Battling Against the Odds? Older People, Care Practitioners and Person-centred Care

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1 Battling Against the Odds? Older People, Care Practitioners and Person-centred Care AGEnet Research Network Sally Richards School of Health and Social Care University of Reading

2 Person-centred Care As policy As experienced by older people In assessment of care needs

3 Standard 2 Person-centred Care NHS and social care services treat older people as individuals and enable them to make choices about their own care. This is achieved through the single assessment process, integrated commissioning arrangements and integrated provision of services, including community equipment and continence services. Department of Health (2001) National Service Framework for Older People (Emphasis added).

4 Department of Health (2001) National Service Framework for Older People. Person-centred care requires managers and professionals to: Listen to older people Respect their dignity and privacy Recognise individual differences and specific needs including cultural and religious differences Enable older people to make informed choices, involving them in all decisions about their needs and care Provide co-ordinated and integrated service responses Involve and support carers whenever necessary.

5 Older People and Primary Health Care 17 focus groups with older people aged Primary Health Care Teams Groups Hypertension (8) At risk (5) Frequent attenders (2) Nurse-practitioner (2)

6 Good Primary Health Care the views of older people Access to help when it matters Friendly service which puts you at ease Team members who get to know older people; take time to listen, inform and explain Practitioners who inspire confidence by being skilful and thorough Pro-active care Good access to other services.

7 A User Friendly Service Familiar place Familiar people Organisational continuity Service matches or exceeds expectations Staff roles and responsibilities are clear Service available to all

8 I hadn t been in the bath for about two years. I d been sitting on the loo, the wash bowl is handy, and washing myself down. My doctor asked me would I have a social worker to see me at home. I said, oh yes. I thought I d like to talk to them and ask them if they could advise me. I only wanted advice. I got a phone call from the Social Services but all he would say to me was have you got 16,000 in the Bank? Have you got 16,000?. In the end, I came off in loads of tears and he said to me you see your doctor hasn t told me your financial circumstances. Ann aged 80-84, At Risk

9 An Ethnographic Study of the Care Needs Assessment of Older People Study of the assessment process from referral to the end of assessment In a social services community team and a hospital social work team Observation; interviews; case studies of individual assessments

10 Mrs Hammond: I've heard people talk about the welfare officer coming to see you and such forth. But beyond that I...you see we've never had anything to do with any of this before. R: It's new to you? Mrs Hammond: You see everything's so new that I can't sort of answer the question you want. R: You were saying that you've heard people talk about the welfare officer coming, did you have any ideas at all about what that might mean? Has anybody you know had the welfare officer? Mrs Hammond: No.

11 Assessment Objectives To understand individual circumstances and aspirations as a basis for decision making (person-centred perspective) To obtain information to justify and support intervention (agency-centred perspective)

12 Potential Barriers to Personcentred Process/Outcomes Meeting of strangers Limited time Sensory/cognitive impairment Environment Referral Eligibility criteria Charging policies Extensive form filling Information gathering/providing inappropriate to older person s starting point.

13 Entering Assessment - Decided Mr and Mrs Hammond (85) were housebound. Mrs H had arthritis, Mr H had severe breathing problems. They slept downstairs in armchairs and stripwashed in front of the fire. Their daughter did the shopping and laundry. They wanted meals on wheels and someone to bath them and do cleaning.

14 Entering Assessment - Undecided Mrs Allan (87) was in hospital after falling at home. Despite impaired vision, severe arthritis and other health problems, Mrs Allan wanted to return home. But she worried about becoming a burden to her friends and neighbours.

15 Entering Assessment - Overwhelmed Mr Reynolds (84) lived alone. He was admitted to an acute ward with septicaemia and then transferred to a rehabilitation unit. He seemed mildly confused and his daughter did not think he was capable of living alone again. The MDT agreed that he would be at constant risk of falling and needed a care-home place.

16 If I had more time, more space in my diary, there are a lot of people like Mr Reynolds that I'd like to spend some time with. Just to make sure that he really does want what's happening to him, that he really has come to terms with the disability... And he's now losing his home, and we have not the time to address that. One would hope that the rest home will give him space to talk about that, because they have more time, but they're not skilled in counselling. At some point all they need is somebody to listen to them, to say something like "its OK, its alright to be sad about losing your home". Whether they will actually say that or not I don't know. It would be nice if we had, because we haven't the time to do it. I wish we did because it's really the most interesting bit of the job is that kind of work.