Dementia and Guardianship: Challenges in Social Work Practice

Decision-making within the context of dementia can be an uncertain and problematic process. This study critically examined challenges in social work practice in instances where a legal alternative decision-maker through guardianship proceedings was perceived as necessary. Theoretical perspectives from social constructionism underpinned the research. Five qualitative case studies were investigated. A thematic network analysis showed that the situations were constantly evolving and different players participated by bringing their own perspectives. In this process alliances were formed that reflected underlying dynamics of power. Contested issues included varied understandings of dementia and capacity, and differing constructions of risk, protection, and responsibility. The implications for practice are discussed with social work being 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. Ethical reasoning as a basis for decision-making was also of significance.