Social workers advise on a case in which a woman with
mental and physical health problems is at risk of falling in her
current accommodation
CASE
STUDY
SITUATION
Susan,* 57, lives alone in a cottage owned
by her mother. She has been diagnosed with multiple sclerosis and
tardive dyskinesia, which involves involuntary, repetitive
movements. She also has schizophrenia. Her MS is
deteriorating.She cannot walk unaided, or use a walking
frame, so moves around by holding onto the furniture, walls, and
rails. Susan can move from her chair to the commode but cannot use
the stairs. Her friend Mike,* 39, has built her a bed downstairs.
They met when they were using mental health services several years
ago. He also manages the household.
Susan has short-term memory and cannot
recall if she has fallen, though carers often find her on the
floor. She has no prescribed medication and has a lifeline
pendant.
She receives personal care in the mornings
and evenings from an agency, which also provides cleaning and
support with laundry.
Susan's social worker has encouraged her
to move but she is adamant she wants to stay and has capacity to
decide where she lives.
PROBLEM
The occupational therapist and care agency
feel the property is unsuitable. Its floor is uneven, and there is
a lack of equipment to safely transfer Susan into bed, with carers
relying on Mike.
Mike has also been verbally abusive
towards the OT, though the agency says he has been
supportive.
The concerns are:
● The agency pulls out.
● Susan refuses to move and the social
worker is held accountable if she has a fall.
● Susan is vulnerable to Mike.
*Names have been changed
The social worker view
Carl O'Riordan, social worker, Erewash disability team,
Derbyshire Council
Susan's rights, safety and aspirations demand consideration. She
has the capacity, and thus the legal right to decide where she
lives.
Susan's safety and quality of life may significantly increase if
she accepts more support at home. However, Susan may have
understandable reasons to mistrust professionals. She may not
appreciate her social worker encouraging her to move and
investigating Mike if there is evidence of abuse. In addition,
research suggests Susan's tardive dyskinesia would almost certainly
have been caused by antipsychotic medication previously used to
treat her schizophrenia. Consequently, Susan may be fearful of
taking medication to reduce the impact of her MS.
Workers should strive to build respectful relationships with
both Susan and Mike, and offer co-ordinated options to increase
Susan's independence. A personal budget may give Susan flexible
control of her support. The floor could be levelled, making it
safer for her to walk and for equipment to be used. A falls
assessment and physiotherapy may improve Susan's mobility. A
telecare falls sensor, a device similar to her lifeline pendant,
could automatically alert carers whenever she has a fall.
If professionals work together, respond to Susan's aspirations
and treat her with utmost respect, she may reach decisions that
make her safer, happier and more independent.
The manager's view
Bev Capel, service manager,
Erewash disability team, Derbyshire Council
I have visited many inaccessible
properties during my career and it is rare to find one that canÕt
be adapted. The occupational therapist and social worker are
understandably anxious about the potential consequences of Susan
remaining in her home. They feel accountable and a risk-averse
approach is easy to adopt. However, personalisation re-establishes
the responsibilities of disabled people. Although it may seem
unwise, it is important that SusanÕs views are respected. In any
case, there are many ways in which the OT can support Susan in
reducing some of these risks.
It would seem that Susan and Mike do not
trust care services and rebuilding this relationship is paramount.
Susan needs to feel safe before she can discuss any worries she may
have about her vulnerability to Mike. Mike may be feeling under
pressure in his caring role and need an opportunity to voice any
anxieties. The offer of a carers assessment may facilitate
this.
Susan needs support to make informed
decisions. The quality of communication in support planning will
determine the level of choice and control afforded to Susan, and
this will undoubtedly facilitate better outcomes for them both.
The user view
Simon Heng, disability writer and
activist
Before surgery stabilised my condition, I
spent years struggling with the gradual loss of my physical
abilities. I even denied to myself that my condition was worsening,
so the kind of assistance I would accept was inadequate, even
dangerous to myself and my carers. If carers couldn't cope, I would
get angry, and blame them.
I was very frightened – faced with this
situation, I challenge anyone not to be, for themselves or those
they care for. This may explain Mike's aggression towards the
OT.
Eventually, I had to accept that my
condition was getting worse, and my care would have to change.
Susan and Mike might need help to accept
that current ways of doing things are becoming hazardous, and that,
for her to retain any kind of independence or quality of life,
SusanÕs support package needs to change.
Then it's a question of resources. Does
Susan need a wheelchair, or a hoist to help get her to bed? Are
resources available to install a new floor and a stairlift, or a
through-the-floor lift so she can access bathroom and bedroom? Does
she need 24-hour care? Could she and Mike manage this through
direct payments?
As for Susan's vulnerability towards
Mike, aren't all severely disabled people vulnerable to their
carers? Is there any particular reason for concern about Mike?
If you have a case study that you would
like one of our panels to consider, please e-mail
ruth.smith@rbi.co.uk
Published in the 5 November 2009
issue of Community Care under the heading 'Should we encourage our
client to move?'