Ageing and disabilities tends to incapacitate humans’ abilities to undertake and fulfil functional activities of daily living. Majority would lose a significant amount of skills and knowledge to attend their care needs. However, personalisation of services has inevitably reactivated some user’s skills and knowledge as they are to some extent able to join in their care. This is a new model, which provides the opportunity for some users to exercise choice and control with regard to their holistic care needs. This permits them to make informed decisions and choices to recruit their own personal assistants who they believed would assist them meet their needs. This preposition contrasted with the ethos of “direct provision” – a formal assessments and care delivery by local social services departments.
The new model is empowering some users to be proactive to participate in their own care on a daily basis and within their capabilities. The framework is classified into different forms and characteristics, which encompasses: “Personal budget; Cash for Care and, or Direct Payments”. These care pathways have provided an avenue to revitalise care reminiscence for many older people and those suffering dementing ill-health. One of the core properties of the model is to redesign service frameworks; from “direct care provision” to self-fulfilling service. This facilitates social re-engineering and enablement so that the aged and disabled people could be fully involved in their own care for as long as possible. This would also stimulate social skills’ re-acquisition and ability to regain some lost skills and experiences whilst learning new skills. This ensures that dementia suffers and the aged could contribute immensely towards achieving their wide ranging needs. Equally, the care pathways have the prospect for reducing dependency culture amongst many service users.
Reflecting on the advantages of the model, psychosocial wellbeing and emotional attainments for most clients groups have become prominent. It provided the opportunity to re-orientate some users with times, people and environment. This increases the propensity for some to be involved in their own care for as long as possible. Thus, they would not totally lose the ability to maintain a whole person approach and the abilities to uphold quality and standards they are used to. In the current health and social care reforms, personalisation of services though may have different cardinal points such costs savings and social re-engineering however, it is also capable to re-establish some social chores that has been lost.
The model has illuminated the desire for most people to care for themselves. This aspiration is never blunted but the ability to do so have been robbed from them due to past welfare policies such as “direct provision”. This might have left them very frustrated and hopeless to attend their holistic care. However, the contemporary service frameworks such as “personal budget and cash for care” have invigorated some users’ skills and capabilities to join in their functional activities of daily living. The care pathways are helping some service users to reconnect with old skills and experiences from their past. It is also opening up new approaches in their mind and within their environment. For some, having their own personal assistants have helped them identify areas of concerned; where they have lost expertise and their personal assistants could gradually help them to reinvent their skills and knowledge.
Although, some older people with dementia have benefitted from having either personal budget or direct payments to revive their skills yet, a high proportion of service users have not been enthusiastic. Dementia and longevity of older people are to some extent inter-connected as a result majority of older people are physically disabled and frail to partake in their care needs. Therefore, the current service frameworks are not appropriate to facilitate home support services for a significant number of the aged and disabled. Practice based-observations have identified that predominant number of the aged and disabled still prefer “direct provision” as this care approach helps them reduce anxiety and stress of managing their own care and dealing with complexities around employment laws, finance and taxation.
Practice based-knowledge has shown that a high percentage of older people who are in receipt of health and social care in the community are diagnosed with dementia / Alzheimer. Apparently, displaying dementia symptoms can be extremely confusing, often belligerent and their ability to learn, reconnect with the past or understand complex/routine tasks have become difficult for most. Nonetheless, as personalisation of services is being universally introduced across social care sector, this would undoubtedly revolutionise a new perspective and probably attract many users or potential users and their families.
This approach would chimes with aspects of the government's recent health and social care white paper as well as the “Big Society” agenda and consumerism focus. In as much as these service frameworks may be appealing to some yet, a substantial number of older people would be unable to facilitate and participate in their own care. Equally, family units are getting smaller and many are migrating to other part of the globe for economic reasons thus, would not be available to support older relatives manage their care support plans. These care models may be suitable for younger older people or non-severely disabled people who have families around to support them as appropriate.
Retrospectively, the focus for “Direct Payments” was that majority of service users would flood the gates of local authority’s social services department and possibly take up the care model in place of direct provision. Experience has shown that direct payments did not attract many users therefore; the new approaches may not be exceptional. “Direct Provision” from social services may still be the right option for a large number of service users as they would rely on social/healthcare workers to organise their care and manage the risks associated with it. However, some of these risks could be managed by trustee yet; practice observations indicate that a high proportion of older people or disabled elders would reasonably ask for “Direct Provision” of care.
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