In this essay I will define client empowerment in planning care as it is applied to adults, especially adults at risk of neglect and abuse, and explore how care management policy aims to empower clients. I will then look at the notion of risk management, and explore what risks are associated with care and support for older people, using the example of Mr Banks as my case study. I will evaluate how risk can be minimised, managed and monitored, including risks to the health and welfare of informal carers.
Care planning is a way of agreeing, arranging and managing the services or help needed to enable a person to live at home or to move into a residential or nursing home. It is the process of developing an agreement between the client and the social worker, where client problems, outcomes to be achieved and actions to be pursued in support of a goal achievement are identified. It involves noting both formal and informal services and intended results in a written document.
In the assessment stage of care planning, each service user receives an assessment of their care needs and must meet appropriate criteria for the services to be provided. When a service or services have been arranged, a care plan will be written and a copy given to the user. This will contain details of what services will be received and for how long, who will provide each service, when and where each service will be provided, if there will be a charge, and how and by whom the care plan will be monitored and reviewed.
Care management is required wherever a person needs a lot of support at home from several different services or need to move into a residential or nursing home. As individuals grow older, their needs and life styles change. Environmental, social and medical services may need to be altered. Care management can help identify necessary additional resources before a crisis occurs. It can help a professional locate these resources. It assists older adults and care givers to decide which community services they need in order to remain living in their home.
Empowerment is one aspect of ‘normalisation and social role valorisation` as described by (Braye, S and Preston-Shoot in 1997.) A highly valued end in social work is to empower the client or service user. Empowerment means, among other things, to place in the client’s hands a meaningful choice of courses of action for the present, and to create valuable options for the future. A helpful intervention will often be one that tends to empower the user.
The process of empowerment addresses two related objectives: the achievement of a more equitable distribution of resources and non exploitative relationships between people, and the enabling of people to achieve a creative sense of power through enhanced self-respect, confidence, knowledge and skills. (C. Rees 1991)
Empowerment in relation to care planning means that for any care plan to work, the client should be included in every possible aspect of planning process and made to feel that they have a real say in determining the course of action to be taken. This not only assures that his or her dignity is respected, but will also make it more likely that the plan will be followed. Whether the service user needs short or long term care, the plan should be flexible enough for amendments to be discussed and agreed as new challenges arise.
However, empowerment through discussion is not always easy to achieve. Depending on the social worker’s relationship with the service user and other family members, and on how willing the user is to admit there is a problem, it may be hard to broach the subject of needing help. It is important for professionals to remember that older people in particular may have experienced many different problems in the course of their lives, that they might be proud and independent, and often unwilling to admit to weakness or any need for help.
This can also be the case with ethnic minorities, who might feel a taboo in placing their elderly relatives in care homes, but at the same time may be failing to cope and providing inadequate care for their relatives in need of help. Good negotiating skills may be needed to get around unwilling or non-communicating service user, perhaps by asking a trusted friend, physician or clergy member to bring up the subject. Both users and their carers are thereby positively involved in making decisions about the future of the client.
Social workers have developed various models of care and working, some of which are more empowering than others. For instance the system of direct payments in lieu of service provision, whereby service users are given financial autonomy, gives them greater choice about how care is delivered and thus greater control over their lives. However, this carries associated risks in that service users thus empowered may make unwise payment decisions or be unable to make real choices. There is also scope for abuse by carers. The appearance of empowerment may therefore prove illusory.
Similarly, it is a general principle within social work practice that where possible, service users should be allowed the choice of remaining at home. Social services departments across the country are committed to the implementation of policies which develop individualised, person centred approaches to service provision and maximise choice (based perhaps in a Kantian analysis of individual moral autonomy based in rational choice). However, this means that risk assessments need continuously to be carried out of the risks associated with person centred interventions, such as the additional dangers and challenges clients may face if they remain at home.
In other words, with empowerment comes risk and this risk needs to be assessed. The process of assessing risk begins when a referral or request is made for services. The social worker will begin to gather information as to the present problem, the client’s condition and what initially is the request for service. Information to be gathered during the assessment may include: presenting problem, or initial request; any client conditions and deficits in functioning; type of help already provided or tried by family, friends or neighbours; appropriateness of the environment; and eligibility requirements (income, age, level of care, client’s strengths, goals and preferences.
Turning to the case study, Mr Banks is a 70 year old man who suffers from shingles and muscle impairment which makes him incapable of carrying out basic tasks for himself. He continues to live in his own home, but a care package (a visiting carer appointed by local social services) has been put in place to help him achieve autonomy.
There is a dilemma in Mr Banks’s case which applies to a number of older adults living in the community and in receipt of care. He is an independent-minded individual who has suffered from depression and is resistant to what he regards as interference in his life. One way this manifests itself is in his refusal to have the central heating turned on in his home. The dilemma which the visiting carer and the professionals in the case face is whether to empower Mr Banks by respecting his right to self-determination, and thus run the risk of him experiencing hypothermia, or to take a more proactive approach by turning the central heating on without his permission (as provided for in the legislation – reference?) and thus disempowering Mr Banks.
Providing care for adults who, through ageing or disability, are unable to live an independent life unaided is a growing concern in all developed countries. Advances in medicine have prolonged life and increased the survival chances of individuals, who, in earlier times, would have died sooner. Changes in family life and structure mean that former assumptions about who should provide care are increasingly questionable. At the same time, societal expectations about standards of care and quality of life have risen remarkably.
It is no longer widely acceptable that those who need fairly constant care and support should routinely be committed to institutions .The care of adults with disabilities or who are failing to cope due to old age or other medical conditions raises difficult issues about their autonomy, which is the right and capacity of persons to exercise choice and live their lives by their own principals. Self rule is widely taken to be the very prime or at least one of the first, principles of morality (Schneewind, 1993). It also captures the notion that it is not just socially unacceptable behaviour that is the object of morality, but the principle that right actions are reasoned and willed.
Review of a care plan to monitor the degree to which it takes account of changing risks, and of deterioration and other changes in the service-user him or herself, is an ongoing process achieved by regular contact with the client, caregivers and service providers. It is a process by which the social worker and client assess the current service plan to determine if it continues to be the best plan possible within the limit of available resources. (Review of services provided to adults with specific needs arising from physical disability, learning disability, mental health difficulty, sensory impairment, or brain injury, and to their carers, is undertaken within the context of the NHS and Community Care Act 1990 and the Disabled Persons Act 1986.)
Banks S (2001) noted that respect for people’s right to self-determination can conflict with risk management. However, users’ rights are not absolute and may be limited by a higher duty to self or by the rights of other individuals, the social worker, agency or community. A person’s autonomy can be impeded by the actions or inactions of others when, for example, there is an identified risk such as accident or assault at home. In other cases a person can adversely affect his autonomy. Some people, whether from choice or incapacity, look after themselves poorly. This may begin as an autonomous choice, but the resulting poor health and well-being undermine future capacity for autonomy.
Some people refuse repeatedly offers of help, or prefer not to undergo the formal processes of being taken into care of public services bureaucracies, However, where need seems to exist but demand for service does not, autonomy is liable to be eroded whatever course of action is taken. Many service users of community care services suffer from dementia, mental illness etc.
They are judged to have some limitations of mental competence: in some circumstances it may seem that they cannot make major life decisions with the proper degree of understanding. The subjective preferences may be difficult to reconcile with practical reality. They may entertain unfeasible options or believe in material facts that are plainly untrue. However, a direct, frequent threat to autonomy is where social workers propose action or inaction that is opposed to the client’s wishes. There may, of course, be good reasons for doing so, including the rights and wishes of other people involved. Nevertheless, social work is often perceived as a threat to individual rights, not a safeguarding of it.Expand this further, referring to your case study.]
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