This assignment is intended to discuss a case assigned to myself whilst on placement and use an analytic stance to discuss the interaction and interventions used with the service user. Within this case study I will aim to describe and analyse the practice, theories and values that have emerged by carrying out this piece of work and highlight the learning experience gained whilst interacting and assisting the service user to remain in the community with support. In order to maintain confidentiality and anonymity of the service user and her family, all names have been changed. For the case study the Pseudonym Mr J will be used.
Description of work undertaken.
The work undertaken in this case study began with a contact from GP respite care for a male called Mr J. Mr J is 82 years old and lives alone without any support. He was placed in GP respite care for two weeks due to feeling generally unwell and unable to look after himself. GP respite is used by a local general practitioner to prevent admission into hospital and is funded by the local authority. Mr J has diabetes, which is controlled by medication, however Mr J regularly forgets his medication. He has partial hearing and uses hearing aids for both ears; he also uses two sticks to assist with his mobility. During the assessment he appeared confused and distressed while his relatives were there. However a meeting held with Mr J without his relatives had a more positive outcome.
Mr J has had previous input with social services. His case notes state that he cancelled all support after six weeks. The initial six weeks support through the DMBC is not charged for. However after six weeks the care provided is mean tested.
Mr J was due to leave GP respite within the next few days. His need for support would be prioritised as critical. However, this presented a problem, as the resources needed were not available. Mr J refused to stay in GP respite any longer and stated that he wished to return home. The assessment of needs was completed and plans to complete a safe discharge home as soon as possible meant finding appropriate care and support.
An assessment of needs (NHS, Community Care Act 1990, Section 47) was completed with Mr J's sister and her husband. Mr J's relatives did not believe that Mr J would cope at home on his own as they felt he was at risk. They confirmed that he had already set fire to the kitchen and often forgot he had left the gas cooker on. Most of the relative's discussion appeared to be aimed at Mr J's mental capacity, as he appeared to be a very confused man. His wife passed away over 15 years ago and he admitted he wasn't sure where she was but thought she passed away about 6 weeks ago. The family confirmed the date she actually died was over 15 years ago. Despite his confusion Mr J had not been diagnosed with dementia. He firmly believed he could cook his own meals and complete his own personal care and wished to go home. He did however agree to receive support for a short time to monitor him and assist if necessary. He also agreed to attend he local day care centre one day a week.
The main aim of intervention in this case was to provide a network of support for Mr J to ensure a safe discharge home. The objective was to offer support, which could promote independence and monitor Mr Js ability to care for himself in the community. It was therefore agreed with Mr J to allow carers to monitor his progression at home and assist where necessary although it was accepted that most of his care would be to prompt his medication and monitor his abilities. It was also agreed to review Mr Js care and removed the care if it was not required. Day care facilities were also planned which would start after he had settled in at home.
Aims of the intervention
The first aim in this intervention was to complete an assessment of needs and establish a positive working relationship with the service user. Secondly the aim would to provide a network of support which would be in Mr J's best interests as it would develop a care plan with Mr J and his family, which would assist in supporting his choice of care, and provision of support networks as agreed. The last aim in this intervention was to prevent isolation and alleviate stress factors to maintain positive outcomes. To accomplish these aims would require positive communication and person centred planning, which could establish and build up a good working relationship between worker and service user.
The legal and policy context
> Data Protection Act 1998
> NHS Community Care Act 1990
> Department of Health (2003) Fair Access to Care (FACS)
> Chronically Sick and Disabled Persons Act 1970
> General Social Care Council 2002 (GSCC)
When an assessment is requested and accepted by the service user, the mandate for consent is given which allows the social worker to access the service user's files and case records. Under the Data Protection Act 1998 personal data can not be shared without the consent of the service user. This consent is usually in writing to enable a care package to begin.
The NHS Community Care Act 1990 states that it is a duty for social services to undertake an assessment of needs under s47. It is also a duty to offer direct payments and a carer's assessment. The Carers (Equal Opportunities) Act 2004 legislation provides the carer with the right to an assessment in their own right. However, Mr Js relatives declined the carer's assessment in preference for a joint assessment
Under The Chronically Sick and Disabled Persons Act 1970, (s1), it is the social workers duty to identify local needs and provide specific information to meet those identified needs. It was identified that Mr J was isolated from society. He was therefore offered day care facilities to provide a network of support, which could assist to prevent isolation and assist Mr J to socialise in the community.
The department of health (2003) Fair access to services (FACS) looks at the service user's criteria and prioritises needs. Mr J's needs were classed as critical due to being discharged from GP respite care. The care package provided on discharged from GP respite care is not charged for the first six weeks, however this care is means tested. The welfare benefits officer would visit Mr J to assess whether he would need to contribute to his care package. However at this time Mr J's health and well being could be at risk without this intervention and the discharge would be unsafe.
Social workers are accountable for their actions and answer to the GSCC. The social worker works within The GSCC code of practice, which is seen as the cornerstone in social work. This code of practice sustains and regulates the social worker and promotes good practice.
Risk Assessment and management
Mr J accepted the assessment but was adamant that he could look after himself and said he was reluctant to have support. Input from his relatives indicated that Mr J had issues with his ability to remember simple every day situations. On several occasions relatives have called to visit Mr J and discovered he has set fire to the kitchen and has frequently left the gas turned on the cooker on. These actions would present Mr J as being high risk to himself; however it was agreed that the risk would be minimised if his meals were provided or supervised. The care package would provide a carer four times a day to monitor and prompt his medication.
It was also agreed to meet the relatives at Mr J's home, they said it would "show the mess he lives in". After meeting them at Mr J's home, It became apparent that he had kept his home tidy. Mr Js home was cold but clean. My only concern was the stairs to the upstairs rooms were very steep. Considering Mr J had been in respite for two weeks and no one lived there for this time it was not surprising it was cold. The GP and Mr J's relatives agreed that could go home as he wished. Mr J was informed of the risks involved in going home; moreover the risks involved were iterated to ensure he understood. People are allowed to take a well-informed risk so long as they do not endanger themselves or others GSCC (2002).
Service user's perspective
The service user believed he was able to look after himself. He knew his wife had passed away but didn't appear to understand why or when this happened. During conversations with the service user it was apparent that he had lucid times where he was able to converse. It was however unclear whether the medication he had been given had created his inability to remember his wife's death. He did however find another companion during his stay at the GP respite and acknowledged that although this person was very similar in features to his wife he was aware she was not his wife.
Social Work Values and Anti oppressive practice
The GSCC code of practice is the corner stone of social work values. Social workers are bound by this code of practice and action can be taken if they fail to do so. The General Social Care Council code of practice forms a part of the legislation, employer's policies and practice standards that social workers must meet.
Mr J wished to go home, however his relatives believed he would be at risk without support. Moreover Mr J has the right to go home if he and can decline services. Social workers have to respect the rights of the service user and promote their independence. Mr J was not a risk to others although he was thought to be a risk to himself by his relatives. His relatives have a preconceived idea of how Mr J should live. The information provided from his relatives was taken into consideration when informing Mr J of the risks. When he was asked if he would accept a care package he accepted and agreed to permit carers, occupational therapist and a GP to attend.
Theory and knowledge /research underpinning practice
The person centred approach (Karl Rogers 1961) was used to maintain a positive relationship with Mr J. The person centred approach provided insight into Mr J's lifestyle this insight was only gained through listening to his views. Treating Mr J with empathy, genuineness and positive regard had a positive effect, which was not judgemental allowed a professional relationship to develop where he felt able to talk openly. The assessment of Mr J's needs was enhanced through the use of the questioning model and the exchange model which according to Coulshed and Orme (2006 : 30) can assist in identifying support networks which could enhance the life of the service user.
Coulshed.,Orme (2006) however believe that there may be an unequal balance of power between social worker and service user. The task centred approach provides a power exchange, which creates a partnership when common goals are set. The eclectic use of theories and approaches assist to provide the social worker with the skills and knowledge to provide assistance for people who are marginalised by issues beyond their control.
Task centred practice according to Stephney and Ford, (2000) is a model used in social work in which a contract is drawn up between the service user and the social worker where they both have agreed tasks to perform. These tasks may be as simple as the social worker agreeing to locate services and the service user's agreement to look at the potential in the services offered. Effectiveness of your intervention
Coulshed and Orme (2006 : 29) conclude that the skill of assessment is in the ability to collect enough of the right type of information. The Information collected during an assessment has to be recorded to remain visible, moreover, this information has to be based on facts and not the thoughts of significant others. The facts were that Mr J's home was kept clean and he had insisted that he could cook and take care of his own personal care. The GP respite provision were happy with his situation and confirmed he was fit for discharge. He was also aware that his relatives did not believe he was able to cope. Mr J appeared to be compliant, moreover he was accepting support therefore it was agreed that he would go home with a care package in place which would monitor his capabilities and report any issues presented. Monitoring and reviewing the situation would confirm whether Mr J was able to cope at home with appropriate support.
Mr J went home safely with a care package, which would assist in providing personal care and prompt him to take his medication. However he did not remember to allow the carers into his home on the first morning. The care plan was reviewed and reduced as agreed with Mr J and his relatives. A referral was made to the Mr J's GP to request an assessment on whether Mr J needed intervention through the medical model on his mental capacity. This would require an assessment by a doctor to see whether Mr J has any medical conditions, which may be contributing to his disorientation and confusion.
Anti - discriminatory practice is supported by the legal framework, informing the service user of their rights to autonomy is seen as an anti oppressive, anti discriminative process which assists in the production of care plans which incorporates the service user's needs.
Critical Reflection on your learning
This case study has given me a more positive insight into my values as a social worker and the effect this can have on others. Informing service users of their rights so they have more control over their own lives is essential. Mr J could do most of what he stated. Had I listened to the relatives my fears for Mr J may have become an obstacle in him returning home. I was asked to invite his relatives to the assessment, which I did but my instinct was that they monopolised the process. I therefore completed my assessment the following day. These discussions with Mr J were more relaxed and forthcoming. Mr J asked me to believe him when he says he can cook his breakfast and look after himself. Although Mr J had the benefit of the doubt he was also happy to be monitored to prove he could provide for himself. On reflection I believe Mr J may well be in need of care in the future, however his independence should be promoted not removed. I was happy to promote his independence; however this was subject to his ability and his mental capacity. During my assessment, the aim was to look at the service user's best interests this would take the service users needs and the needs of his relatives into perspective to assist in the development of a tailor made care.
The GP respite provided were unaware that he required hearing aids to assist with hearing. His relatives held a negative view on Mr J's abilities and the case notes held by the local authority mentioned he was not taking his medication as prescribed. However support which would monitor him at home with specialised carer's to assist with his needs would provide a positive outcome by maintaining his independence where possible, however the input from others was taken into consideration during the planning of his care package. There are many reasons for unusual behaviours in people. However the medical model is not within the social workers scope. Therefore a referral to the GP was completed to ensure Mr J's medication was not to blame for his situation.