Social Work Theories - Older Adults
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Keywords: case study older adults
This essay concerns the application of social work theory and practice with adults within the context of a specific legislative framework. The assignment specifically takes up different aspects of social work theory and practice that concern the carers of old and disabled individuals. It makes specific use of the case study on Betty, her daughter Elizabeth, and other members of Elizabeth's family. The case study is provided in the appendix to this essay. It is considered as read and is thus not described in the body of this essay.
The assignment deals with the role of carers in the UK social work infrastructure and their needs and rights. It also takes up the importance of interprofessional participation and partnership between social and health care professionals and carers in delivery of social and health care, including the management of risk.
2. Identification of Issue
This assignment focuses on the responsibilities, difficulties, and needs of Elizabeth, the 49 year old daughter of Betty, who is 74 and has been living with Elizabeth and her family for the last 2 years. Elizabeth, who is white, is married to Charles (48), who is black and of African-Caribbean origin. They have two children, Mathew (22) and Elisa (19), who live with them.
Betty suffered from a stroke two months ago and is recovering in hospital. She has developed poor left side mobility on account of the episode and will require a wheel chair to move about. She has been medically assessed as ready to return home, where Elizabeth is expected to care for her. The situation and the caring relationship, whilst transparent and logical, has become complicated because of Charles's redundancy from employment and his strained relationship with Mathew, who is yet to start earning. The domestic environment could become disturbed because of the possibility of Charles resuming his old drinking habits, the tendency of Mathew to engage in substance abuse and his stealing from his grandmother to fund his drug purchases and the possibility of Elisa's moving out to live with her boyfriend. An application of Erikson's theory of human development reveals that Betty is now firmly entrenched in her late adulthood, whereas Elizabeth is in her middle adulthood. Betty, if she is properly cared for, will find it easy to accept her life stage and prepare for her final years with complacency. For Elizabeth, these are years of activity and being in charge. Taking care of Betty will add meaning to her life, reduce stagnation, and establish a caring and stable home environment.
Elizabeth is obviously in a complex and difficult situation and whilst she must care for her ailing mother, she also has responsibilities towards her husband and children. Social work policies in the UK detail the ways through which social and medical care should be provided to adults in need (Oliver & Decoster, 2006, p 243). Specific policies exist for providing medical and social support to elderly people with mental and physical disabilities. Such services are provided through the aegis of social work practitioners, mental health professionals, medical professionals and medical workers. These diverse professionals are expected to work in partnership for the delivery of comprehensive social and medical care to the old and disabled (Oliver & Decoster, 2006, p 243). With the majority of such service users being expected to be cared for in the community, in their homes and in the midst of their near relatives, carers form an extremely important component of the social work delivery process (Stalker, 2003, p 67). Elizabeth, in her role as the primary care for Betty forms the pivot for delivery of social and health care services.
This assignment delves into the social work infrastructure and policies in the UK that are available for carers and makes particular use of relevant frameworks including the Single Assessment Process and National Service Framework for Older People. The essay also discusses relevant sociological and psychological theories for human development and behaviour and examines the ways in which inter-professional practice and partnership of professionals with carers can help in improvement of social work delivery.
3. Social and Medical Care for Adults and Old People
The official approach for providing social and medical care for older people was revamped and improved significantly after the publication of the White Paper on Modernising Social Services in 1998 and the adoption of a national agenda for improvement of care and services (Baker, 2004, p 12). The National Service for Older People (NSF-OP), which was adopted in 2001set standards for the promotion of better services and greater integration of health and social care services for people (Baker, 2004, p 12).
The NSF-OP is developed around 8 standards, namely (a) age discrimination, (b) person centred care, (c) intermediate care, (d) general hospital care, (e) stroke, (f) falls, (g) mental health and (h) health promotion. The NSF for older people very importantly introduced the concept of person centred care, which aimed to ensure that older people were treated as individuals in their own right and received care packages that satisfied their individual needs, irrespective of boundaries between health and social services (Baker, 2004, p 12). These standards aimed to ensure the integration of health care and social work services for older people and ca;;ed upon health and social care workers to participate and collaborate with each other to provide holistic and rounded services to people in need (Baker, 2004, p 12).
The person centred approach for provisioning of social and health care is an important outcome of the gradual development and acceptance of the social model of disability (Moulin, 2002, p 43). The still dominant medical model of disability assumes that disabilities result from the physical or mental limitations of individual persons and are largely unrelated to their social or geographical surroundings. It places the origin of a problem with a person and states that solutions can be found by focusing on the individual, rather than on his or her surroundings (Moulin, 2002, p 43).
Whilst the medical model has for centuries dominated human approaches towards disabled people, recent decades have seen the emergence and the progressive acceptance of the social model, which views disability to be the consequence of social and environmental barriers that restrict people with disabilities from participating in society (Moulin, 2002, p 47). The person centred approach is routed in the social model and aims to empower people with disabilities by allowing them to participate and agree to the medical and social care plans that are made for them (Moulin, 2002, p 47). Such empowerment provides service users with significant independence to participate in their rehabilitation and treatment process and allows care plans to focus on rehabilitation and prevention, rather than on symptomatic treatment (Moulin, 2002, p 47).
The single assessment procedure was introduced in the SAF- OP, specifically to further the standard concerning person centred care (Baker, 2004, p 14). The SAP facilitates a single assessment for the medical and social needs of individuals and calls upon respective agencies to work together for provisioning of appropriate and holistic care to individuals in need (Baker, 2004, p 14).
The SAF-OP is particularly relevant for Betty, because it provides a framework for providing of holistic social and medical services to individuals who have experienced strokes.
4. The Role of Carers
Whilst Betty's medical condition and social needs are certainly addressed through policies like the SAP, the SAF-OP, the progressively greater use of the social model, the person centred approach, the existing social health care infrastructure, the efforts of the individual carer, in this case her daughter Elizabeth, will play a critical role in the delivery of such care. The progressive elimination of hospitalisation and institutionalisation for people with physical and mental ailments and the replacement of such approaches and methods with community centred care commenced in the 1960s and progressively increased over the years through appropriate policy modifications.
It is now widely accepted that people with disabilities live far more enriched, satisfied and productive lives amongst their families, friends and communities than in specialised institutions. Betty, after her recuperation from her stroke, is expected to come back into the community, live with her close relatives and family members, and be cared for by people who care for her. Such community care, whilst extremely desirable as an alternative to institutionalisation, however calls for the services of specific carers for individuals, who cannot manage their own activities, and thus need to be looked after by other people (Office for National Statics, 2006, p 1-2). Such carers, in the overwhelming majority of cases, constitute of family members, spouses, siblings, parents or even children (Office for National Statics, 2006, p 1-2) Betty, after her stroke, has reduced left side mobility and will need a wheel chair for her personal movement. Whilst she may, in all probability, be able to look after her own needs to some extent, it is probable that she will certainly need the care of another person. Elizabeth, her daughter and the person with whom she is living at present, is expected to fulfil the role of her carer.
Carers occupy a unique role in the British social care infrastructure. Practically 11% of the population, i.e. approximately 6 million people, provide unpaid care in the UK to individuals in need. Whilst practically half of these carers fall in the age group between 45 and 64, many of them are very young as well as quite old. The majority of people who receive care live either in residential premises (Office for National Statics, 2006, p 1-2). Caring for an elderly person, as Elizabeth will be required to do, calls for significant amounts of sensitivity and commitment. Most people involved in care for older people look after parents or relatives who were previously used to looking after them (Weinstein, et al, 2003, p 114). Elderly people often wish to remain self reliant and make their own decisions as long as possible.
Such changes in family relationships can often be complex and lead to situations of conflict if they are not handled with adequate care and thought (Weinstein, et al, 2003, p 115).
Whilst caring for older people has to be handled with great sensitivity to avoid upsetting the people who are being cared for, it also calls for a great deal of hard work, effort, and self sacrifice on the part of carers (Williams & Robinson, 2000, p 18). Carers often have to adjust their responsibilities towards their employers, if they are employed, and to their other family members who may need their emotional and physical support, in order to look after the individuals whose care has been entrusted to them (Williams & Robinson, 2000, p 18). With carers playing critical roles in supporting and providing essential services to disabled and ailing elderly people, it is essential for them to work in close coordination and participation with responsible medical, health and social care professionals in order to facilitate the provisioning of holistic medical, social, physical and emotional support to their elderly wards (Stalker, 2003, p 81). Such partnership helps in better assessment of risks that are faced by persons in care and formulation of appropriate care and intervention plans. Social and medical care plans thus need to be carefully formulated by the concerned social workers after appropriate assessment with the use of person centred approaches and the involvement and agreement of the service user and the carer (Stalker, 2003, p 81).
Elizabeth, as has been stated before is experiencing difficult domestic conditions at home because of the unemployment of her husband. Whilst her husband Charles did not previously have any objection to Betty's staying with them, his attitude might now change because of her illness as well as straitened domestic circumstances. He has a history of alcohol misuse and domestic abuse and his employment redundancy, as well as annoyance with Matthew's unemployment, drug abuse and household thievery may upset him enough to relapse into his old ways. Elizabeth could in the normal course of events expect assistance from her two children in discharging her caring and household duties. This however looks improbable because of Elisa's plans to shift in with her boyfriend and Matthew's disturbed emotional state and surreptitious misuse of drugs.
5. Assessment of Needs of Carers
Carers, like Elizabeth, perform vital and pivotal roles in the delivery of social care to individuals under their care, who are otherwise unable to manage, at home, without some form of support because of issues like disability, mental health needs, and illness or learning difficulties. Such carers have their own problems and needs that can easily be overlooked by the people around them. Elizabeth's problems, as explained in the previous section, whilst not apparent are complex and real.
The previous New Labour government recognised these needs, and introduced significant legislation for the protection of the rights of carers, through the enactment of the Carers and Disabled Children Act, 2000, and the Carers (Equal Opportunities) Act, 2004. The Carers and Disabled Children Act provides carers with the rights for separate assessments of their needs, if they provide or intend to provide regular and substantial care to others (Department of Human Services, 2003, p 18).
The person under care is usually assessed for his or her needs under the provisions of the 1990 NHS and Community Care Act (Department of Human Services, 2003, p 18). This is the best way of helping, both the carer and the person in care. The services provided to people who are in care often helps to support carers through the provisioning of some of the care that is being given by carers. The Carers (Equal Opportunities) Act aims to assure that carers can avail of opportunities that others often take for granted (Department of Human Services, 2003, p 18).
Assessments of needs of carers take into account the need of carers to continue with their work, return to work and excess education as well as training or leisure activities (Department of Human Services, 2003, p 19). The provisions of UK law state that carers are entitled to assessment, when they provide, or intend to provide, regular and substantial care to individuals in need, and the person being cared for, can access services from the Community Mental Health Team or the Department of Community Services (Department of Human Services, 2003, p 19).
Such rights for assessment provide carers with (a) opportunities to reflect and discuss their own needs as carers, (b) share their caring experiences, (c) obtain recognition for their roles as carers, (d) obtain information and advice, (e) identify and discuss existing and potential difficulties, and (f) create contingency plans for circumstances that may not make it possible for them to continue in their caring roles (Stalker, 2003, p 83). Assessments are made to investigate the ways in which social and health care professionals and the existing infrastructure can help people in their caring roles by maintaining their health and wellbeing (Stalker, 2003, p 85).
Such assessments concern issues like different aspects of individual caring roles, availability of breaks from caring, health issues of carers, maintenance of relationships with the person being cared for and others in the family, caring for home, accommodation, finances, work, education and training, support, emergencies, alternative arrangements and the future. As is evident, existing policies aim to make the assessment of carers as holistic as possible (Stalker, 2003, p 87). Such assessments take up a whole range of issues like the time being taken for caring, understanding the condition of the person being cared for, and difficulties in providing suitable care (Stalker, 2003, p 88). Health, relationships, finances, and work, are very important components of the assessment process, and social and health care professionals aim to assess whether carers can be helped in their relationships with people important to them and in their health, their finances and their leisure activity (Department of Human Services, 2003, p 19).
Assessments for carers lead to personal discussions with them on the help required by them and the preparation of care plans that try to accommodate the wishes and constraints of carers to the maximum extent (Department of Human Services, 2003, p 21). The Department of Community Services can, after such assessment, provide help to both the carers and to the people who are being cared for. The persons who are being cared for can be helped with direct payments in order to allow them to purchase their own care, practical or personal care at home, respite care, adaptations and home equipment, and day care services (Department of Human Services, 2003, p 21). Carers can be helped with support in the form of (a) direct payments to help them to buy the support they need, (b) substitute care in order to enable them to take breaks from caring, (c) assistance with specific tasks and equipment to help them in their caring efforts, (d) advice and support in their role as carers and (e) short breaks (Department of Human Services, 2003, p 21). Elizabeth can ask for an assessment, discuss her various problems with the social worker and try to work out, not only the best available care plan for Betty, but the ways in which she can obtain help to perform her caring functions effectively, maintain her home, help her children, and continue a good relationship with her husband.
This essay takes up the analysis of the case study of Elizabeth, her mother Betty, and her immediate family, and uses Elizabeth's particular circumstances, as a would be carer for her mother, for an examination of existing legislation, theory and practice in areas of social and health care for adults with disabilities and their carers.
Social work policies, practice, and theory for carers, as well as the persons they care for have evolved significantly over the last decade. Whilst assessment policies and intervention tools for adults with ailments or disabilities have been streamlined significantly in order to account for their individual needs and to empower them with independence in choosing their care and treatment plans, the importance of carers in the delivery of social work in a community care environment has come to the forefront.
Carers are acknowledged to be critically important in the delivery of care. Social and health workers are expected to work collaboratively and in partnership, with each other and with carers, for the planning and delivery of holistic care and health services that take care of the individual needs of service users. Carers are also entitled to assessment of their needs and various forms of assistance to make their caring duties more effective and less onerous.
Whilst Elizabeth's responsibilities towards her mother and her family members are undoubtedly onerous, the social and health care policies of the country provide significant facilities that can help in making her responsibilities easier and her life more enriching and fulfilling.
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