Stage 2 - Making sense of the 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
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
For an excellent introduction to the task of assessment
in dementia (and most other aspects of this case including cultural
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
- 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
- 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?
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
, 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
- 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
- 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.