"A strange, grey area": Care relationships between support staff and adults with a learning disability in long-term social care residential settings in England

Relationships are dynamic and situated at the core of human life. In England, a significant number of support staff (e.g., support workers) and adults with a learning disability provide and receive care in long-term social care residential settings such as care homes, supported living, or other residential arrangements. In these settings, support staff and residents encounter and build relationships with each other in the vastness of everyday life and care is surrounded by high staff turnover, lack of funding, considerable staff responsibilities, and a fragmented social care system. Unlike other relationships (e.g., therapy), research exploring learning disability care relationships seems to be a relatively neglected area. This has potential theoretical and care practice implications. This doctoral project aimed to explore care relationships between support staff and adults with a learning disability in long-term social care residential settings in England and further our understanding of what makes such relationships positive. To this end, I posed four research questions that explored conceptualisations of care relationships, relational processes and practices, barriers to and facilitators of positive care relationships, and the impact of relationships. Three studies were conducted as part of this research project. The first study, a systematic literature review that focused on the social care paradigm in the United Kingdom, provided valuable insights into learning disability care relationships and served as a compass for future empirical research. The second study built on the systematic literature review and employed a qualitative design to explore the views and experiences of support staff regarding care relationships. Valuable insights were offered framing the care relationship as a “a strange, grey area” and situating it in the wider material and ideological reality, whilst emphasising the range of relational skills, processes, and practices that support staff use and engage in, as well as the transformational impact of positive care relationships and the detrimental effects of lacking them. Finally, the third study built on the previous two studies and employed an ethnographic design seeking to examine care relationships not only through people’s verbal accounts but also in real-time, as they occur in the residential setting. Through the analysis, the care relationship was framed somewhat as an act of balance between conundrums and was located in the (care) home and its (care) home pragmatics. Moreover, the invisible process of staff and resident connection and the little everyday moments it entails became more concrete, and, once more, the powerful impact of care relationships on the lives of staff and residents was highlighted. Lastly, the research project draws overall conclusions about care relationships by assembling the three studies whilst exploring the threads that weave through this research as a whole, before discussing research impact and suggestions for future research, care practice, and policy.