2.3 Making choices and developing a personal care plan
The social work task of supporting a person's admission to care involves many skills. Social workers must be able to assess the person's needs and coping mechanisms, and the quality of provision to meet needs. They must be familiar with the National Care Standards for their nation. To liaise effectively with service users, families, home providers and other professionals involved in assessment, good communication and negotiating skills are essential.
If there is a need for residential care, social workers may play a role in providing information about it to service users and their families. Phillips and Waterson (2002) found that while the task of searching for suitable accommodation was generally undertaken by families, they appreciated advice, guidance and recommendations on selecting a home and on the financial implications. The role of the social worker here has been described by Phillips and Waterson as an ‘honest broker’, offering impartial advice to empower service users and their carers to make an informed choice. This may involve the social worker putting them in touch with organisations such as Help the Aged or Age Concern, which can provide advice and guidance on many aspects of care homes and funding.
Personal financial resources remain significant when considering inequalities in provision between local authority, voluntary sector and private providers. Those who are reliant on financial assistance from the local authority to pay fees may be disadvantaged in many ways. For example, additional personal resources such as a telephone in their room may not be available. The residents at Drummond Grange all stressed how important it was to create their own personalised space and to be able to get in touch with the outside world easily by having a phone in their rooms.
Inequalities persist, and there is more choice of provision for those who can afford it. An important task for the social worker supporting an older person's move into care will be to undertake a financial assessment to ascertain their eligibility for financial support towards the cost of their care. This may be distressing for the older person, especially if selling their home to contribute to the cost of their care is a possibility. The older person may experience feelings of loss akin to those associated with bereavement.
One way of supporting service users and their families with finding suitable care accommodation is to help them devise a list of questions that they can ask about the care provided when visiting homes. You will explore this in Activity 5 .
Activity 5: Being an ‘honest broker’
Make a list of questions that a service user might find it helpful to ask in order to make a judgement about the suitability of a placement for them.
Our list included:
What are the fees charged for care and what precisely is included in them?
Is the location good for maintaining relationships with family and friends?
What are the links with the local community?
Does the home have suitable facilities to cater for the service user's needs and preferences?
Can residents choose when to wake, when to retire to bed, when and what to eat?
Will the home be able to meet the service user's spiritual and cultural needs?
Does the atmosphere feel right?
Are the staff friendly, approachable and sensitive?
Can service users bring their furniture and/or pets into the home with them?
Are written policies and procedures readily available?
How are service users involved in the running of the home?
Can residents entertain visitors when they like?
Further information to help with the selection of homes is found in inspection reports which provide information about the quality of care within establishments. These reports note the strengths of provision and indicate areas where improvement is needed. When assessing the quality of care, inspectors incorporate the views of service users, relatives and staff working in the home, in conjunction with their own observations. The challenge for residential providers is to create an environment for care which respects group needs and individual differences, and responds by offering appropriate support.
Once the choice of placement has been agreed, work begins on developing personal care plans with staff in the home. At this stage, social workers may help families negotiate effective ways of continuing to play a part in the care of their relative. Wright (2000) identified five discrete roles that family caregivers might assume in care homes. These were described as:
checking the quality of care
handling the cared-for person's finances
giving practical help
assisting with personal care.
The last two roles were taken on by the minority of respondents in Wright's study. Accommodating a family's preferences about the roles they may want to play in care of their relative helps to sustain the relationship between the service user and their relatives after admission. All decisions about relatives' involvement should be recorded on the service user's personal care plan. You will consider important features of person-centred care planning in Activity 6 .
Activity 6: Developing and reviewing personal care plans
This activity looks at care planning for residents at Drummond Grange. Watch the video clip then listen to the audio clip. Both are linked below.
Note the key features of a service-user approach to personal care planning as you watch and listen.
Click to watch the video clip (4 min 44 sec)
Transcript: Care planning
Click to listen to the audio clip (2 min 22 sec)
Transcript: Personal care planning
The information derived from a single assessment process should enable the service user's needs and preferences to be at the heart of the personal care planning process. The inclusion of the service user's perspective is essential for anti-oppressive practice. Where service users have difficulty communicating verbally, social workers may need to use alternative strategies to gain an insight into their views. Social workers may also need to draw on the understandings of family and close friends. In some instances, they may act as advocate for service users in negotiating their care plan. ‘Support, representation and advocacy’ is a key role for social workers to undertake. However, sometimes it may also be good practice to secure the involvement of an independent advocate to ensure that there are no conflicts of interest.