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Introduction Beginnings Making sense of the information Deciding what to do Reviewing the plan

Stage 2 - Making sense of the information

Case Information

  • The community nurse, together with Kawthar's sister Neeta, act as advocates for Kawthar and Ahmed and maintain a person centred methodology, as they decide to carry out a holistic assessment and follow through the assessment process. They realise, far from assessment being carried out even if badly, often it isn't even undertaken (Sinclair et al., 1995). The doctor and psycho-geriatrician assess the medical needs of Ahmed and confirm the diagnosis of dementia. Tests and scans are carried out as part of this, including confirming no other causes than dementia are contributing to Ahmed's current condition.

For an excellent introduction to the task of assessment in dementia (and most other aspects of this case including cultural issues) see:
Tibbs, M.A. (2001) Social Work and Dementia, Good Practice and Care Management, Jessica Kingsley.

A number of needs have emerged from the assessment. This confirms the preliminary hypothesis of the psycho-geriatrician that Ahmed is experiencing the rapid onset of dementia. This generates two priority needs, communicated to the panel linked with the Fair Access to Care local criteria: first, Ahmed needs services to respond to his condition; second Kawthar needs services as carer. There is a dilemma for the practitioners in reconciling the requirement that needs are met: that is, to provide fair access to care and comply with person-centred principles of meeting Ahmed's and Kawthar's wishes, with any delay in implementing a care planning process due to finance or any other administrative reason.

  • The social worker and the nurse discuss with Kawthar and Ahmed the possibilities at this stage. They also discuss the options with colleagues at FirstCare.
  • Kawthar wants to continue to care for Ahmed at home. The social worker and other team members recognise the integrity of this wish and at the same time acknowledge certain risks exist which pose practice dilemmas. They refer to other practitioners' experiences in weighing arguments for and against taking risks (George, 2000).
  • The practitioners take the case to the panel to bid for the money in the budget, to purchase the necessary care.
  • The panel decide to endorse Kawthar's wishes and provide the necessary support services.

Key Questions

  • What view does Ahmed have of his needs?
  • What view does Kawthar have of Ahmed's needs and her own needs as main carer?
  • What is the balance between meeting Ahmed's and Kawthar's needs, managing risks and protecting Ahmed?

Research Focused Questions

  • What knowledge is needed in order to complete the assessment?
  • How can meeting Ahmed's needs be reconciled with meeting Kawthar's needs as main carer?

Relevant Knowledge

Empowering Users and Carers

An important principle of community care is involving people using services and their carers. Barnes and colleagues examine important issues arising in implementing this (Barnes, et al. 1999).
Also see Barnett, E. (2000) Including the Person with Dementia in Designing and Delivering Care, Jessica Kingsley.

The Government strategy for carers provides a useful summary of principles for working with carers (DoH, 1999). Far from formal support for carers reducing the incentive for people to help each other, weakening family ties and reducing neighbourliness, these all are likely to be enhanced by additional support. Social work and community care contribute to this support for carers. Failure to do this increases the likelihood carers will experience poverty, ill health and social exclusion.

Means, Richards and Smith, (2003 pp. 37-39) and Payne (1995, pp. 18-20) point out community care policy and practice relies heavily on spouses/ partners and other family members caring for the person receiving services. Care in the community all too often means the family do the caring. The burden of care by the family tends to be borne by women (Dalley (1996).
  • The Carers (Recognition and Services) Act 1995 is a sign of government recognition of the responsibilities borne by informal adult and young carers. It imposes a duty on local authorities to assess carers, where requested, who regularly provide substantial quantities of care. The Carers and Disabled Children Act 2000
  • upgrades the Government's commitment to support carers;
  • expands the rights of carers. Carers have the legal right to an assessment even if the service user does not want to engage with it.
  • enables and encourages the local authority to develop direct payments and systems of voucher payments for older people.
New elements in the national strategy for carers (DoH 1999) include: recognition of the crucial role they play in supporting service users; practical i.e. financial support for carers to give them respite from caring; extending the rights of carers to unpaid leave from work while they are caring.
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