On initial referral and screening
You have been asked to undertake an initial screening to determine whether a full assessment should proceed. You will make a recommendation on this to your manager.
- You may only consult one family member at this stage.
- You may only consult two other professionals at this point.
- You may only consult two data sources now.
We can just manage but things are getting more difficult 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. Is there anything you can do to help us?
You won't need to talk to anyone else will you? We don't want people to think we can't cope.
I don't want you to talk to Evelyn, she has enough worries of her own. I don't really want the warden knowing our business. You can speak to the doctor if you wish.
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.
Have you asked Richard or Betsy for permission to speak to Evelyn?
Richard and Betsy have a right to privacy and you do not yet know whether they have a carer role that would entitle them to information.
Consult two professionals:
Have Richard and Betsy given you permission to talk to me?
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.
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 offer any relevant information. We facilitated their move into sheltered housing several years ago. It sounds to me as if you should be considering residential care.
Consult two 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.
Mental health in older age. In the time available you discover some references that you decide to follow up later. www.mind.org.uk/information/factsheets
In the time available you identify a memory clinic resource run locally but you have yet to follow this up.
You recall from your training how care-giving can impact on relationships within families, and the importance of recognition and support for carers. You find a link to an orgainisation that provides information, guidance about the law on carers' assessments and research findings on what worked well to support carers. www.carersuk.org/Information/Helpwithcaring/Carersassessmentguide
In the time you identify a local Age Concern group.
In the time available your research finds references only to national organisations. You have no other details at this stage. www.shapingourlives.org.uk
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.
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 9 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.
- Disabled Persons Act 1986 - section 4 absolute duty to assess a disabled person.
- Mental Health Act 1983 – section 13 assessment responsibilities in relation to the possible need for admission to hospital.
- National Assistance Act 1948 - section 29 definition of disability relevant to the decision about use of the 1986 Act.
- Human Rights Act 1998 - duty to positively promote people’s rights.
- Data Protection Act 1998 - what information can be shared between agencies in what circumstances.
- Carers (Recognition and Services) Act 1995 - assessment duty towards carers 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 being assessed.
- Disability Discrimination Act 2005 - a duty to counteract discrimination and promote equal opportunities.
The following 5 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
- Carers and Disabled Children Act 2000 and Carers (Equal Opportunities) Act 2004: Combined Policy Guidance, 2005
- Fair Access to Care Services 2002
Make your decision:
The correct decision is to assess. There is sufficient evidence already to consider Betsy as a disabled person. There is an absolute duty to do an assessment, therefore, derived from section 4 Disabled Persons Act 1986. The degree to which Richard is disabled may be unclear but he appears to need community care services and therefore is eligible for assessment under section 47, NHS & Community Care Act 1990. Fair Access to Care Services will inform the assessment. There is sufficient information to suggest that both are also be entitled to carers assessments.
You may wish to reflect on whether all the information you gained came to you with Evelyn’s permission, or whether those involved broke any data protection principles in divulging information to you without Richard and Betsy’s consent.
It is also important to note that the s4, Disabled Persons Act duty to assess the needs of a disabled person may be omitted from agency policies and procedures, despite the strength of the mandate it provides for assessment on request.