Good practice: adults

Good practice adultsGood Practice Adults This assignment ordain focus on a case from practice, demonstrating the challenges in promoting independence specifically in vulnerable elderly adults while balancing risk and autonomy. Further more, this work impart demonstrate problem solving skills, drawing on legislation, research and principles of good practice in the context of Adult Services from an inter-professional perspective.The Department Of Health defines a vulnerable person asSome one(a) who is or whitethorn be in encounter of community c ar work by reason of mental or otherwise dis susceptibility, age or illness and who is or may be unable to take keeping of him or herself against significant harm or exploitation. (DOH 1999).Background of caseMrs A is eighty two years old, has mild learning difficulties and fails unaccompanied in her own home since the death of her husband one year ago. She has a daughter who visits occasionally due to their difficult relationship. Mrs A was referred by her GP as she had been feeling unwell for nigh time she has diabetes and sometimes forgets to take her medication. Mrs A has refused service in the past by various sustentation services due to lack of trust and sees their involvement as an rape in her private life. encountering within the field of the elderly in adult affectionate services is described as geriatric mixer Work (Nathanson and Tirrito 1998). There be specifics needs that honest-to-god batch experience, the more informed a social worker is ab discover the elderly and their requirements the better chances argon that the social worker will endure the safe services.It is essential to gain a outdoors intellectual of stinting, social and cultural factors and life perspective followed by an understanding of the need for service.The Valuing throng policy is the first White Paper in almost forty years since Better Services for the Mentally Handicapped (1971).The get under ones skin then w as to close large institutions and to integrate people into the community (www.mind.org.uk). Valuing People aimed to transform the lives of adults and children with learning disabilities through a person-centred approach and to enable people to begin empowered in order for them to be included in society. This policy is one in a series of policies that are an example of the political device driver of change such as the White Paper, Our Health, Our Care, Our Say A New Direction for Community Services (2006) that are aiming to transform social caution and to turn in service users more choice and to wanton away the system more personalised (Johnson Williams, 2007).The 1989 White Paper, Caring for People states the duties of local health authorities to assess people needing social care and/or support. It is based on the as trades unionption that community care is the best form of care available. The White Paper states that the proposed changes are intend to, first of all, enable peo ple to live as normal a life as possible in their own homes or in a homely environment within the community. This is especially important in the long-term needs of the elderly, whom have long expressed their wish to be able to plosive speech sound in their homes. Furthermore, local authorities must rear the right amount of care and support to enable people to achieve maximum independence and provide people with a greater say in their lives and the services they need. This is particularly significant with elderly people. Many older people are not in need of 24-hour care that a nursing home would provide they may just need a small amount of help, maybe for a lucifer of hours a day. Although the majority of people over the age of 65 live independently and have no major care needs, a significant minority do have some problems with physical and mental health. 1 in 10 elderly people suffer from forms of senile dementia. It can be seen that it is aboveboard day-to-day things that most elderly people require assistance with. Their main wish is clear they simply want to stay in their own homes or in the homes of their family. (HMSO 1989).The affectionate Worker requires Mrs As consent to an opinion and if eligible, a care plan, while making it clear that she has the right to refuse. When on the job(p) in confederation with a service user and their family, the worker needs to take account of Trevthicks (2002) fifteen points to effective partnership working. These include explaining to the family their role and power to intervene. A clear mandate is the basis of a partnership-based intervention and sensitivity given to power imbalances involving family consultation and participation in decision-making and problem solving (Bray 2001). The whole team working with Mrs A have a debt instrument to be aware of her individual rights to confidentiality, choice, dignity, respect, autonomy, cultural, and equity. Elderly people need to be active participants rather than a ctive recipients. The depute is not to look after, but to motivate, empower and promote self-esteem. (Hughes et al 1995).A number of vulnerable adults are oblivious to the fact that they need any help thitherfore it is essential that when a concern is highlighted, it is acted upon instantly to prevent the situation deteriorating. Many adults are also too proud to ask for help and as a result recognition of their vulnerability is only identified as shown in Mrs As case by a GP. Detection of vulnerability may also be triggered by an admission to hospital or a concernedfriend or family member contacting the social services department. During a visit by the social worker, it is clear that Mrs A had been earnestly neglecting her needs she is underweight and neglecting her hygiene. The misuse of medication is in itself a risk of covert self tread, and could have resulted in her death. plague can take place in many contrary contexts and it is important not to exploit a vulnerable pers ons civil rights. Mrs A has mistrust with other people becoming involved in her life. Therefore when and how to intervene builds on the concept of significant harm introduced in the Childrens second. When making an sagaciousness of an individual, many factors need to be considered, for example, the extent of vulnerability and risk of repeated acts that meet the criteria of the Community Care Act 1990. To ignore the assessment of older people can be an example of ageism in its own right, contributing to an elderly person feeling disempowered.Assumptions about older people include older people are poor, lonely, are ill, no longer contributing to the economy and seen as a burden. When working with older people it is important not to make these stereotypical assumptions and generalise. non all the elderly have the same characteristics a sixty five and a ninety year old are classed as one group. Although age is inevitable, and people experience similar patterns and problems of aging, there are also wide-spread differences in aging patterns (Applewhite 19985). Acknowledging that each individual will be at a different stage in his or her life, needs and circumstances will vary, including different ethnic minority groups to avoid making ageist assumptions and avoiding all stereotypes and stigmas. To work effectively with older people, one must develop anti ageist practice. Midwinter (1993) says that old age is like having returned to a second childhood where others will make decisions for you. Working in partnership, the Social Worker and the GP/nurse may encourage Mrs A to engage respite care (enablement) for up to six weeks to avoid being admitted to hospital. During respite care an assessment of her needs will evaluate the level of support that will be indispensable (if any) when Mrs A returns to her home. Mrs As daughter may request that her buzz off be put into a care home, while Mrs A is adamant that she can care for herself at home with some support. With in the risk assessment process family members may worry about the social workers ability to recognize potential risk for their relatives, therefore a balance between extending barriers in some areas of risk and minimizing risk in others areas needs to be made. Using a utilitarian approach, it is the social workers job to assess the whole situation and work for a solution in the best interests of all concerned. (Banks 200128). The Social Workers ultimate aim is to support Mrs As rights to control her life and make informed choices about the services that she receives (GSCC 1.1).Good practice dictates working in partnership with service users to encourage greater trust and empowerment of clients. In turn, they are likely to feel more confident in talking about their fears, and worries and possible abuse. Health and Social care agencies working together is only a part of an overall scheme to protect vulnerable adults from abuse. Enabling service users to recognise abuse and knowing h ow to alert others to this is another strategy. It also ensures an agreed approach that all involved are aware of and can monitor. Protection is provided by the clarity of the situation. It is important that health and care social workers act as good role models in wrong of worker-user relationships as this helps the service user to recognise when the relationship is abusive. In addition, it is important for professionals to enable service users to know how to protect themselves, such as building absolute self-esteem through knowing their rights and knowing how to complain. (Public Interest Disclosure Act 1998).An Adult Protection policy will identify and help support Mrs As decisions for her care and help her to understand risks and the services available to her. The social worker has to constantly question their own judgement and ensure they listen to the service users escort while assessing if Mrs A is capable of making an informed choice taking into account her rights and the needs of her family. It is a requirement to assess if Mrs A has the expertness to make her own decisions and if she is incapable by reason, for instance, of mental illness under the Mental Capacity Act 2005, the decision will be made for her. If it is deemed that Mrs A has capacity she has the right to live in whatever way she chooses should her choice includes staying at home without help from services her health could be at risk and she may enter a revolving door policy in and out of health care provision. Providing support to Mrs A does not eliminate her susceptibility. If an individual is living alone and receiving services to support their needs, they still have a level of vulnerability. Elderly people at home are more at risk from abuse by strangers than if they were living in supported accommodation. They are at risk from people calling and gaining access through force or intimidation, who either sneak from them or charge very expensive rates for minor repairs. They are al so at risk from physical and sexual abuse as there is no one there to stop the perpetrator. Mrs A has health and social care needs and is seen to be at risk from self-neglect and possibly neglect by others, including services if insufficient or inappropriate support is provided to adequately support her well being. (Pritchard, J 2008).Home may be Mrs As choice, however the assessment will consider balancing risk and autonomy. The social worker can identify Mrs As strengths and skills and identify ways in which these can be alter upon. There are services available that can supply security systems to protect from theft, and physical abuse, and other environmental variables, these are implemented with clear guidelines and the coordination of multi self-confidence workers, working together to deliver a programme of care in the best interest of Mrs As needs and individual choices. Parsloe (1999) stresses that there is a operose presumption that older people should exercise choice and be given opportunities to take risks towards maintaining their independence and self-determination unless or until their capacity to do so is seriously impaired. This notion is acceptable, but as seen with Mrs A there is also a high risk of illness due to poor self medication this is sometimes overlooked as the risk-taking model is more promoted than risk minimisation. People are allowed to take a well-informed risk so long as they do not endanger themselves or others GSCC (2002). A presumption in this case is that Mrs A has capacity the challenge here is to recognise that service users have the right to take risks and helping them to identify and manage potential and actual risks to themselves and others (GSCC 4.1). The provision of the practice setting is governed by law which consists of primary and secondary legislation together with government guidance which must be followed by all local authorities. Section 46 of the National Health Service and Community Care Act (1990) sets o ut community care plans and lists the available services which include laundry services, meals on wheels, social work support and residential care. This act places a duty under section 47 on social workers to conduct a needs-led assessment if it is apparent that a person might need community care service. Once a community care assessment is carried out, the care manager will make a decision about whether to provide support or not to the service user. Fair Access to Care Services (FACS) provides an eligibility framework for adult social care to identify whether or not the duty to provide services is triggered. Should the criteria be met, a multi disciplinary team approach working together to ensure Mrs As choice to stay at home is predominant with regard to her rehabilitation and care plan. The team have a duty to provide a network of support that promotes independence and to monitor Mrs As ability to care for herself in the community. Multi-agency working of care planning and the s ingle assessment process has encouraged greater inter-agency working together, with the clients needs being central to the process. quite an than working separately, and each agency providing their own service without reference to the others, joint working encourages a sharing of approach and less replication of services. A control of Individual Budgets was introduced for two years in 2005 to 13 local authorities. Individual Budgets is a system that brings resources together from different funding streams into a single sum that can be spent flexibly in accordance with a service users needs and preferences. Service users are free to choose the money as a prepare payment or request the local authority to provide services, or even use a mixture of both A care worker can be sought from the LA or a personal assistant (PA) appointed by Mrs A , paid for with direct payments ensure that her autonomy and choice is maintained. In practice, an agreement can be made to review Mrs As care and remove the care if it not required or increase the care package should additional need be identified at a future review.Direct payment stems from the four principles of Valuing People that are rights, inclusion, choice and independence. The Governments vision was that the uptake of direct payments would give people more choice in how they choose to live their lives. However, the uptake of direct payments since the origination of the Community Care (Direct Payments) Act (1997) had been slow, mainly due to a lack of awareness and people, including professionals, can be very wary of change and taking on the unknown.The government therefore introduced new legislation in 2003 to make it a duty for local authorities to offer direct payments (www.dh.gov.uk), but figures (2006) reveal that out of a possible million people only around 46,000 had taken up direct payments (www.eastern.csip.org.uk). It raised issues that service users experienced and set out football team objectives which inc luded people facing lack of choice and control, social isolation, housing, health, and poor partnership between professional agencies, voluntary groups and families. The main stakeholders from the implementation of Valuing People are people with learning disabilities themselves and their families/carers, as they were instrumental in pushing the government to push through the policy.The government is clearly one of the main stakeholders and it could be argued that this was an economic driver of change. Latest figures from the Individual Budgets Pilot study reveal that the cost of people using budgets compared to commissioned services is not much different, but long-term, costs will be reduced as people become more independent and their support hours are reduced (www.dh.gov.uk). The introduction of Putting People First, promul penetrationd by the DH in December 2007is a shared vision and commitment to the transformation of adult social care over a period of leash years. Key elements are prevention, early intervention and re-enablement, personalisation, information, advice and advocacy. This presents change for people who receive services and importantly for social care workers that will need to implement these changes in their work. The changes in social care that have been taking place since the policy have meant that the role of the social worker is changing and the publication of the Local billet Circular Transforming Social Care (20084) described the role of the social worker as being focused on advocacy and brokerage, rather than assessment and gate keeping. This involves improved skills in listening, working in partnership with service users, families and other professionals and empowering people to take control of their lives. The changes are proving challenging because it means a displacement in the balance of power and allowing people to take more risks. A person-centred approach to supporting Mrs A is the method used within this case study, beforeh and direct payments this had been more about supporting people in the community.The principles ofrights, inclusion, choice and independence set out as the vision in Valuing People have clearly been achieved in some peoples lives, and is effective for service users such as Mrs A who prefer to maintain their privacy at home and choice of care through direct payment. It can be seen to transform service users lives in that they are living independently and feel included in society.There are many people living in residential care they spend most of their hours in centres and lead very oppressive lives.McCabe,M. (200612) describes the failings of institutional care as having fixed routine, lack of choice, dependence on others and lack of privacy and community care creating maximum dependency.However, care needs to be taken so that people are still supported when they do live independently, specifically service users who have spent years in residential care and not prepared them to live i n their own homes adequate risk assessments are needed to address any areas that could leave them vulnerable. ReferencesApplewhite, S. (1998) Elders and the Twenty-First Century. Issues andChallenges for Culturally Competent Research and Practice.New York Haworth.Banks, S. (2001). Ethics and value in Social Work 2nd ed. Basingstoke, Hampshire Palgrave Publishers. Department of Health (2001) Valuing People. capital of the United Kingdom Department of Health.Department of Health (2001) National service framework for older people. 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