Stage 3 - Deciding what to do
- The social worker and the community nurse collaborate with Kawthar,
Ahmed and other family members in formulating a community care package.
- They undertake dementia mapping (Kitwood,
1997) now it is clear Ahmed is suffering from dementia.
Also see Innes, A. (ed) (2003) Dementia Care Mapping,
Applications Across Cultures, Jessica Kingsley.
- The Health Authority is responsible for meeting medical needs,
so a diagnosis of these by healthcare professionals is necessary
before social services can accept responsibility for care. The health
and social work practitioners work in conjunction and not in isolation
from each other.
- A needs assessment emerges for the assessment process.
- The community nurse and social worker are aware Kawthar has been
under great pressure. They carry out an assessment of Kawthar's
circumstances. She wants to see a doctor. The doctor contributes
to the assessment. The doctor confirms Kawthar is suffering sporadically
from reactive depression. Sometimes she copes well. At other times
she needs support as carer. She is managing the tensions between
maintaining their marriage whilst coping with Ahmed's progressive
condition (Ray, 2000).
S., Shaw, S. and Glendinning, C. (2000) ‘Health Care Professionals’
Support for Older Carers’, Ageing and Society, 20/6: 725-744.
M., Davies, S. and Grant, G. (eds) (2001) Working with Older People
and their Families: Key Issues in Policy and Practice, Open University
- The practitioners working with Kawthar and Ahmed recommend as
part of the assessment that Kawthar should have a care coordinator
in her own right. Her circumstances justify a medical referral for
medication and psychological treatment such as cognitive therapy.
Trotman, F. and Brody, C. (2002) Psychotherapy
and Counselling with Older Women, Cross-Cultural, Family and End of
Life Issues, New York: Springer.
- The practitioner considers there may be a need for Kawthar and
Ahmed to have information about dementia and support. The first
thing to do is discuss this option with them. The Alzheimer’s
Society will be able to offer information about dementia and support.
Organisations such as Help the Aged could be willing to help Kawthar.
The voluntary agencies may have a lead worker for different cultures.
- Ahmed falls and suspected broken ankle. It swells up. He is admitted
- What ethical and practice dilemmas are there?
- How can these dilemmas be managed?
- Does Ahmed need more support than can be provided by his family
- Would residential care be an option for Ahmed? Will Ahmed and/or
Kawthar accept intervention if necessary to ensure Ahmed receives
adequate 24-hour care? Is it accepted by practitioners, Ahmed and
Kawthar that the level of need only justifies residential care as
a last resort?
- Would respite care in a day centre for frail elderly clients,
at which a number of men from Ahmed's ethnic background already
attend, help to meet his needs and relieve Kawthar of some of the
burden of caring?
- What other services, in addition to, or instead of, the above,
may be needed?
- Will resources be sufficient to fund any or all of the above options?
- What fresh information has come to light?
- What changes to the assessment does it imply?
- What are the resource implications of these?
- What changes to the community care plan should be made?
- What are the resource implications of these?
- Will resources be adequate to fund the changes?
Research Focused Questions
- What needs have emerged?
- Is there evidence that effective services are on offer?
- What skills will be most effective, should the practitioner need
to handle the changes in Ahmed's circumstances if additional support
Discharge from hospital
- What local arrangements exist for managing discharge from hospital?
- How can the social worker ensure the discharge process complies
with best practice?
- The local hospital discharge policy may dictate practice regarding
days required for notification of discharge.
- Care planning may have to start on admission.
- A pre-discharge meeting may be required.
- There may be no discharge until a safe care plan is in place.
- There may be a requirement for a patient discharged from hospital,
considered at risk, to be supported by a Collaborative Care Team,
as a short term measure.
If there is a hold-up, for instance, over the supply
of a suitable bed, the social worker could contact the Occupational
Therapy Service in the Primary Care Team. They could deliver the appropriate
equipment within a day. The Community Support Team could resume care
The possibility of residential care
The National Care Standards Commission (NCSC) (NB
this is changing to Commission for Social Care Inspection in April 2004)
requires residential homes and nursing homes to maintain specified levels
of staffing which enable homes to meet residents' needs. In theory,
all homes operate to a standard which meets the same quality requirements.
In practice, there is great variation between homes and between the
weekly cost of residential care in different homes and localities.
It is possible to arrange residential care under Section 21
of the National Assistance Act 1948. This would be traumatic for Ahmed
and upsetting for his family.
He and his family would have restricted choice, in three ways:
1. Their options would be limited if Kawthar could no longer cope with
2. The choice of a place in a specific home would be limited by the
local demand for places and availability of a place at short notice.
3. Kawthar and Ahmed's financial circumstances may need means testing,
under the regulations for charging. This means, in effect, the choice
of the client and carer is over-ridden by the decisions taken by assessors,
following procedures for determining whether the local authority meets
the cost of care.