3 Planning ahead
The vignette from Activity 1 indicated that the hope is for Geoff to live with Gill and Ian ‘forever’. The Shared Lives coordinator said to the researcher:
So again, long-term planning, we equally do. And I think for me, for the individuals that we support, like Geoff and Jackie, I’ve tried to make a conscious effort as we go round and do their plans, especially when family are involved, to look at that area of the plan where we address, is there a will in place and have they got any funeral arrangements?
In the next activity, you will reflect further on what else might need to be included in a conversation about Geoff’s future, and who needs to be involved.
Activity 3 Reviewing plans for Geoff
Timing: Allow about 10 minutes
Imagine that you are working alongside Geoff, the Shared Lives Coordinator, Gill and Ian to plan for Geoff’s future. In the text box below, create a list of all the aspects of his life that need to be considered. This may include things that have not been raised through the case study so far. After you have made your list, you will watch our panel members discussing their views.
Download this video clip.Video player: gopa_2_session3_video2.mp4
Transcript
PAM
Well so he’s 73--
LISA
He is. He’s getting on in life.
PAM
He’s going to get ill at one point of his life so with dementia or something, so he needs to have the care, end of life care.
LISA
Yeah, so it’s thinking about when he becomes ill. And also about those other things about how he might want his funeral to go and everything.
PAM
Yeah, they should talk to him about that.
LISA
Yeah.
DAWN
They should do that sort of now really.
GAIL
I think it would be the same for the Shared Lives family as it would be for any other family. I think it should be looked at the same way as they would going in. How do we-- in the same way you would any other older person because this person-- Geoff is 73, and he’s getting older. He’s OK now but what things might he need in the future? And look at additional things that can be put in the house to support him in the same way that you would with anyone else. The aim has got to be to keep him at home for as long as possible as long as those people are willing to have him there, and that’s the same for any family, isn’t it? It’s, we can look after mum or dad at home, but if actually it becomes too much for us, we need to be looking at alternatives, but that’s not the first port of call. And I think quite often for people with a learning disability-- excuse me-- for people with a learning disability, that’s quite often we hear that oh, well, they’ll need to go into some kind of nursing home. Or they’ll need to go into some kind of residential place, which over the age of 73, I would imagine would just be a nursing home full of people that don’t have learning disabilities. They will have other people there with Alzheimer’s or dementia or other people that can’t-- which would be horrible, wouldn’t it for Geoff? But I would say as with everything with someone with a learning disability, how would you feel and what would you want as a person? And put yourself in Geoff’s shoes and think, well, yes, he’s happy where he is now. Things are good. What is it that’s good about it? What’s working and what’s not working for him at the moment?
Review regularly because things change. Conversations with the Shared Lives family to say, let us know if things change. Let us know sooner rather than later. So if you notice that things might need to be put, we can help. We can get a notice to come and visit. We can put some grab rails up in the bathroom. We can do all of those things like you would for any other older person. I would also be thinking about having those discussions with them whether they’re happy to do all of those things as well. So again, it’s that planning ahead, thinking ahead to when that might not happen. If Geoff is a sprightly 73-year-old who’s physically really active, there’s no reason why he might not be a sprightly 78-year-old, a sprightly 80. But inevitably, things will slow down. And even people who have been at their most active, the body can only do so much at a certain age. So it’s that thinking ahead and planning ahead now, having those conversations, I think. Forewarned is forearmed in everything, I would say.
BEN
So in terms of this gentleman who’s in his 70s, there’s a number of routine checks that I would assume that he would have been having because of his age, not because of his learning disability, since maybe his 50s. And if we’re saying that currently his physical health seems OK albeit given his age, it may change quickly, suddenly. The first question that came into my head would be well, the first thought was this chap is of retirement age. However, the description is that he has a good life in a place that he likes. So first thing I would do is ask Geoff what he wanted. I would say, you have a life here on this farm. You seem to be OK and enjoying it. It’s difficult, isn’t it, because you don’t want to feel like you’re clipping somebody’s wings or anything like that. But you need to if he’s really active, then it’s his quality of life, isn’t it? You don’t want it to kind of impede on that person’s quality of life. I guess it would be about maybe raising awareness with the Shared Lives carers about I don’t know, just ensuring they keep a close eye on his physical health through routine GP appointments.
Like I said, there will be routine things I’m assuming that Geoff will have had to have been through given his age. But yeah, just to keep an eye on his physical health. If they’re concerned about his physical health, it would either be the GP or learning disability services are involved. Work closely with learning disability services, but you wouldn’t want that. I personally wouldn’t want to upset Geoff’s routine if he is telling us either verbally or through the way that he is in his home that he’s enjoying his life. I mean, I don’t think his age should be any limitation on what he does and what he enjoys. I think it would be a shame to kind of stop that just because he’s in his 70s. As a practitioner, you listen to those-- the concerns that are expressed either by Geoff himself or the family carers or professional carers, and I guess in this instance, I’d be looking to reassure people that at this moment in time, notwithstanding anything that may crop up in the future, Geoff seems to have or does have a good life. And I wouldn’t want to impact on that through any unwarranted intervention.
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Discussion
You will have come up with your own list of considerations for Geoff’s future. But based on the vignette and the panel comments, some key questions you might want to discuss if you were supporting Geoff include:
- Is everyone clear what Geoff wants, and if not, how can his views be ascertained and embedded in plans and decisions about the future?
- Is Geoff having regular health checks that other men his age have, e.g. bowel cancer screening?
- Is Geoff having his learning disability annual health check?
- Have you identified what is working well for Geoff and how this can be sustained? What is working less well, and how can that be addressed?
- Has specialist support been accessed for Geoff, for example, Occupational Therapy input? If so, what are the recommendations?
- What are Gill and Ian’s views about continuing to support Geoff in their home as he gets older? Are they prepared to make the necessary adaptations in their house if needed?
- There is little mention of relationships beyond the house. There is some talk of the extended family but little evidence of people coming and going from the house, seeing other people, or having opportunities to meet new people. This might suit Geoff’s personality, but maybe he would benefit from spending time with other people and developing new relationships. How could this be explored?
- We hear a lot about the outside space and the room with the table that people sit around. The lounge has portraits of Gill and Ian and their children when they were younger, but there are no photos in the house of the people living there through Shared Lives. Does this matter? How much choice and control do people have over decisions about furniture and décor? What is their personal space like?
- Is there a clear process in place to review Geoff’s future plans?
Anyone supporting Geoff, or someone in a situation similar to Geoff’s, needs to be mindful that he, like everyone else, is getting older. While Geoff is fit and active now, he will, inevitably, experience changes to his health that are impacted by his age. It is important that all those involved in supporting Geoff are working together – with Geoff – to plan ahead.