This assignment focuses on Adults and community care case study. The work highlights the main issues that need immediate attention and attempts to provide an account on how to address them. An improvement of the quality of life for Jan and Magda may be realized so that they could live a fulfilling life in old age. On the other hand investigating the main issues, demands a discussion the importance of interdisciplinary and multi-agency working. It is also possible to explore the policies and legislative mandates and frameworks that inform both the assessment and intervention. This exploration provides guidance as to what is acceptable under law and policies. At the same time, the importance of incorporating theories and approaches will be discussed and analysed. Then l will draw attention to the importance of incorporating theories into practice, guides what a social worker may need to look out for; and enables one to account for the values and situation in society of day to day work of social workers. The last part shall analyse the importance of interventions in an anti-discriminatory and anti-oppressive way. This essay draws reference from the code of practice and other relevant professional guidelines under the law.
The work being a course assignment may not explore all the needs due to limit of words, but major topics discussed in this assignment are interlinked; therefore it is not going to possible to discuss one issue alone without refereeing to the other. A summary is given at the end.
Assessments of significant issues
The key issues highlighted in the case study may be categorised as medical, financial, mobility and social needs.
In-order to address the issues highlighted, an assessment for Magda is required. Consultation with interdisciplinary and multi-agency bodies should be carried out as observed by Macka(1990). Information can be gathered through meetings, in Magda’s case key attendees would be the general practitioner, the community nurse and the community mental health team and a social worker. The multi-agency meetings facilitate sharing of information between all organisations in a safe and secure manner. (Surrey Council) Information collected will help the assessor to make an informed assessment and risk assessment. However the consent of service user to sharing of information should be sought as suggested by Milner and O’Byrne(1998) It is important for Magda and Jan to attend such meeting however it is possible for professionals to hold meeting without service users.
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When using single assessment process, it is important to acknowledge that there are 4 types that fall under the SAP; these are contact, overview, specialist and comprehensive. More than one assessment can be carried out at once. Different local governments’ authorities may implement SAP using slightly different assessment tools and the threshold of eligibility may also differ from one local authority to the other.
Under the NHSCCA 1990 Section 47 (1) (a) Magda has the right to an assessment, and within the same act; S 47 (1) (b) will help the assessor to determine the eligibility criteria known as the Fair Access to Care DH 2010. Here the assessor will be working in accordance GSCC code of practice which states that Social workers should promote the independence of service users and promote them as far as possible from danger and harm. GSCC (2002) Eligibility is graded on four bands, the low, moderate, substantial critical (Surrey Council, 2011).
The White paper caring for people (DOH 1989) aims to enable people to live a normal life as much as possible in their homes or in a homely environment in the community. Assessments should help Magda and Jan to identify not only their needs but also their strengths and abilities under this paper. The wishes of service users should be kept on the forefront of the care planning and service delivery. This upholds the GSCC code of practice ref. 4.1. GSCC (2002). Hence the interventions led to promoting good health and quality of life in the community.
The (DOH 1989) also states that the right amount of care and support provided helps people achieve independence by maintaining basic living skills to achieve attainment of daily living activities John’s (2005) p.79. “The Carers (Recognition and services) Act 1995, extended the duty of assessment to rights of carers to have their needs assessed alongside those of the person whom they are caring” Referring to the case study Jan appears not coping well as Magda’s carer. Here probably with adequate and appropriate support package Jan will be able to carry out his caring duties if Magda was to stay in the community. The task for social workers in this case involves helping Magda to overcome the structural, institutional, cultural, professional and personal barriers that may contribute to physical disability, in line with views of Adams et al (2002).
It appears that Magda is unable to communicate her personal wishes due to a language barrier; she may need an option of having an independent advocate who can represent her. There are issues around the use of relatives as interpreters as relatives may be biased towards their personal wish that may be contrary to wishes of the service user. The amendment to the Race Relations Act 2001, states that no one that uses public services should be disadvantaged because of their race, colour or faith as advocated in Br J Soc Work (2010).
In Victoria Climber’s case, where interpretation was done mainly through an aunt, stands as an example where vital information was missed despite being seen up to 40 times by social services, the police and the NHS. It is most likely to be true that the use of professional interpreter could have led to changes and outcomes for Victoria Climber’s case. Thus in Magda’s case it is only right to gather information in regards to Magda through a professional interpreter. In line here Magda has capacity and has the right to make decisions about her care plan.
The key legislation essential in this assessment is The National Health Service and Community Care Act 1990 (NHSCCA) which addresses the provision of information about services, assessment and service delivery principles. Section 47 of this act requires a local authority to assess all those who may be in need of community care services, and having regard to the results, decide whether the needs call for provision according to Johns (2005). An initiation of an assessment for Magda may be done through the powers of this Act.
The first piece of legislation to materialise that would involve Jan is the Carers (Recognition and Services) Act 1995. This Act is an important step towards recognising carers and the supporting role they play in looking after their family members, and the difficulties they face. This Act gives carers like Jan the right to an assessment both physical and mental. This would be carried out annually. However if the person being cared for refuse an assessment, then the carers would not be entitled to an assessment. The department of Health’s publication Building Bridges (1998) also provides the legislative framework recognising the carer’s role.
The Carers and Disabled Children Act (2000) strengthened the rights of carers to an assessment of their needs. This is irrespective of whether the person they are caring for receives the service or not. The help ranges from driving lessons, counselling and or even money to replace a broken machine.
After all the considerations of the laws and boundaries the needs and resources, a care plan is formulated. The social worker should promote the right of Magda to self- determination to where she should live. If on the assessment Magda is found to have capacity and is adamant to stay in her home, in such a case weighing the risks available to Magda if she remains in her own accommodation. If there are no majooor risks her wish should be respected. Even though self-determination is a basic principle in social work practice, all practitioners know that there are situations in which the client should not be given the right to self-determination. Part of the community Care Act (1990), highlights choice, Kemshall (2002, p76) states how this can be conflicted with one’s own personal view, “choice, a central principle of community care, can be significantly undermined by professional desires to prevent risk.”
Magda’s has had her leg amputated due to gangrene, which causes mobility difficulties. Her poor sight due to diabetes adds on to mobility needs. The aim is to prevent disability where “Disability is defined under the DDA1995 as physical or mental impairment which has a substantial and long term adverse effect on a person’s ability to carry out normal day to day activities”(Mandelstam 2005) p 490.
Magda is already known to the mental health services; however she appears to being violent to Jan. It is important for Magda to have a specialist mental health assessment. Ulasand Connor (2000) Through the mental health route, Magda may be eligible for services through the Mental Health Act 2007 which has introduced the supervised treatment in the community. This Act modifies the 1983 Act and amends the 2005 Act. If Magda lacks capacity a named person can make a decision on Magda’s best interests under the Mental Capacity Act 1 (5). Under this acts the social worker would be able to promote healthy, safety and personal wellbeing of both Magda and Jan.
It may be suggested that in situation where risk is low Magda may also be entitled under section 29 of the National Assistance Act 1948 to a mandatory grant for essential adaptations that will enable her to move around her home more easily Brayne, et al (2001). Examples of the type of adaptations that may be carried out are: Installing a stair lift, providing a toilet and shower downstairs, installing a ramp. Bornat, J. (1994). Magda may get funding for adaptations through Housing Grants, Construction and Regeneration Act (1996), disabled facilities. Magda’s diabetes and schizophrenia and amputation places a duty on the local council to assess needs provide services through the Chronically Sick and Disabled Persons Act (1970). Under this act, the Local Authority has a duty to assist a service user with practical help in and around the home. This includes the personal care, transport services and meal facilities for the service user, sharky (2000).
A home carer may be arranged for Magda under section 2 of the CSDPA 1970 to provide personal care, such as assistance with bathing and dressing, help with getting in and out of bed, and help with medicines. It also includes practical assistance in the home to improve safety, comfort, and convenience and manage with daily tasks more easily and independently as suggested in Maczka, K .(1990).
The 1968 HSPHA (section 45 DHSS Circular 19/71) instructs the Social Services to cater for the delivery of hot meals to Magda at her home by a meals-on-wheels service. However a charge is usually made for each meal. Section 21 Sch. 8 of the 1977 National Health Service Act provides a laundry service for people who are incontinent or who for some reason cannot do their own laundry in line with Vernon, S. ( 1997).
If the risk is high for Magda to live in her house and does not want to go into residential homes, supported housing may be an option. The National Assistance Act 1948 Sec 20 facilitates provision of appropriate accommodation. This Act may be used if Magda is voluntarily moving, however her condition should satisfy two requirements and one should be medical. Supported housing offers a wide range of support tailored needs. Service users in supported housing can live as independent and as private. There is an option of companionship from staff if one needs it. Most services offered in Magda’s home are available if she chooses to go in supported housing in Heywood et al. (2002).
It is probably possible that, after the assessment Magda had been seen as unfit to live in the community even with support, and has to go to residential home against her wishes. The National Assistance Act gives compulsory powers to put Magda in a care home. This decision may be made in her best interest of Magda.
The General Social Care Council codes of practice that call for attention towards empowerment and choice. The guidelines are aimed at employers and employees to maintain to a reasonable standard of practice within the social work field. The General Social Care Council, codes of practice expects social care workers to, “Supporting service users’ rights to control their lives and make informed choices about the services they receive; ” (G.S.C.C. 2002 p1).
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The other issue is that the couple are experiencing financial issues; Jan is accumulating debt in the local shop. There is need to investigate the reason why Jan is accumulating debt. There is need explore whether the accumulation of debt is not due to alcohol, drug abuse and or gambling. There is a possibility of Jan being vulnerable and experiencing financial abuse from a member(s) of the community. In order to get the true picture of what is taking place, it is important to discuss the debt problems with Jan. It is equally important to check if Jan and Magda are getting all the benefits that they are entitled to.
The assessment of people’s needs is a local authority’s responsibility part of the section 47, NHSCCA 1990. The assessment of needs guides whether service provision by community care is required. Needs led assessments are being highlighted in order to move away from resource led assessments. This act allows professionals to fit a person into an existing service rather than getting the service to fit the person’s needs. Limited resource eliminates availability of choice. An example would be, a home carer being sent to an elderly person home to provide caring duties. Due to lack of resource and money the carer has to provide home care at an early time of 7pm. This is considered too early for the client who wishes to go to bed after 8pm. But as there may be no other services the client could settle for what is provided, this is a violation of the client’s choice. These issues can be magnified as forms of discrimination and oppression. The principles of consumerism underpin many of the objectives from community care provisions, this is what is in line to Thompson (2003): Station 1998.
The Carers (Recognition and Services) Act 1995 and the Community Care (Direct Payments) Act 1996 established statutory intervention in the caring field. Direct Payment scheme does allow users to obtain cash instead of services from local authority. Direct Payment scheme promotes a caring service, which revolves around contracts and employment law, Crawford and Walker (2006). Personalisation of service promotes independence, enabling individuals to have a greater choice and gives clients the responsibility for meeting their housing related support needs
The local authority still has an overall say, ” local authority has discretion over whether to offer someone direct payments and can decide whether they are appropriate and whether the disabled person can manage them (DOH 1998a in Sharkey, 2000).
The White paper Caring for people (DOH, 1989), aims hope to enable people to live a normal life as much as possible in their own homes or in a homely environment in the community. It also states that the right amount of care and support should be provided to help people achieve independence by maintaining basic living skills to achieve daily living activities. The main aim, which highlights empowerment, is the prevention of gate keeping allowing individuals to have a greater say towards how they live their lives and the service provision. Kemshall and Littlechild (2000).
Ungerson and Kember further state how feminist research looks at the significance of women in informal care and the effect this has in differences between male and female participation in the labour market. Feminists such as Mc Laughlin and Glendinning (1994), Lewis (1992), Ungerson and Kember (1997) etc. have recognised that gender relations in the welfare state are not as simple as mainstream theorists such as Esping-Anderson would have us believe.
On the same line, the other feminist’s such as Barnes (1997) have also looked into gender differences in the welfare state by studying informal care, and the gendered imbalances surrounding it. Barnes claims that women have the main responsibility for informal care. (1997:13). It can be assumed that many policies of the welfare state are at the present, not geared towards Mclaughlin and Glendinning’s de-feminisation.
According to Henwood 1998, 1in 8 persons is an informal carer to either a relative or a family member, which has led this group of people to become more recognised for the support they give to clients. Supporting carers not surprisingly has proved increasingly popular with the government, because it helps to reduce the demand of local authority funded service, reasserting the responsibility onto families and individuals. However as straightforward as this may seem, the government cuts has added to the difficult task of translating the support into actual rights and benefits in my view.
Finch and Groves (1977) argue that policies for community care were, within a context of public expenditure cuts, and were fundamentally incompatible with policies for equal opportunities for women. They claimed that in practice community care equals care by the family, and in practice care by the family equals care by women. (Ungerson, 1987: 494) Because of feminist contributions and increased knowledge of community care the Equal Opportunities Commission commissioned a study of carers and for the first time a serious effort had been made to plot the incidence of caring and to discover the sex ratio. The results found, ” Out of the 116 carers, 87 (75%) were women and 29 (25%) were men.” (Equal Opportunities Commission, 1982b, 3) The ‘Equal Opportunities Commission’ then published a set of recommendations for the support of carers, in terms of services, financial benefits and employment rights, (The Equal Opportunities Commission).
“The carers visible to government statistics are married men aged less than 64 years old caring for their disabled wives and single people caring for infirm parents. Carers are only visible to policy makers when they receive some kind of state benefit, yet many welfare benefits exclude married womenâ€¦.”(Equal Opportunities Commission, 1982b: 3) Further to this councils have adopted a top down model in which local disability organisations are not closely enough involved within.
Social workers need to work in partnership with service users and not make assumptions about what they feel is the best for them, even if it appears obvious and the wishes of the service user must be respected. It requires skill and professional judgement on behalf of the social worker to balance the wishes of the adult with the need to protect them. There are no specific laws relating primarily to old people like there is for children under the Children Act 1989 therefore social workers must draw on legislation from different areas in order to provide the best outcome. The training and specialist knowledge the social worker has, the more positive the outcome is likely to be. Also the available resources within the local authority have a significant impact on the care and support that an old person receive and varies widely in different regions. This lack of resources inhibits the proper application of the law, Crawford and Walker (2006).
As a social worker it is important to be aware that people are different and where there is difference there is the potential of unfair discrimination. Stanton, (1998). Anti-discriminatory practice is a complex area with many and diverse dimensions such as disability, race, gender, age and sexuality. Much of the discrimination inherent in social work can be seen to be unintentional, due to lack of awareness rather than deliberate attempts to oppress. Thompson (2001).
It is important to intervene in a non-discriminatory and non oppressive manner when working with older people. Thompson, (2001) p 88, explained that social work with older people has a considerable discriminatory potential. Society has a tendency of marginalising issues relating particularly to problems of old age. This behaviour can be referred as ageism, and ageism behaviour is in itself discriminatory. Hughes and Mtezuka (1992) describe ageism as “the social process through which negative of and attitudes towards older people based solely on the characteristic of old age itself, resulting in discrimination”.
There is a lot of reference to empowerment and choice in social work settings when in actual fact, one wonders if this is fully promoted. “Given that the majority of disabled people are on low incomes or are reliant on welfare payments, their choice is effectively limited to services chosen for them by the local authority social services department”. Barnes et al (1999) cited in Kemshall and Littlechild (2000) p 218 On the same subject, Hugman (1998) cited in Kemshall , stresses that these services are made possible through the tax payers money and the same people paying into the taxes are the professionals that control the budgets which poses are a question to the idea of choice made by the consumer. The government cost cutting scheme has negatively affected welfare services, making reference to empowerment and choice meaningless.
The power I hold as a social worker, could be used constructively as a useful tool for empowering this family in order to take steps to combat the imbalances that exist between us, and, if used appropriately can enhance their lives, whereas abuse of this power would reinforce the power imbalance and oppression. These power issues can be used to inform my practice and as Stein (1976) in Williams, F. (1989:172) suggests, ‘the relationship between races, social classes and between helping professionals and their clients are all variations of unequal power relations in society’. The power imbalance between white social workers supporting ethnic minority clients, places the professional on a privileged position, this may contribute to discrimination and oppression. Thompson (2003).
It is possible then to address these imbalances of power, discrimination and oppression? By developing an understanding of the concept of ‘race’ and cultural differences and identities and oppression. Race and oppression cannot be fully understood without also understanding the notion of power and as Thompson distinguishes “the social worker may not be sufficiently sensitive to issues of power/powerlessness and oppression”. Thompson 2001: 139. As it has been argued by Thompson (2003:p49,80) that a sophisticated understanding of the presentations of power and its significance within social work are crucial in order to challenge inequality, discrimination and oppression. (Total of 3660 words)
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