept help; facilitating their autonomy or limiting their loss of autonomy; protecting them, ensuring their safety while acting in their best interests. Combining these different goals, entails encouraging them in what they want to achieve whilst intervening when they endanger themselves. As a result caregivers need tact and diplomatic skills. But these are insufficient when it is necessary to protect the patient against their will. In particular when they are living in their own home they are far less constrained by social norms and so practical compromises become necessary. In discussing these practises, the article explores the notion of "ruse" which we consider as both a form of practical problem solving and as a deception. After introducing several forms of "trick" used in caring, the article considers whether such practices are compatible with care ethics.