Assessment Care Adult

The purpose of this assignment is to discuss the approaches and models of assessment, which can provide possible insights and better understanding to the presenting issues in the case study. The essay will begin by giving a brief overview of the issues that are present within this family. It will then outline the purpose of an assessment and critically evaluate models of assessment. For the purpose of this essay it will explore two concepts namely abuse and memory loss focussing mainly on Ted. This essay aims to critically evaluate the research and theory that underpin the concepts. It will define abuse and elder abuse; discuss risk factors for elder mistreatment. Various causes of memory loss will be discussed. The issues of discrimination that older people endure will be highlighted.

The issues presented in the case study are; Queenie has moved to long-term care in a residential home. She was Ted’s carer for over 18 months. Ted is in need of care and has asked his daughters to share looking after him. Ted is reported of having an authoritarian approach to parenting. He suffers from chronic arthritis in his legs, has suffered from a mild stroke and has weakness in one of his arms. Ted has been reported of presenting as being confused and is experiencing forgetfulness. He has bruises on his arms and chest; there is a possibility that he is undernourished and dehydrated. Regan is an informal carer and looks after her father Ted. She has moved in with Ted. Regan is experiencing increased difficulties in balancing her 25 hours part time bar work and looking after Ted. She has been drinking heavily and has increased her involvement with her father’s financial affairs. Regan has declined offer from her sister Cordelia in looking after her father, she also discourages her from visiting Ted. Regan is a victim of domestic violence.

McDonald (2006, p31) defined assessment as “a perceptual, analytic process of selecting, categorising, organising and synthesising data”. This means gathering of information, evaluating it to identify areas of strengths and difficulties and explore plans in order to achieve preferred scenario. Thompson (2005, p64) highlighted that assessment is a “holistic process” that takes into account all relevant and interactive domains. Trevithick (2006) stated that the purpose of an assessment is to assist people sustain their livelihood and decrease deterioration. Stepney and Ford (2000) suggested that choosing the right model of assessment determines the quality of the assessment. Coulshed and Orme (2006) described two approaches to assessments namely positivists and constructivists. Positivist approach is on the assumption that undertaking an assessment requires a person to have good “administrative” and interpersonal skills. This helps people to address, identify and respond appropriately to issues that are affecting them. Berger and Luckman cited in Coulshed and Orme (2006) highlighted that the constructivist approach is based on the notion that individuals are able to identify their problems and can contribute to recognizing their needs or solutions. Therefore it is important that social workers are open and honest to service users in what can be offered.

The government’s publication on multi agency working ‘no secrets’ cited in department of health(DOH) (2000) required joint working between health , social services and primary care groups in relation to protecting vulnerable adults. In the case study, the social work would work in partnership with the General Practitioner (GP), housing department, Occupational Therapist, Physiotherapist and the family.

Smale and Tuson cited in Milner and O’Byrne (2002) identified models of assessment that help workers in exploring the needs, risks and resources that suited service users. By using the questioning model, Milner and O’Byrne (2002) stated that the worker derives information from clients by asking standardised questions. The model assumes that the worker has the expertise of the perceived issue. This can be seen as disempowering and oppressive because people are individuals and react to things differently. Sharkey (2007, p72) argued that thequestioningmodel also concentrates mainlyon theservice users’ needs andfails to considerother accessible servicesthat could be of benefit to a person.

In the procedural model, Sharkey (2007) stated that the worker follows the agency’s procedures to identify the criteria for needs. This method involves filling in extensive forms and can disadvantage a service user, Coulshed and Orme (2006) argued that the workers are inclined to focus more on producing data rather than the individual. Smale and Tuson cited in Milner and O’Byrne (2002, p53) defined the exchange model as an “empowering approach”. In this model, Milner and O’Byrne (2002.p53) suggested that service users are seen as “experts on their own problems”. In this approach the client is put at the centre of the assessment. This model assumes that professionals do not have all the answers and the clients have the potential to solve their own problems. Sharkey (2007) stated that this model can be seen as oppressive citing medical professionals who ignore the views of the clients assuming that they are highly skilled. On the other hand, McDonald (2006) stated that this approach upholds people’s dignity, in that there is no intrusion into people’s privacy with unnecessary questions. The three models of assessments can provide with a good quality of assessment depending on the purpose and objective of the assessment.

The DOH (2000) defined a vulnerable adult as a person who is 18 years and over. A person “who is or may be in need of community care services by reason of mental or other disability, age or illness; or may be unable to take care of him or herself, or unable to protect him or herself against significant harm”. From this perspective it can be argued that Ted is a vulnerable adult.

Help the Aged (2007) postulated that “ elder abuse occurs when an older person is harmed, mistreated, exploited or neglected by someone they know and should be able to trust”. Wolf cited in Pillemer and Wolf (1986) described abuse in three forms; the physical form involves imprisoning a person, signs of bruised skin and causing an individual to endure pain. Physiological abuse involves verbal abuse and intimidation, material abuse involved misuse of a person’s resources.

Ted has been reported of having bruises, according to Hudson cited in Pillemer and Wolf (1986), it can be difficult to determine whether the presence of bruising in an older person has been caused by abuse. This is because of the physiological changes that develop with ageing and the skin. Page (2001) stated that the skin of an older person becomes thinner and prone to rupture as a person becomes older. Page (2001) further stated that in old age the bones become softer and fracture easily. On the basis of this hypothesis, there is a possibility that Ted’s bruises could have been caused by old age. Tanya cited in Pillemer and Wolf (1986) was on the view that, a carer’s value or lack of knowledge on balancing diet could impact on the older person negatively causing malnourishment. In that case, they argued that it creates an ethical dilemma because the intention is not of harming a person. eMedicineHealth (2005) stated that dehydration can be caused by over exposure in the sun, “fever, vomiting and diarrhoea”. Bryant (2007) stated that older people intentionally avoid drinking fluids in order to avoid frequenting the toilet. According to Bryant (2007), getting older can also attribute to dehydration as the skin gets thinner it increases evaporation. Copeman and Hyland cited in Bryant (2007) identified other factors that contribute to dehydration as; drugs that reduce fluids, “immobility, confusion, drowsiness and depression”. From this aspect it can be difficult to determine whether dehydration has been caused by neglect unless there is there is a medical assessment. Therefore there is a possibility that Ted’s dehydration could be caused by confusion or the aging process of the skin.

Wolf cited in Pillemer and Wolf (1986) stated that neglect could be intentional or unintentional because of the carer’s lack of knowledge or lack of resources.

Wilber and Reynolds cited in Landau (1998) suggested thatfinancial and other material misuse involves stealing, “extortion, and force”, of which could result to deprivation of the elderly. According to Johnson cited in Landau (1998) it is difficult to detect financial abusedue to the victim’s trust on their perpetratorsin managing their financial affairs. The elder person could also be forgetting and misusing his money. There is a possibility that Ted could be misusing his money.

Landau (1998) stated that self-neglect derives from the older person’s lack of desire or lack of competence to meet his or her basic needs. On the other hand, Twigg (2000) pointed out that in old age support with personal care can be humiliating and degrading; especially if it is done by an offspring identity of being a parent is lost. From this aspect it could be argued that there is a possibility that Tom is neglecting himself.

Ted has also been reported of experiencing forgetfulness and confusion. Brotchie (2003, p4) stated that this could be attributed to many factors; a person may present as being confused due to ailments such as “chest and urinary infections”. Changes such as death and separation from a loved one can lead to a phase of confusion. This could lead to depression, acute depression can be perceived as dementia. Brotchie (2003) suggested that people who suffer from depression may experience low level of motivation, they may not remember to eat, avoid personal care and present as in disarray. A mixture of liquor and medication can also cause confusion. Head tremors can also cause a person to be confused. Coyne and Mares (1995) suggested that memory can be affected as a result of a stroke.

Brotchie (2003, p2) described dementia as a “group of symptoms which result from the destruction of brain cells”. Brotchie (2003) postulated that there is no specific symptom of dementia. People are different and dementia progresses according to their individual circumstances. Brotchie (2003) defined the general symptoms of dementia as; memory loss, this escalates with time, however not all signs of memory loss are linked to dementia. The other signs are changes in personality, inability to communicate and loss of practical skills. Davies (2000) described Alzheimer’s disease as a common cause of dementia stating that it is more common in old age. Other symptoms of Alzheimer’s include; “changes in behaviour, mood, thought auditory and visual hallucinations”. Brotchie (2003, p5) stated Alzheimer’s can only be diagnosed through a post mortem of the brain or a “brain biopsy”.

There is a possibility that Ted is developing dementia, however caution needs to be exercised when assessing Ted because it could also be possible that he is depressed because of the recent changes in his life, like his wife and carer going into a residential home. A medical assessment could provide with a possible diagnosis of the problem, in that the case the social worker would liaise with the GP. Regan is reported of discouraging her sister’s visit to see Ted, it is not clear if Regan tries to discourage other people from visiting Ted, if this is so then Ted could be experiencing loneliness which the Audit Commission 2004b cited in Joseph Rowntree (JRF) (2006) stated was a cause of ”anxiety and depression”. Andrews et al. cited in JRF (2006) was on the view that “life satisfaction and psychological wellbeing among older people are influenced to some degree by their levels of social activity and contact.”

Decalmer and Glendenning cited in McDonald (2006) proposed three theories on why elder abuse occurs. The “situational model” described by McDonald (2006, p56) is based on the fact that elder abuse occurs if the victim is socially segregated or is financially strained. It is also on the premise that the perpetrators ill health, stress and inability to cope with the pressure of work can lead to abuse. McDonald (2006.p56) stated the social exchange theory is on the premises that “social interaction involves a balance of rewards and punishment” which are triggered because the vulnerable person is reliant on their carer. Philips cited in Pillemer and Wolf (1986, p207) stated that “symbolic interactionism “assumes that people take on new roles over a period of time depending on the changing circumstances.

Pillemer cited in Pillemer and Wolf (1986) suggested that elder abuse can occur if the perpetrator suffers from mental illness or abuses drugs. The past relationship could harbor unsettled conflicts. Cicirelli cited in Pillemer and Wolf (1986) argued that elder abuse could develop because of the demanding selfish nature that comes with ageing. However not all older people are of this nature and this is stereotyping older people.

Walsh et, al. (2007) stated that children abused their older parents in revenge of how they were treated when they were young. Walsh et al (2007) pointed out that the negative perception of old people in society causes them to be stereotyped as unproductive with no value to society. Landau (1998) stated that the carer could be stressed because of pressure from work load, undergoing personal problems and unable to organise themselves. The effect of this could be the carer using violence on the older person.

Penhale (1993) was on the view that elder abuse can go undiscovered because of non-disclosure by the victim. Some of the reasons that hinder older people from disclosing abuse were defined by Penhale (1993) as; the older person could be reliant on the perpetrator for providing care. They could also be scared of disclosing in case it results to being accommodated in residential setting. The older person may hold himself or herself responsible for the abuse. Steinmetz cited in Penhale (1993) stated that if the perpetrator is the victim’s child, the victim can refuse to disclose because of “guilt and stigma at having raised a child who abuses them”. Block quoted in Champlin, cited in Penhale (1993) suggested that the victim could be protecting the family’s status in society by preserving their reputation within their neighbourhood. Ted appears to be affluent because of his savings and comfortable house, this could mean he is respected in his community and could be avoiding loosing his respect and status.

Finch (1984, p240) stated that family members take on the role of caring because of “obligation and duty “, this is done out of moral obligation rather than “individual feelings or emotions”. Finch (1984, p209) was on the view that older parents use “emotional blackmail” prompting their children to look after them. Finch (1984) suggested that family members also undertake caring out of humanitarian and benevolence grounds. Sharkey (2007) highlighted that in some communities there is a cultural expectation that children will look after their parents in old age, in accordance with order of hierarchy.

In conclusion, this essay has explored different pieces of research and theory that provide possible explanations of the issues identified in relation to Ted. It has shown that defining abuse is a complex issue that requires the expertise of both the health and social services. It has also highlighted the discrimination that older people endure in society.

References

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