Ageing and disability: Transitions into residential care
Ageing and disability: Transitions into residential care

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Ageing and disability: Transitions into residential care

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’

0 hours 10 minutes

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.

Discussion

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.

Figure 3
Harry Venning ©
Harry Venning
Figure 3: The challenge of meeting group needs and responding to individual differences

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

  • companionship

  • 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

0 hours 30 minutes

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)

Download this video clip.
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Transcript: Care planning

Narrator
At Drummond Grange, care planning is a crucial stage in managing the transition from independent living to residential care.
Maria
We have a very holistic approach, which means that we try to look at the person in an all-round way.
Now sometimes the choices and their options are something that may not be realistic to them, because we would be unable to fulfil that role. It wouldn’t be able to happen and therefore sometimes you have to work as part of the care plan in introducing an element of reality and looking at a compromise. What can be achieved? And what can’t?
It’s often the very little things that make the big difference. Lots of little things put together are usually what end up being the source of satisfaction for them all.
Elizabeth
I think it just evolved. You know when I like to get up in the morning, whether I like to have breakfast here or go down to the dining room. It’s all a matter of choice. If you want to have all your meals in your room, you can have all your meals in your room.
And then they offered me the use of this electric chair. This belongs to the house. And that made a tremendous difference. And that just opened up the garden to me and the fresh air and I could just get anywhere, along to somebody else’s room.
Everything evolves sort of slowly, so it doesn’t, it doesn’t just happen overnight.
Staff member
Who’s been on your bed?
Bill
Well, I’m not telling you!
Staff member
That’s shocking – look at the state of that!
Narrator
Once their plan is agreed, each resident has a key-worker who’s responsible for keeping track of the various aspects of the care that’s being given.
Bill
In my case I am able to say that I want – I’m not getting up early enough in the morning let us say. I am able to discuss that and have it put on the care plan, that I will be up by a certain time. Or that other aspects of my daily living are looked after to suit my preferences.
Narrator
To keep up with changing circumstances, Drummond Grange’s personal care plans are regularly reviewed.
Eric
I have changed through the years since I’ve been here, in my ability to get in and out of the chair for instance. But now I’m totally dependent on a hoist. And being dressed I could at least help a lot more before I had the amputation.
And I realised that I couldn’t wash myself, for instance under my arms and even the front, the way I’d like it to be. So I had to ask – but the staff should have picked up that. I think, I hope it’s written into my care plan.
Narrator
Care planning encompasses both physical and emotional needs.
Elizabeth
It’s very easy just to sit in your room and say I won’t bother going down for a meal, I can’t be bothered talking. But I don’t think that does you any good.
I think it’s awfully important to keep yourself as healthy as you can. Get as much fresh air as you can and do everything you can within limits.
But I think you’re due it to yourself and to everyone else around you to keep yourself as healthy as you can. And there’s an awful lot you can do. And also you can do an awful lot to keep your mind active.
Narrator
For those who like to keep up with their reading, the mobile library comes once a week.
And the newspaper group gives residents the chance to air their views on the issues of the day.
There’s an ever-changing programme of activities that goes on all year round.
They really do awfully well to keep our interest in life up and not have us all slipping into apathy here. ‘No, I’m older, I’m finished and I’m just awaiting the time.’ We may actually be awaiting the time because that’s what we all came in for. But it’s never just uppermost on the surface.
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Transcript: Personal care planning

Maria
Care planning is very, very individual. We have something in Scotland in particular called a ‘personal plan’ and the personal plan is where a resident and their family would make these personal choices. Now sometimes the choices and their options are something that may not be possible, may not be realistic to them because they would be unable to fulfil that role. It wouldn’t be able to happen and therefore sometimes you have to work as part of the care plan in introducing an element of reality and looking at a compromise.
But all the way along the line it means that the resident and the relatives have been party to agreeing what that final care package will look like. It’s reviewable on a six-monthly basis as a minimum and the resident or the relative or a member of staff, if they feel there’s a change in the care or there’s something that they don’t like, or something they want to introduce, can actually call for that to be reviewed within that six month timeframe. It’s usually quite often centred around things like ’Can I be bathed seven days a week?’
Now, some of that really depends on whether they have some independent ability or whether that needs two or three members of staff to carry out that process, that either affects what the eventual decision is that’s made, or it has to affect the financial side of the agreement. You know, if it’s going to be seven days a week, twice a day, I want to be in the bath, but I need three people to bath me, and it takes two hours. You can imagine the kind of impact that would have on the rest of the residents within the unit and the overall home as well. So it really is very dependent on negotiating very carefully and as realistically as possible from both sides what can be achieved and what can’t.
Some of them are very simple, you know, ‘I don’t want to be woken before 9.30 in the morning’ or ‘I don’t like to go to bed till 12 o’clock at night’, ’I like to watch X programme’. So often they are things that are very easily achievable, but they’re very personal to that individual. It’s really what they want to do and that’s some of the things that are special. And it’s often the very little things that make the big difference, not the big things, lots of little things put together are usually what end up being the source of satisfaction for them all.
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Discussion

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.

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