The Pillars for preserving personal health and social care in society are underpinned by involving family members during critical and substantial care needs of older people. Practice experience has uncovered that a large number of family caregivers are caring for their older relatives, offering them practical and psychological support. Some considers it to be their duty and responsibility thus, feeling guilty for not participating in the care of their older relatives. Most family members see the family care system as a link that connects the old and the young, as well as family history, which points them to the future. On reflection, family care giving includes personal care, nursing care to an extent, assistance with medication/drugs administration, housekeeping, transportation, meals preparation and assistance to feed.
The framework is drawn from several social psychological theories such as: Reactance Theory; Equity Theory and the Threat to Self-Esteem model, which identifies the psychological and environmental processes involved when people consider giving or seeking care assistance to older relatives. However, from a broader perspective there are a variety of factors which could influence the family care system or reciprocal family care for example, ageing and poor health of some family caregivers, financial wellbeing, and social needs, accessibility and environmental factors such as housing, transport, and cultural antagonism. Yet, the delivery of services; health and social care in particular are intertwined with education, knowledge and awareness of holistic assessment and care management.
In practice, older people appreciate value for money. This has been supported by both practice observations and research findings, which reveals that interdependence between family members in their own home would enhance the existence of care giving. Thus, better understanding is required regarding the impact of prolonged and complex care giving by strangers. In view of that, older people see respect and dignity as issues of great concern when it comes to receiving personal care from caregivers. Practically, older people do not feel comfortable with strangers assisting them with personal care but would accommodate their own family members as they understand their wishes and standard of care they are used to. This view draws reference from "Modernisation of Social Care" which demands proactive action to achieve better governance that is more responsive to the plight of older people. This means raising all services for older people to the standards of the best and recharging social services with fresh vigor, incentives and new ideas.
Older people deserve this right like any other citizen of the state and should receive quality care in their own home without prejudice (irrespective of gender colour of the skin and disabilities). However, in practice there have been wide variations in quality and in some areas ineffective and waste of resources. Thus, family involvements in care needs assessment and care would help to develop a consistent care approach that is based on family values, norms and principles, which could be cascaded from one generation to another. Thus, it is hoped, this practice would potentially ease the shortage of formal caregivers; reduce wastes and duplications in the social market. The family will be the champion of the care systems and support for older relatives. This care model would support personal social services in the wider welfare systems, promoting whole systems frameworks. Involving family members would re-invigorate care in the wider community as well as family networking which is geared toward supporting older relatives. The service framework would offer the opportunity to develop innovative and integrate services that provides greater choice and control of services for the growing older people population.
Involving family members during long-term care would promote users empowerment, which allows them to participate in their own care. Reflecting on practice experience, the presence of family members in care giving is more important to older people that enable them to regain health and confidence as opposed to when in receipt of professional help. The availability of family support is found to be an important factor in determining whether a service user can be discharged home from hospital, rather than entering institutional care. I believe that family support places a high value on kinship, kindness, caring attitude, reliability, un-hurried care, consistency and continuity of care. This model of care advocates a joint ownership of care management between the family and the service users who supposedly being the overall controller of their care. In most cases, ageing and cognitive impairment have limited the ability of many service users to understand and manage their care packages, without working alongside their families.
By contrast, family care systems could propagate some form of abusive situations during care giving. However, the principles of care needs assessment and care management dictates that the presence of an advocate would deter any act of gross abuse such as: financial; physical; sexual; emotional and neglect to the frail vulnerable older people and this collaborate with the “Department of Health (2000) (No Secret)”. To reduce this incidence, it would be reasonable to have a family caregiver and not necessarily a qualified social worker, someone actually being involved, who also has basic understanding and knowledge of the needs of their older relatives. Families play a crucial role in the lives of older relatives; family involvement is most often interpreted as an indicator of social support rather than an influence on decision-making and protection of the vulnerable older person.
In retrospective the dominant sociological view, for a number of years has been that; older people turn first to their families for help, then to neighbours and finally to the state, because they expect their families to help in case of need. In some cultures, not only does most care come from the family but that most people think that this is where the responsibility should lie. This view is central to the philosophy of community care and more prominently end of life care services for older people in the wider society. In hindsight, there is a need to reinvent family care giving as the norm to enhance older people's welfare and psychosocial wellbeing during longevity of care in the community.
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reconstruction of Social Work Through Personalisation
Showing posts with label Care needs assessments. Show all posts
Showing posts with label Care needs assessments. Show all posts
Saturday, 21 May 2011
Tuesday, 3 May 2011
Sustainability of Balanced Diet by Aged Relative during Later Life Care Through Family Participation
The majority of the stakeholders believed that the model would help reduce waiting times for assessment and care, hospital bed blocking and antagonistic relationships between social workers and family members. It could equally reduce re-imbursement fees (DH 2003) and enable social workers to concentrate on core and complex case management. The model could generate some savings to the county council in the long run. The family caregivers would be involved from the onset, planning and providing care for their older relatives as soon as possible. Such an early intervention would reduce stress, anxiety, and frustration and would promote psychosocial wellbeing amongst the users and their family members.
Intimate Knowledge of the Person Providing Care
Most stakeholder groups, particularly the family caregivers, service users, one of the two councillors, five of the seven practitioners and three of the four managers acknowledged that knowing the caregiver very well could potentially reduce the tendency of care breakdown. The older relatives would be assured that they would not be seeing different faces visiting them to offer care, consequently they would not be repeating themselves all the time to explain their care plan to strangers. This opportunity would enhance family relationships, as they would be in a better position to share their family norms and values, history and culture. Almost all the practitioners and mangers claimed that knowing the caregiver would reduce any complaints arising because of missed visits, lateness or poor quality of care giving.
Shared Care Packages
Almost three quarters of the stakeholder representative’s thought that the model would promote shared responsibilities. Most thought that shared care packages would reduce reliance on the state and delegate responsibility to the family. The families would play a crucial role in the system by assuming responsibilities and being accountable for their part in the process. Most managers, family care givers, service users and one councillor thought that the model would promote partnership and collaboration between the state and the family; as a result, blame culture would be reduced. Some of the managers, and one of the two councillors in particular thought that the model would enhance capacity within the welfare system as well as the distribution of scarce resources to all users.
Cost Benefits/Savings
The study indicated that the proposed model could save the County Council some money in comparison with the existing service frameworks. This view was shared by three quarters of the managers, and the two councillors despite differences in their political opinion, and a large number of the practitioners. The managers, the councillors’ thought that the difference in unit cost would be significant, and any savings could be reinvested into the system to support more service users. The councillors and managers as well as some practitioners highlighted some of the attractions of the model as including no overheads and variable costs because the £8.00 per unit cost would be a fixed cost for the financial year. Since the unit cost would be above the national minimum wage, this could attract more family members into the social care market and give the council a competitive advantage over other potential employers.
Individualised Care
A large number of the stakeholders thought that the care model would facilitate individualised care. This would enable the older relatives to see themselves as individuals who have rights, choices and opportunities to achieve their aspirations in life. Most service users and family caregivers acknowledged that because strangers have limited time available they are unable to offer quality care to service users, and this could be depressing and frustrating. Family caregivers know the standards of care their older relatives are used to and would endeavour to facilitate that. This means that family care giving would promote person centred care, giving the users the opportunity to enjoy their holistic functional activities of daily living, like any other person (Equal Opportunity Act 2006).
Respect and Dignity
Respect and dignity were seen as essential components of care giving by most stakeholders. The majority of the family caregivers and one of the two councillors thought that family caregivers are better positioned to accommodate and respect their older relatives, irrespective of their character or behaviour than strangers. Most acknowledged that some families have a particular lifestyle which may not be tolerated by strangers but which their family members were used to and have tolerated throughout their lives. Family care giving in this respect would help to reduce care breakdown, complaints, stress and breaking relationships between the cared for person, family members and social workers. Payment to the family caregivers was seen as a justifiable incentive for them to undertake assessment of care needs, planning and providing care for their older relatives.
Maintaining Quality of Care
The study uncovered some differences of opinion between the groups regarding standards, and the quality of care giving to the service users. Most practitioners, managers, and one of the councillors pointed out that social care workers carried out their role within professional guidelines. Almost one half of the practitioners argued that the Commission for Social Care Inspectorate and In-house Quality and Development Section of the County Council monitored the services they provided for older people. As a result, the professionals are in a better position to maintain quality standards than the family caregivers. However, most family caregivers and service users argued that family caregivers knew their relatives better than they knew social care workers. Most felt that their in-depth knowledge of their older relatives had given them the advantage to maintain quality care standards over and above that provided by strangers
Sensitive Nature of Care Giving
Eleven of the fifteen service users thought that care giving (e.g. personal care) can be sensitive and they would prefer their family members, mainly their spouse, daughters or daughters-In-law to assist them rather than strangers. Some felt that it would be embarrassing for strangers to assist them, as they have no bond with them, whereas their spouses, daughters/daughters In-law are part of their family with whom they have some form of relationship and that would be more accommodating. In contrast, four out of the fifteen service users, one third of the practitioners, two of four managers, one of the two councillors, and a few family caregivers, argued against family caregivers assisting their older relatives with personal care. This on the ground that offering intimate personal care to some one very close is sensitive and could influence their relationship.
Intimate Knowledge of the Person Providing Care
Most stakeholder groups, particularly the family caregivers, service users, one of the two councillors, five of the seven practitioners and three of the four managers acknowledged that knowing the caregiver very well could potentially reduce the tendency of care breakdown. The older relatives would be assured that they would not be seeing different faces visiting them to offer care, consequently they would not be repeating themselves all the time to explain their care plan to strangers. This opportunity would enhance family relationships, as they would be in a better position to share their family norms and values, history and culture. Almost all the practitioners and mangers claimed that knowing the caregiver would reduce any complaints arising because of missed visits, lateness or poor quality of care giving.
Shared Care Packages
Almost three quarters of the stakeholder representative’s thought that the model would promote shared responsibilities. Most thought that shared care packages would reduce reliance on the state and delegate responsibility to the family. The families would play a crucial role in the system by assuming responsibilities and being accountable for their part in the process. Most managers, family care givers, service users and one councillor thought that the model would promote partnership and collaboration between the state and the family; as a result, blame culture would be reduced. Some of the managers, and one of the two councillors in particular thought that the model would enhance capacity within the welfare system as well as the distribution of scarce resources to all users.
Cost Benefits/Savings
The study indicated that the proposed model could save the County Council some money in comparison with the existing service frameworks. This view was shared by three quarters of the managers, and the two councillors despite differences in their political opinion, and a large number of the practitioners. The managers, the councillors’ thought that the difference in unit cost would be significant, and any savings could be reinvested into the system to support more service users. The councillors and managers as well as some practitioners highlighted some of the attractions of the model as including no overheads and variable costs because the £8.00 per unit cost would be a fixed cost for the financial year. Since the unit cost would be above the national minimum wage, this could attract more family members into the social care market and give the council a competitive advantage over other potential employers.
Individualised Care
A large number of the stakeholders thought that the care model would facilitate individualised care. This would enable the older relatives to see themselves as individuals who have rights, choices and opportunities to achieve their aspirations in life. Most service users and family caregivers acknowledged that because strangers have limited time available they are unable to offer quality care to service users, and this could be depressing and frustrating. Family caregivers know the standards of care their older relatives are used to and would endeavour to facilitate that. This means that family care giving would promote person centred care, giving the users the opportunity to enjoy their holistic functional activities of daily living, like any other person (Equal Opportunity Act 2006).
Respect and Dignity
Respect and dignity were seen as essential components of care giving by most stakeholders. The majority of the family caregivers and one of the two councillors thought that family caregivers are better positioned to accommodate and respect their older relatives, irrespective of their character or behaviour than strangers. Most acknowledged that some families have a particular lifestyle which may not be tolerated by strangers but which their family members were used to and have tolerated throughout their lives. Family care giving in this respect would help to reduce care breakdown, complaints, stress and breaking relationships between the cared for person, family members and social workers. Payment to the family caregivers was seen as a justifiable incentive for them to undertake assessment of care needs, planning and providing care for their older relatives.
Maintaining Quality of Care
The study uncovered some differences of opinion between the groups regarding standards, and the quality of care giving to the service users. Most practitioners, managers, and one of the councillors pointed out that social care workers carried out their role within professional guidelines. Almost one half of the practitioners argued that the Commission for Social Care Inspectorate and In-house Quality and Development Section of the County Council monitored the services they provided for older people. As a result, the professionals are in a better position to maintain quality standards than the family caregivers. However, most family caregivers and service users argued that family caregivers knew their relatives better than they knew social care workers. Most felt that their in-depth knowledge of their older relatives had given them the advantage to maintain quality care standards over and above that provided by strangers
Sensitive Nature of Care Giving
Eleven of the fifteen service users thought that care giving (e.g. personal care) can be sensitive and they would prefer their family members, mainly their spouse, daughters or daughters-In-law to assist them rather than strangers. Some felt that it would be embarrassing for strangers to assist them, as they have no bond with them, whereas their spouses, daughters/daughters In-law are part of their family with whom they have some form of relationship and that would be more accommodating. In contrast, four out of the fifteen service users, one third of the practitioners, two of four managers, one of the two councillors, and a few family caregivers, argued against family caregivers assisting their older relatives with personal care. This on the ground that offering intimate personal care to some one very close is sensitive and could influence their relationship.
Friday, 29 April 2011
End of Life Care by Proxy: Empirical Research Findings – The Need for and Potential of Family Care Systems
This publication reflects the findings of a fieldwork carried out in Essex, which looked at the views of older people service users, their caregivers and the County Council representatives. Besides, practice observations has also revealed that a large number of the stakeholders (service users, family caregivers and staff and councillors) are of the view that family caregivers have the potential to offer more emotional and practical care for their older relatives, rather than strangers. They cited a number of reasons (fear of strangers, knowing the person providing care, sharing family norms and values as well as fulfilling duties and responsibilities) as to why the family care system would be more appropriate than direct provision or direct payments (Ugwumadu 2011).
A high proportion of the stakeholders claimed that enabling support systems (aids and equipment, respite and day care, shared care packages) would encourage family caregivers to continue care giving to their older relatives. They thought that aids and equipment would reduce dependency levels, accidents, falls and potential deterioration in health amongst the family caregivers. Day and respite care would enable carers to have breaks from care and increase their commitment to continuing care for their older relatives. Offering carers respite care would bring about shared responsibilities between the social service and the family, enabling the State to concentrate on the commissioning of other services, while the family take a lead responsibility to offer care for their older relatives.
Reflecting on assessment of needs, the study revealed contrasting views amongst the three groups. A high proportion of the service users and the family caregivers felt that families are best placed to carry out needs assessment rather than social workers. They said that they know the service user and their needs better, and would be able to draw up a flexible care plan that would accommodate a holistic need for their older relatives. Some argued that social workers do not have enough time to spend with the cared for person to obtain the in-depth information necessary to prepare a wide ranging care package. In contrast the majority of staff and councillors thought that social workers are professionally trained and have wide ranging practice based knowledge, skills and experiences to meet older people needs, in line with legislation and availability of resources. Some stated that family members lack basic knowledge and skill and their involvement might encourage potential abuse and poor quality of care for older people.
In terms of a payment to family care assessors and caregivers, the study found contrasting views amongst the stakeholders. A large number of the service users and family caregivers felt that family care assessors and caregivers should be paid. For them a payment would help them maintain their lifestyle and at the same time assist their older relatives with their care. A payment on the other hand would otherwise act as an incentive and that could attract families who would not have thought about offering care to their older relatives. For some of them the payment that they receive would be used to buy extra care to support themselves in their caring role, as well as giving them the time to undertake other activities in order to support their nuclear or reconstituted families. Yet a high proportion of the staff and councillors thought that a payment to family care assessors/caregivers is not the best preposition with which to redesign the welfare system, in line with the 21st century community care for older people. What is needed is joint investment between the welfare institutions (e.g. health, housing, Works and Pensions) to tackle the new demand for care from older people.
The study found that a large number of the three stakeholder groups expressed some ambivalence over family care giving. Most of them stated that care giving would impose a lot of difficulties on some of the family caregivers and their nuclear or reconstituted families. This is a decision most of them would not take in haste. They cited a number of reasons (employment, ageing and poor health, distance, potential abuse) why they need to take time to think it over before embarking on it. On the one hand some of the staff and councillors raised the issue of compliance to legislation, policies and procedure and lack of knowledge by some of the family caregivers to undertake assessment and care. A large number of the family caregivers said that despite the difficulties they are committed to care giving to their older relatives.
Consistent with the conceptual dimensions, the majority of staff and councillors expressed concerns over family care giving; this was in contrast with both the service users and family caregiver’s views. For them family care giving would mean abdication of duty and responsibilities by social services. Some felt that social service should continue to meet the obligations, bestowed to it by Parliament and that social workers are best placed to deliver those services to older people and their families. These views were supported by a fewer number of the service users who claimed that family care giving means interfering with their family and their livelihood. They prefer to seek support from social services, friends and neighbours; their family would be the last resort, when other opportunities have failed.
Those stakeholders (users, family caregivers, staff, managers and councillors) who do not think that family caregivers should be the sole assessors also think that family members are unlikely to provide quality care during care giving. Some family caregivers lack knowledge and skills to undertake assessment and might be unable to maintain standards of care. The framework might encourage abuse (financial, physical, deprivation, exploitation) during care giving.
Refer to www.Articlesbase.com for detail reading
A high proportion of the stakeholders claimed that enabling support systems (aids and equipment, respite and day care, shared care packages) would encourage family caregivers to continue care giving to their older relatives. They thought that aids and equipment would reduce dependency levels, accidents, falls and potential deterioration in health amongst the family caregivers. Day and respite care would enable carers to have breaks from care and increase their commitment to continuing care for their older relatives. Offering carers respite care would bring about shared responsibilities between the social service and the family, enabling the State to concentrate on the commissioning of other services, while the family take a lead responsibility to offer care for their older relatives.
Reflecting on assessment of needs, the study revealed contrasting views amongst the three groups. A high proportion of the service users and the family caregivers felt that families are best placed to carry out needs assessment rather than social workers. They said that they know the service user and their needs better, and would be able to draw up a flexible care plan that would accommodate a holistic need for their older relatives. Some argued that social workers do not have enough time to spend with the cared for person to obtain the in-depth information necessary to prepare a wide ranging care package. In contrast the majority of staff and councillors thought that social workers are professionally trained and have wide ranging practice based knowledge, skills and experiences to meet older people needs, in line with legislation and availability of resources. Some stated that family members lack basic knowledge and skill and their involvement might encourage potential abuse and poor quality of care for older people.
In terms of a payment to family care assessors and caregivers, the study found contrasting views amongst the stakeholders. A large number of the service users and family caregivers felt that family care assessors and caregivers should be paid. For them a payment would help them maintain their lifestyle and at the same time assist their older relatives with their care. A payment on the other hand would otherwise act as an incentive and that could attract families who would not have thought about offering care to their older relatives. For some of them the payment that they receive would be used to buy extra care to support themselves in their caring role, as well as giving them the time to undertake other activities in order to support their nuclear or reconstituted families. Yet a high proportion of the staff and councillors thought that a payment to family care assessors/caregivers is not the best preposition with which to redesign the welfare system, in line with the 21st century community care for older people. What is needed is joint investment between the welfare institutions (e.g. health, housing, Works and Pensions) to tackle the new demand for care from older people.
The study found that a large number of the three stakeholder groups expressed some ambivalence over family care giving. Most of them stated that care giving would impose a lot of difficulties on some of the family caregivers and their nuclear or reconstituted families. This is a decision most of them would not take in haste. They cited a number of reasons (employment, ageing and poor health, distance, potential abuse) why they need to take time to think it over before embarking on it. On the one hand some of the staff and councillors raised the issue of compliance to legislation, policies and procedure and lack of knowledge by some of the family caregivers to undertake assessment and care. A large number of the family caregivers said that despite the difficulties they are committed to care giving to their older relatives.
Consistent with the conceptual dimensions, the majority of staff and councillors expressed concerns over family care giving; this was in contrast with both the service users and family caregiver’s views. For them family care giving would mean abdication of duty and responsibilities by social services. Some felt that social service should continue to meet the obligations, bestowed to it by Parliament and that social workers are best placed to deliver those services to older people and their families. These views were supported by a fewer number of the service users who claimed that family care giving means interfering with their family and their livelihood. They prefer to seek support from social services, friends and neighbours; their family would be the last resort, when other opportunities have failed.
Those stakeholders (users, family caregivers, staff, managers and councillors) who do not think that family caregivers should be the sole assessors also think that family members are unlikely to provide quality care during care giving. Some family caregivers lack knowledge and skills to undertake assessment and might be unable to maintain standards of care. The framework might encourage abuse (financial, physical, deprivation, exploitation) during care giving.
Refer to www.Articlesbase.com for detail reading
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