Assessment and care planning
It has been decided that you will proceed with an assessment of Richard and Betsy’s needs for community care services, and that you will also consider their needs as carers for each other. You may assume that Richard and Betsy have given permission, albeit reluctantly, for you to talk to whoever you need to. You must decide whether their needs call for the provision of services under a care plan.
- You may consult any family member at this stage.
- You may consult four professionals at this point.
- You may consult four data sources now.
I do not know what my daughter has told you but we are fine. The warden comes to see us and helps us with whatever we need. You’d have to ask my wife if you want to know anything else.
I am finding it more difficult to manage every day, and we certainly cannot get out – I can hardly move most days. Richard used to be able to help me, but now it’s more a case of me looking after him. He may seem okay to you but he is less able to remember things now and I find it tiring to have to be reminding him. Is there anything you can do to help us? I suppose you will have to talk to other people who know us but we have always been private and independent people. When you talk to Evelyn, don’t worry her too much about us as she has enough worries of her own. I like the warden but she never seems able to stay for long. You can speak to the doctor if you wish.
I used to help my parents out a lot with shopping, cleaning and support but I am less able to do this now because of my ill-health. My parents have always been close but recently my mum has found it hard to cope with my dad as well as with her own ill-health.
Consult four professionals:
I have seen Richard more regularly recently and there has been a marked deterioration in his orientation and recall. This will need monitoring and I have referred him to the psycho-geriatrician for an opinion. Betsy is becoming increasingly worried about Richard but is reluctant to give details – she also worries about her daughter. Her own physical disability is gradually becoming more severe, mainly arthritis – nothing can be done about this. They appear to have a close relationship but the strain is beginning to tell.
Richard has just been referred to me by his doctor but I have not yet met them.
I visit daily. I am becoming concerned about Richard and the impact on Betsy of his increasing frailty. However, they are very independent and keep the conversation to surface topics.
Richard and Betsy have not been coming recently. There are always reasons but they used to come regularly. On their last visit, Betsy seemed quite anxious and frightened but she would not talk about it. Richard presents as if nothing is wrong but with experience you can see that he is increasingly disorientated.
We have been providing frozen meals for some time. Richard and Betsy are very private but now you mention it, recently the agency staff have reported seeing Betsy looking very anxious, even tearful, and perhaps frightened.
I have provided some aids and adaptations to assist Richard and Betsy move around their home and to manage tasks of daily living.
I am not sure I can help. We facilitated their move into sheltered housing several years ago. It sounds to me as if you should be considering residential care.I am not sure I can help. We facilitated their move into sheltered housing several years ago. It sounds to me as if you should be considering residential care.
Consult four data sources:
No information contained on the register.
Records that following a referral nine months ago Richard and Betsy were provided with meals delivered to their home. It was noted then that they were already attending a voluntary organization day facility for recreational and social events. Some occupational therapy aids have been provided.
You find a statistical report on mental health of older people, indicating that mental health problems are common but often overlooked. www.statistics.gov.uk
You have identified a memory clinic resource run locally to which you could refer Richard. You find a web link to a national organisation that provides research findings and information to support carers of people with dementia.
www.alzheimers.org.uk
www.disc.org.uk
www.carersuk.org
www.carers.org
You recall from your training how care-giving can impact on relationships within families and the importance of recognition and support. You find a web link to an organization that provides information, guidance about the law on carers’ assessments and research findings on what works well to support carers. www.carersuk.org/information/helpwithcaring/carerassessmentguide
You have identified a local Age Concern group. Age Concern England provides fact sheets, reports, and information on issues and campaigns. www.ageconcern.org.uk
You find a local group run and managed by older people, able to support others in finding their way through the maze of services.
These advise you of the discretionary duty to assess older people under section 47, NHS and Community Care Act 1990, and of the need to involve Approved Social Workers for mental health assessments. Under Fair Access to Care Services eligibility criteria are set to cover people with moderate needs and above. The procedures advise you not to refer to unmet need. Any care package costing over £100 a week will have to be submitted to panel for approval because of the authority’s resource shortages.
Think of any Acts of Parliament that you judge relevant at this stage of the case.
Think about which guidance documents would be relevant at this stage of the case.
At this stage of the case, with the information you have, the following 15 Acts are relevant. How many did you identify correctly?
- NHS and Community Care Act 1990 - section 47 discretionary duty to assess where there appears to be a need for community care services. Section 46(3) lists the services you can provide after an assessment.
- Disabled Persons Act 1986 - section 4 absolute duty to assess a disabled person. Section 8 requires you to assess the willingness and ability of any carer to care.
- Mental Health Act 1983 - section 13 gives assessment responsibilities. There are options for admission to hospital and to guardianship.
- Mental Capacity Act 2005 - may prove relevant if Richard lacks capacity, temporarily or permanently to look after his financial and personal affairs.
- National Assistance Act 1948 - section 29 definition of disability relevant to the decision about use of the 1986 Act. It also lists the range of services that can be provided, amplified in circular LAC(93)10. Section 21 enables the provision of residential care.
- Chronically Sick and Disabled persons Act 1970 - section 2 lists the services available for disabled people.
- NHS Act 1977 - section 21 and schedule 8 list the non-residential services available to respond to illness and mental disorder.
- Health Services and Public Health Act 1968 - section 45 provides for non-residential services for older people.
- Human Rights Act 1998 - contains the duty to positively promote people’s rights.
- Data Protection Act 1998 - governs what information can be shared between agencies in what circumstances.
- Carers (Recognition and Services) Act 1995 - assessment duty towards carers of any age providing regular and substantial amounts of care.
- Carers and Disabled Children Act 2000 - assessment duty towards carers over 16 whether or not the cared-for person is undergoing assessment.
- Carers (Equal Opportunities) Act 2004 - carers over 16 must be informed of their right to an assessment.
- Housing (Grants, Construction and Regeneration) Act 1996 - enables the provision of Disabled Facilities Grants.
- Disability Discrimination Act 2005 - a duty to counteract discrimination and promote equal opportunities.
The following 8 pieces of guidance are relevant at this stage of the case.
- Care Management and Assessment: Practitioners Guide, 1991
- Community Care in the Next Decade and Beyond: Policy Guidance, 1990
- Community Care Assessment Directions 2004
- Direct Payments Guidance: Community Care, Services for Carers and Children's Services (Direct Payments) Guidance 2003
- Fairer Charging Policies for Home Care and Other Non-residential Social Services, 2003
- Carers and Disabled Children Act 2000 and Carers (Equal Opportunities) Act 2004: Combined Policy Guidance, 2005
- Fair Access to Care Services 2002
- Guidance on the Single Assessment Process for Older People, 2002
Make your decision:
The correct decision is to provide services under a care plan. Services should include community care services for Betsy and Richard (which are defined in s.46 of the NHS and Community Care Act 1990). These can include personal care, household tasks and resources to promote social and recreational activities. The care plan should include attention to future needs also. The plan will also need to make suitable provision for both Richard and Betsy as carers for each other, with their respective needs taken into account when devising individual and joint care packages. To be lawful the care plan must have a reasonable chance of meeting the needs identified.
Application should be made for a disabled facilities grant to undertake any necessary adaptations to housing.