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The role of a Social Worker relating to Older Adults with dementia in the community
This assignment will explore the role of a social worker considering older adults with dementia in the community. It will identify the intervention and services available and the impact of social work within this service user group, taking into consideration social, political and economic factors.
Social work is thought to have been influenced by the middle ages, when there was a breakdown in this feudal system due to famine and war; therefore, resulting in an increase of those in need. To resolve this problem, England passed several Poor Law’s between the mid-1300’s and mid-1800’s. The most significant was the Elizabethan Poor Law 1601 (Zastrow, 2009, pp.11-14), which was designed to maintain order and contribute to the general kingdom. This law gave the local government the power to raise taxes and use the funds to build/maintain Almhouse’s (Hansen, 2011), to provide sheltered relief for the less fortunate and vulnerable. This law set the pattern of public relief under government responsibility in Great Britain for the next 300 years, shaping the social work of today.
Social work is aimed to bring about positive change in people’s lives for individuals, families and the community (Adams, 2010, pp. 4-6). It is a profession that promotes social change and problem solving, to empower and enhance the well-being of service users (SU). Social work is an extremely diverse profession that works with a diverse range of service users; therefore, requires many to work in key specialisms such as children and families, young offender’s, learning disabilities and older people (Beckett and Horner, 2016, p.36), they must therefore ensure they have the adequate knowledge relating to their specific area, such as dementia. Dementia is a progressive cognitive condition resulting in it becoming increasingly difficult for an individual to maintain their level of independence (Lymbery, 2008, p.28).
Many social workers do not perform one single role but in fact participate in a combination of roles and may work in a variety of settings within a framework of relevant legislation and procedures to support individuals, families and groups within the community. The Professional Capabilities Framework applies to all social workers in all settings (BASW, 2018). It provides a shared understanding of what is expected of social workers across the profession and at different levels. The framework consists of nine domains which sets out how a professional social worker should practice.
To be able to practice effectively, the social worker must use essential knowledge, skills and values to respond effectively to people’s needs and aspirations (Marshall, 1990). Social work assistance may be required when an individual becomes physically or mentally unable to cope with everyday independence (Adams, 2010, p.156). Their aim is to provide practical and emotional support and to identify services that the SU and their family may require, maximising their quality of life and identifying possible safeguarding issues. It is a social workers duty to protect vulnerable individuals from risk, abuse and neglect.
In 2014, the Care Act was introduced, which condensed many existing laws regarding safeguarding adults. This gives professionals a statutory responsibility to protect adults to have the right to live in safety, free from abuse and neglect (Skillsforcare, 2014).
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Communication plays a vital role in effective social work practice both with the SU, family and other social workers/professionals. It is important that social workers have the capacity to adapt their communication skills to different contexts, as it is central when assessing, planning and coordinating a case (Adams, 2010, pp. 141-146). Communication skills include verbal, non-verbal and written aspects. When working with individuals with dementia, it is important to recognise non-verbal communication, as the SU may be unable to express themselves verbally. Such situations should be approached in a sensitive manor as the SU may be aware of their increasing vulnerability; therefore, a level of respect and empathy should be used, this may also help aid the forming of trust between services and the individual.
Effective communication skills will also be useful when applying basic aspects of counselling. Although a social worker is not a qualified counsellor, it will be inevitable when providing emotional support for individuals, as they are likely to be experiencing high levels of stress at the point that they require social work assistance (Adams, 2010, p. 156). Although, it is important to recognise the limits of one’s knowledge and professional role within such aspects.
As a social worker, it may be required that they need to act as an advocate for the SU to represent them by ensuring their voice is heard to share their views, perceptions or wishes.
Empowerment has become a significant concept in social work practice. It involves giving the SU choice and control in their lives (Maclean and Harrison, 2015, p.33). Its origins lie in seeking to connect the personal problems in peoples lives, including personal issues, to wider social and political issues whilst addressing inequalities. Empowering individuals can be carried out by promoting independence where possible, this will promote self-esteem and general wellbeing of the SU using a holistic person-centred approach (Maclean and Harrison, 2015, pp. 33-36).
Social work theories are general explanations that are supported by evidence obtained through the scientific method. Having the knowledge of a range of theories may help to understand why a person may be behaving in a particular way. Using theories can help to explain practice to the SU/families and can specifically relate to their current situation (Maclean and Harrison, 2015, pp. 9-11). For example, Eric Erikson’s (1950, cited in Maclean and Harrison, 2015, p. 97) developmental theory argued that there are eight stages in human development. Stage eight (integrity vs despair) specifically focused on older adults, stating that at this stage they may reflect on past life and feel a sense of satisfaction or disappointment, which may affect the emotional/psychological being in later life. This is particularly useful to consider when working with older adults at a specific stage in their life to understand how they may being feeling.
The way in which these roles are carried out can involve direct work, in which a social worker uses their interactions with the SU as a means of facilitating positive change by acting as an advisor, mediator, educator and catalyst. Another way in which it can be carried out is by taking an executive role, which draws on external resources therefore acting as a gatekeeper, care manager, responsibility holder, control agent, co-ordinator and service developer (Beckett and Horner, 2016, p.20).
The root of the profession is underpinned by core professional values which relate to human, legal and civil rights of the SU, the equality, dignity and worth of the individual to protect from discrimination and prejudice whilst maintaining person autonomy, independence and freedom of choice (CommunityCare, 2010). They therefore must be sensitive to cultural and ethnic diversity and strive to end discrimination, oppression and other forms of social injustice such as Ageism.
The PCS Model, defined by Professor Neil Thompson (2005) refers to the need to recognise discrimination and the focus of anti-discriminatory practice. It is presented at three separate, but interrelated levels known as personal, structural and cultural which links personal experience, beliefs and attitudes with the wider social group. It recognises that discrimination is not just an individual issue, but is also present within cultural and social structures and networks. This attempts to explain how and why discrimination occurs and therefore leads to internalised oppression (Coventry, No date).
Social workers that specialise in working with dementia, must first acknowledge how devastating it can be for both the SU and their family. Usually when a referral is received, it will be at a point when the SU and their family are near to their limits of coping (Dobrof, 1986, p. 56). It is therefore important to consider both SU and their family/carers when assessing, to ensure all needs and circumstances are identified, evaluated and responded to adequately (Davies, 2012, p.278). Assessment under the Mental Capacity Act (2005, cited in Walker and Crawford, 2014, p. 160) is essential for the SU, as it is important not to deny them their right to make unsupported decisions, even when the liberty of the individual is at stake. The SU should be at the heart of decision making (McDonald, 2010, p.137).
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Social work with older people takes place in various settings; such as, sheltered housing, residential homes, nursing homes, day services and domiciliary care (Adams, 2010, p.154). The SU and their carers should receive person-centred care and services which respect them as individuals and which are arranged around their needs (DoH, 2001).
Although the SU is at the centre of the social work intervention, it is legal policy to consider the carers needs within the process. The Care Act (2014) sets out these obligations to consider a ‘carers assessment’ to highlight caring capabilities and any support they may need including emotional, practical and financial.
The process of intervention should identify the most appropriate ways of achieving the objectives set out in the assessment of need, for both SU and carers (McDonald, 2010, p. 72). It is likely that as a result of an assessment, a care plan will be considered to identify service providers, relevant resources and positive outcomes.
There is a vast amount of interventions available for both SU and Carer/family, they may include a variety of group activities or day services run by charitable organizations such as Outreach UK (OutreachUK, 2017) or Alzheimer’s Society (AlzheimersSocietyUK, 2017). Day centres provide quality time for the person with dementia and invaluable respite breaks for their carers (SkillsForCare, 2012). There are many support services available to enable the SU and their carer to keep socially included by attending events such as a Dementia Café, this gives the opportunity to meet new people and speak freely to others in a similar situation (BPS, 2014). All the above examples enable the SU to maintain a sense of independence, improve physical functioning, increase confidence and continue to participate in society (Kerr, et al. (2005). Sometimes changes to the social or physical environment can be effective at improving well-being and reducing unwanted behaviors.
The main focus for the SU is to allow them to stay at home for as long as possible, but when the needs of the SU and family/carer becomes too great, the social worker will assist to get the SU home help in the form of domiciliary care, to help aid their independence (Berkham, 2006, p.123). As a person’s dementia progresses, they will need more support and care, and there may come a time where full-time residential or nursing care is needed. Care homes give people with dementia the chance to live in a home environment with trained staff on hand to look after them day and night. A care home can offer similar kinds of care to what family members/carers provide at home, such as help with washing, dressing and providing meals (NHS, 2015).
Working in collaboration is essential practice in social work to allow individuals to be offered the range of support they require (SCIE, 2010). The Health Act (1999) introduced new partnership flexibilities to enable health authorities and councils to improve services of health and social care. Its aim was to bring together the public, private, voluntary and community sectors, service users and their families in effective partnership. Multi-disciplinary/agency teams play a vital role in ensuring that all aspects of the SU’s needs are considered, so that effective advice, skills and interventions can be given. It aims to bring together professional agencies, SU, Carers and service providers to work together to promote better quality of care to achieve the same outcome.
The demographic shift as older people live longer means there is an increasing demand for services; therefore, collaboration can help address financial strains; as social work has moved beyond the lone social services departments and has now incorporated a range of charitable/voluntary organizations to aid support for SU and their families/carer (CommunityCare, 2009).
There can be major implications for individuals who require interventions, as services arranged by a Local Authority is not always free. People with dementia are currently spending hundreds of thousands of pounds on their care, as local authorities are increasingly unable to provide people with the support they need because of the lack of money in the system (AlzheimersSociety,2017).
The Care and Support Commission, led by Andrew Dilnot, published its report (GovUK, 2013) in July 2011, its recommendations included the introduction of a cap on social care costs and a more generous means-test “to protect people from extreme care costs”. On 17 July 2015, the Government announced a four-year delay on the introduction of the cap, as the proposals to cap care costs were estimated to cost the public sector £6 billion over the next 5 years; therefore, the government decided it was not the right time to impose these costs (Jarrett, 2015). Therefore, there remains an uncertainty towards the finance of social care in the future.
To conclude, social work aims to empower, safeguard and provide services to help promote someone’s wellbeing. Social work is continually evolving with changes to society, laws and policies. Social work requires an individual to be well-informed, confident and competent in practice whilst having a strong ethical and value base.
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