Arranging an appointment to visit Thomas and Yvette within their home, which they may be more comfortable in, as the care manager needs to take into account the venue when carrying out an assessment. The reason for an initial assessment would be to assess both Thomas and Yvette’s individual needs from their perspective and using the information gathered from the referring agency. The referring agency has stated that Yvette is eligible for residential care support for Thomas, the care manager should discuss with Yvette whether she is aware of what this option involves and does she want this for Thomas. Providing Yvette and Thomas with any published literature that outlines available services could help them to realise how external services could best help them maintain their independence, if this was their choice. Thomas ability to undertake any day to day tasks in his daily living arrangements would need further assessment.
One of the key aspects of care management and working in partnership is to inform the client and carer of the options that are available to them. By being open and honest with Yvette and Thomas about their choices and explaining to them their expressed wish does not necessarily mean they will receive them. The limited resources in local authority funding can prevent all clients’ needs being met. To safeguard both the service user and care manager, clear and concise written records should be complied at the initial contact stage outlining any differences or actions to be followed up. Additionally, consent should be received from the service user if any personal information is to be shared with any third party agencies in regard to assessing their case for services. Empowering Thomas and Yvette would be one of my prime aim’s as the care manager and I would hope to achieve this by including them throughout the assessment stages, i.e. updating them on any developments that happen (Payne, 1993, Payne 1995).
Providing information that may inform Thomas or Yvette’s decision regarding their care arrangements, promotes a sense of worth to the client. As well as allowing them to feel heard, which appears to be a one of the problem’s encountered by Yvette, i.e. other professionals making decisions for them. Focussing on the individual strengths of both Yvette and Thomas are paramount, so they don’t feel inadequate. Acknowledging with Yvette that she has done a good job by caring for Thomas and that it is totally acceptable for her to seek support or respite in order to have some time for herself. It is not uncommon for carers to feel guilty and experience feelings of loss when they agree to explore alternative options of care for their partners or relatives, as a professional they should be supported and offered therapeutic counselling, if identified (DOH, 1991, Orme and Glastonbury, 1993).
As there is some evidence to suggest that both Yvette and Thomas may have some difficulties in communicating and Yvette chooses to speak in Polish on occasions. It would be appropriate to offer them support during the visit with a Polish speaking interpreter, as this is their first language, as well as providing a chance for clear interpretation of their views. This would also provide a chance for both Thomas and Yvette to relate to someone from their own culture and empowering them to voice their feelings and wishes (DOH, 1991)
One of the aims in working with older people assessed to be in need is to work with them in a person - centred way. The person - centred approach enables the client to be at the forefront of the assessment process as well as promoting user participation throughout. Clients unable to communicate their personal wishes, due to a disability or a language barrier should always be given an option of having an independent advocate who can represent them. This will ensure their needs are recognised during the initial contact and assessment stages, which contribute to the decision-making process when determining the level and type of care provision they may receive.
In promoting Yvette’s wish to care for Thomas and their independence as a couple, it is especially important to acknowledge their ability to cope on their own, as Yvette has stated that she does not want any support and is suspicious of professionals. Yvette would need to be given some information to inform her decision of continuing as the prime carer for Thomas, as she has a right to have an assessment under the Carer’s and Disabled Children’s Act 2000. Safeguarding Thomas and supporting him would be of prime importance in the care manager’s role, establishing what his emotional health and physical health care were like, had it deteriorated and why?
By finding out if Yvette could continue to manage on her own as Thomas presents with high support needs. Thomas may also be frustrated that he is unable or has limited abilities to care for himself and is dependent on Yvette for care and support.
After determining the level of support required the care manager will assess the needs of Thomas and Yvette. The initial assessment process enables the care manager to draw up a care plan jointly with the client. It will outline the roles and responsibilities of supporting agencies and professionals who are involved, as well as serving as a useful tool outlining the aims and objectives. There is an element of reviewing, monitoring and evaluating the progress of the client and setting realistic time frames. The care manager can therefore address any discrepancies that may arise in regard to delivering the care, i.e. if a partnership agency fails to carry out a piece of work as agreed. By ensuring that the care manager does not lose sight of the necessary intervention or preventative services required by the client will help them during the reviewing and evaluation process later on (DOH, 1991, Smale, 1993).
The care manager’s role in regard to identifying, purchasing and providing suitable community care services is a partnership one, which should be undertaken in full collaboration with the client. Care managers need to determine creative and effective ways to co-ordinate care packages for older people and ensure that partnership agencies are not duplicating other areas of work being met by others. It is also important to realise that the care manager is not the expert and requires the skills from other professionals to meet the needs of the client.
Thomas and Yvette’s needs would be assessed taking into account Thomas’ physical, emotional, cultural and social needs and exploring other care arrangements for Thomas should Yvette be unable to care for Thomas at home. As discussed earlier Yvette has the right to have a Carer’s assessment carried out, so she is fully aware of her entitlement to financial support and additional services for Thomas.
As some older people may find it difficult to express themselves to some one in authority it is a good idea to suggest that if they have any questions at all after a meeting that it is alright for them to make contact to clarify anything they do not understand fully.
Yvette and Thomas have been independent by caring for one another before Thomas became unwell and Yvette became tired and exhausted, as the prime carer. The thought of having to make some changes in their lives and day to day routine would be a frightening experience for them to accept. Yvette and Thomas will need reassurance that any transitions in their care arrangements will be made as smoothly as possible.
Contingency arrangements would need to be agreed if the package of care provided at home either broke down or was not meeting the needs of Thomas, as hoped. The physical and emotional needs of Thomas will have to be taken into account therefore specialist services may be found to be more suitable at the interim stage, such as a day centre or residential nursing home. This would allow care professional’s to assess Thomas daily and monitor his health, providing Yvette with some respite during the week and provide homecare support at weekends to assist her with Thomas. Setting short term and long term plans within the care plan will allow for any changes that may have to occur later on and will also enable Thomas and Yvette to accept the need for help (Smale, 1995, Wenger, 1994).
One of the many difficulties that the care manager will encounter in assessing the needs of individual clients with complex care needs is that each situation is unique. Therefore a care plan has to be tailor made to the client’s care specifications and not moulded to accommodate the needs of an agency providing services.
The dilemma that can arise for the care manager delivering and coordinating a package of care is the overall costing of the services. After a financial assessment is carried out at the initial stages the client’s income may determine their ability to contribute to the services provided, in some cases clients will be unable to afford them and may choose to manage without support.
The quality of life for Thomas and Yvette is important, as is the ability to keep them together as a couple. It would be good for Yvette to be encouraged to accept support from community agencies, such as the referring agency that support carers and those in need from her community, as she may need ongoing support. The assessment process can be measured as being successful or not by evaluating the outcomes reached, receiving feedback from the client, carer and agencies providing a service. As the participants throughout will have met the different goals set out from the care plan.to ensure both Yvette’s and Thomas’ needs are met wherever possible.
The care management and networking models aim to achieve desirable outcomes for the client. In order for this to be successful it important to acknowledge a client’s personal identity and rights of choice to provide an appropriate service to them. Yvette and Thomas needs can be fully met if the care manager and others providing their care acknowledge these key factors throughout the assessment stage.
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Bibliography
Department of Health (1991) Care Management and Assessment: Practitioner’s Guide London, HMSO
Orme. J and Glastonbury.B (1993) Care Management London. Macmillan Press Ltd
Payne. M (1993) Linkages: Effective Networking in Social Care London, Whiting and Birch Ltd
Payne. M (1995) Social Work and Community Care London, Macmillan Press Ltd
Sharkey. P (1995) Introducing Community Care London, Collin’s Educational Ltd
Smale. G (1993) Empowerment, Assessment, Care Management and the Skilled
Helper London, HMSO
Soriano. F.I (1995) Conducting Needs Assessment: A Multidisciplinary Approach London Sage Publications
Wenger.G.C (1994) Support Networks of Older People: A Guide for Practitioners
Bangor, University of Wales
