A key aspect of the new Care Act is the approach to assessment and eligibility
that will affect frontline adult social care practice.
Assessments play a vital role in determining the level of care and support individuals receive
and should reflect more accurately a comprehensive picture of people’s needs.
I think it’s important that people sort of have knowledge before they go out and meet somebody.
Around, you know, they use the information that’s available, which is in the referral, from - whoever that’s from, whether the person themselves
or from another professional. To actually have a bit of understanding about what the condition is
and what they will need to work with the person at the pace that’s appropriate for them.
In this film two people, one with mental health needs, the other with a physical disability,
talk about their conditions, assessment, how their needs can fluctuate
and the impact this has on the level of care and support they need.
My name’s Lee Brooks, I’ve got bipolar disorder. It’s a mood disorder
and it fluctuates in various ways. It’s defined by the fact that you have highs, you have lows.
I always describe it to people as Jekyll and Hyde. You’ve got Mr. Happy, who likes to go out and party,
and then you’ve got the other guy, who will quite happily climb into his bed and
there ain’t a thing in the world you can do to get him out.
When it comes to looking at people’s needs, you’ve got frequency, severity and duration.
With frequency, how often are the moods changing. When my moods fluctuate,
different effects are pulled into play.
For instance, my illness can have levels of severity, it can have levels where I’m fine, I’m stable at the moment,
not fine but I’m stable.
And the duration, how long is this illness around for.
When I had one of my worst lows, I was six months not leaving the house.
When it comes to assessors talking with care users, people need to be made aware
more of fluctuating needs.
As I’m sitting in front of them right now, the base line that they’re getting is Lee in a good state,
it’s Lee in a good place. Tomorrow, he might not be here, he might be manic,
he might not be able to get out of bed. You know he might not be functioning at all.
It’s a completely different kettle of fish. But they’re looking at Lee in a static state. I’m not static.
Well six months ago I was feeling depressed. But I’ve had a couple of things happen since so I’m ok.
“Oh, so you don’t need the care that you needed back then, then.”
Well, no, it doesn’t quite work like that. I’ve got fluctuating needs. So you can’t put into the care plan
“Right, you’re going to do this every single day.” You’re going to say, “Right, if you can manage this,
these are the kinds of things you’re going to aim to work on to bring you back to a state of recovery,
and we’ll work from there.”
I think the most important thing is that the Care Act recognises fluctuating needs. There’s an expectation that
we as organisations, as professionals working with people, take into account that there are people
who do have needs that fluctuate, maybe on a daily basis, it may be that it will fluctuate over a period of time.
Many people with disabilities, illnesses and long-term conditions who need care and support services
have had negative experiences of the ‘one size fits all’ approach of the past.
I’m Gillian Quenker, and I’ve had diagnosed Parkinson’s since 2005.
You wake up in the morning not knowing really what the day is going to entail.
My symptoms can range from a shake or a tremble, to not being able to move at all, to very low voice.
I walk with a stick and I’ve also got a walking frame that I use.
As a carer, I support Gill in many ways. Gill’s balance is not particularly good,
although it does vary from day to day or from time to time.
When my condition’s at its worst, then my function’s very limited
and I might just sit for ages or go to bed and sleep. I find that’s the best thing if I’m really low
if I sleep. Then when I wake up again, I’m able to function a lot better.
It’s quite difficult to predict when the fluctuation’s going to occur, but you learn to pace yourself,
you try to make sure you don’t do too much in one day.
Because our condition can vary so much, we have worries that we’d be assessed,
and it would depend what they were like on the day.
One of the tests, if you like, is how far you can walk, and that would differ immensely
depending on what day it was and what time of the day it was.
So we were quite relieved when we realised that the fluctuation of our condition would be taken into account.
I think the assessor needs to find out what a good day is, and what a bad day is,
and what an in-between day is, because they’re all so different. So somebody could function quite at a high level
on a good day, but given the same time the following day it could be the complete opposite.
So they’d have to be aware that there’s totally different levels of functioning for that person.
This new requirement recognises people as individuals by endorsing a much-needed degree of flexibility
and responsive care, as well as offering valuable support for people
with mental health and physical health conditions which may vary over time.