Review and re-assessment

A care plan has been in place for some months. It is now time to review needs and the services currently provided to meet them. You will need to make a report with a recommendation for the future.

  • You may consult any family member at this stage.
  • You may consult four professionals at this point.
  • You may consult four data sources now.

Consult one family member:

Who are you? I don't remember you coming before. My wife and I are perfectly happy, thank you, and do not need your assistance. In fact, it might be better if you did not call any longer.

Yes, I am finding it difficult to cope with Richard. He messes himself most days and I have to help him with even the most basic tasks. This is not easy when he does not always know who I am and when he becomes frustrated with himself. He has always had something of a temper but I used to know how to manage his moods. He is less predictable now and I am not sure how much longer I can carry on with having do to do so much for him.

I can only visit occasionally now but I have seen my father deteriorate. He does not know who I am and I am not sure that he recognises his wife. He is incontinent sometimes and has become very demanding. This situation is upsetting my mother, who telephones me every day and always sounds distresed and anxious. I have noticed marks on her arms but she brushes off any mention of them.

Richard’s dementia has progressed, and he needs an increasingly high level of personal care. Betsy is not really able to cope with his demands and needs. I am worried about the impact that having to look after Richard is having on her own mental health and physical well-being. She is becoming increasingly agitated.

Richard’s dementia has progressed and he can no longer be expected to assist Betsy. He is no longer able to recall who he is with and what he has been doing. Betsy too is increasingly reliant on domiciliary carers to meet her own needs and I think she too needs a higher level of care.

Betsy is finding it very difficult to cope with Richard who is becoming very demanding. She breaks down quite often when I visit but is reluctant to say too much. I am quite concerned about the impact all this is having on her. I have occasionally noticed marks on her but she brushes them aside.

Richard can only attend when he can be encouraged into the transport. He become very disorientated as a result of his attendance and this must have an effect on Betsy when he returns home. She has stopped coming to the centre, she says in order to have a break from Richard.

My workers have become concerned about bruising, which she says are the result of bumping into furniture and occasionally falling at home.

I have provided all the aids and adaptations that are possible within their home. Betsy is finding it increasingly difficult to move around her home and to manage personal and practical tasks.

There is not much more I can offer. A move into residential care is indicated.

No information contained on the register but the officer responsible for overseeing adult protection procedures has received an enquiry from the domiciliary care manager about whether bruises seen on Betsy should be investigated.

Richard and Betsy have been provided with meals, and with aids and adaptations. The general practitioner has been providing regular updates. The GP has begun to express serious concerns about the deterioration in Richard’s mental health and its impact on Betsy’s mental and physical health.

You identify findings from a report on good practice and outcomes in adult protection work.
www.adss.org.uk/publications/guidance/safeguarding.pdf

You find a web link to Action on Elder Abuse, which provides information and research findings to support good practice.
www.elderabuse.org.uk

The Department of Health web pages carry details of the new procedures and powers available under the Mental Capacity Act 2005. The Department has also published guidance on protecting vulnerable adults from abuse and on decision-making concerning nursing care as against residential care.
www.dca.gov.uk/legal-policy/mental-capacity/index.htm
www.dh.gov.uk
www.dh.gov.uk/policyandguidance/organisationpolicy/integratedcare/continuingcarepolicy/fs/en

These advise you of inter-agency frame work for managing cases involving older age abuse. A system is in place for sharing information, for joint nvestigations and for case conferences. The circumstances when referral should be made to an Aproved Social Worker are also specified. Attention is drawn to the question of incapacity and the options that an appointed guardian might offer.

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 16 Acts are relevant. How many did you identify correctly?

  1. 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.
  2. 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 carder to care.
  3. Mental Health Act 1983 - section 13 gives assessment responsibilities. There are options for admission to hospital and to guardianship.
  4. Mental Capacity Act 2005 - if Richard lacks capacity, temporarily or permanently to look after his financial and personal affairs, and has not given a lasting power of attorney, provision exists through the Court of Protection to appoint a deputy to determine, for instance, where he lives.
  5. 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.
  6. Chronically Sick and Disabled persons Act 1970 - section 2 lists the services available for disabled people.
  7. NHS Act 1977 - section 21 and schedule 8 list the non-residential services available to respond to illness and mental disorder.
  8. Health Services and Public Health Act 1968 - section 45 provides for non-residential services for older people.
  9. Health and Social Care Act 2001 - funding and arrangements for nursing services are the responsibility of the NHS (section 49).
  10. Human Rights Act 1998 - contains the duty to positively promote people's rights.
  11. Data Protection Act 1998 - governs what information can be shared between agencies in what circumstances.
  12. Carers (Recognition and Services) Act 1995 - assessment duty towards carers of any age providing regular and substantial amounts of care.
  13. Carers and Disabled Children Act 2000 - assessment duty towards carers over 16 whether or not the cared-for person is undergoing assessment.
  14. Carers (Equal Opportunities) Act 2004 - carers over 16 must be informed of their right to an assessment.
  15. Housing (Grants, Construction and Regeneration) Act 1996 - enables the provision of Disabled Facilities Grants.
  16. Disability Discrimination Act 2005 - a duty to counteract discrimination and promote equal opportunities.

The following 13 pieces of guidance are relevant at this stage of the case.

  1. Care Management and Assessment: Practitioners Guide, 1991
  2. Community Care in the Next Decade and Beyond: Policy Guidance, 1990
  3. Community Care Assessment Directions 2004
  4. Direct Payments Guidance: Community Care, Services for Carers and Children's Services (Direct Payments) Guidance 2003
  5. Fairer Charging Policies for Home Care and Other Non-residential Social Services, 2003
  6. Carers and Disabled Children Act 2000 and Carers (Equal Opportunities) Act 2004: Combined Policy Guidance, 2005
  7. No Secrets: Guidance on Developing and Implementing Multi-agency Policies and Procedures to Protect Vulnerable Adults from Abuse, 2000
  8. Fair Access to Care Services 2002
  9. Guidance on the Single Assessment Process for Older People, 2002
  10. Care Management for Older People with Severe Mental Health Problems, 2002
  11. Mental Capacity Act 2005: Code of Practice (draft), 2006
  12. Mental Health Act Code of Practice, 1999
  13. Direct Payments for People with Mental Health Problems: A Guide to Action, 2006

The correct decision is to reassess the current care plan, to investigate the need for protective measures, and to consider the need for alternative accommodation. An assessment of Richard's mental health would be appropriate inorder to establish whether he lacks capacity and whether guardianship, admission to psychiatric hospital, or use of mental capacity legislation are appropriate. The possibility of older age abuse should be investigated and measures taken to protect and support Betsy. Their accommodation needs should be reassessed as residential care and/or nursing care may be more appropriate to meet their needs. Immediate protection will sometimes be the proportionate intervention but such action would have to be the only means of enabling people's welfare to be safeguarded and promoted.