ABSTRACT
This chapter explores concepts of vulnerability and marginality. It describes an alternative care paradigm that is driven by the needs of the individual service user, client, or resident by rejecting essentialised notions of vulnerability and marginality. If residents with dementia can be in charge of their own lives, then notions of vulnerability must be revisited. They will no longer be resigned to chairs in the day room, but supported to garden, be active, cook and clean, or to socialise as ways of challenging traditional notions of vulnerability. The chapter suggests that the reader needs first to critique traditional approaches to evaluation that are largely based on neoliberal values and exclusively positivist notions of evaluation that valorise particular kinds of knowledge. It proposes that human service funders and providers move beyond merely positivist notions of accountability and rebalance assessments of efficiency and efficacy, so that efficiency is seen in the context of the effectiveness of negotiated care.
