Hello,
I have just carried out a review with an eldery person who is in very sheltered housing. The housing scheme has been providing 7 x 15min visits a day to prompt with medication.
The 'guidelines' being given to us from higer up in our LA department in order to cut costs, are that we cannot put in visits for just a medication prompt as "this is a health issue, not social issue"
Without medication promts, this particular persons health will decline and it is not a sustainable option. , While in this particular care, he may be able to self fund some of the visits, in other cases this may not be possible.
Does the NHS fund carers to prompt medication?Is there a way to challenge (whether myself, or the family, or an NGO) to challenge my LA on this tactic for cutting costs?
Thanks
It IS a Health issue - what if a change of dressing was required? Back to the never really resolved question as well as when is a bath a medical as opposed to a social need?
Medication and treatment issues are more clear-cut though and I think that your LA is correct.
cli_snapple: Hello, I have just carried out a review with an eldery person who is in very sheltered housing. The housing scheme has been providing 7 x 15min visits a day to prompt with medication. The 'guidelines' being given to us from higer up in our LA department in order to cut costs, are that we cannot put in visits for just a medication prompt as "this is a health issue, not social issue" Without medication promts, this particular persons health will decline and it is not a sustainable option. , While in this particular care, he may be able to self fund some of the visits, in other cases this may not be possible. Does the NHS fund carers to prompt medication?Is there a way to challenge (whether myself, or the family, or an NGO) to challenge my LA on this tactic for cutting costs? Thanks
dont they do things like phone call prompts or alarm buzzers in your authority - or is it that they wont fund?
in my authority complaining was always the best way as they were terrified of the press and agreed with 70% of complaints - i know some definitely had no grounds
Could perhaps a few of the visits be linked in with meal provision or personal care needs? If all this person requires is 'prompts' with medication will they even meet FACS?
It could really depend on the medication - if it is something that needs to taken at te same time every day and timing is critical then I would say there would be a strong case for putting it forward for reconsideration, if however timing is not critical then would the person be able to manage with a blister pack a telecare/ alarm reminder or a member of family or a friend calling? Equally if the person requires more than just a 'prompt' i.e. supervision and administration this would also be important, unfortunately semantics and careful wording can make all the difference in a funding request. Similarly, looking at what risks are involved in stopping this support, i.e. is it going to cost the LA more a month down the line if the person has a fall as a result of something like not taking a blood pressure medication correctly and then requires a much higher level of care?
Has the person's medication been reviewed recently and are all doses necessary, could perhaps they be condensed into three visits, again in conjunction with personal care needs?
In all honesty this level of support would not be funded in my local authority except in exceptional circumstances and they are one of the more generous ones in this part of the country.
Same here, if his only need was with medication prompts, I'd be looking at Technology or failing that let the district nurses administer it, and I bet the GP will come out to undertake a medication review and alter all the medication and the days meds will be split in to 2 manageable doses!
I had a GP on duty today, saying please commission 4 x half hour visits daily for the next two weeks to administer eye drops (for a service user not even known to us), I advised him to get DN's out to do it or show the SU how to do it! By the time I'd done the paper work for this short term service, it would have been more effective in terms of time to go and administer the drops myself!
Any chance your reablement team could work with your SU?
If it's only medication prompting and nothing else, we'd refer it to our district nurses.
cb:If it's only medication prompting and nothing else, we'd refer it to our district nurses.
How likely is it though that the district nursing teams would take responsibility for this? This is where people fall between the gaps between health and social care, social services do not have a duty to provide and pass to health, and health services in turn do not have the resources to provide this type of service unless absolutely necessary.
We refer to DN's if its support with medication only - it is argued that this is a health need and as there are no other social care needs then we woudn't fund support - we also argue about the cost involved - i.e. our cheapest commissioned visits is £6.73 per visit for something that potentially takes 1 minute to do - does it cost a DN £6,73 to do it? The answer is No! They do take it on usually after considerable arguement, they do have resources - they employ healthcare assistants who meet lower level healthcare needs. SS do not say some one needs medication so why would we pay to administer it?
Hatgirl: How likely is it though that the district nursing teams would take responsibility for this? This is where people fall between the gaps between health and social care, social services do not have a duty to provide and pass to health, and health services in turn do not have the resources to provide this type of service unless absolutely necessary.
Maybe it's a local protocol thing because if it's only a medication visit we would insist it is a health rather than social care matter and they do go in and do this.. This scenario isn't that uncommon - the difference might be that within an extra-care sheltered, the DNs might argue that there is 'care' provided but they know this protocol as well as we do and this is, indeed, what happens locally.
Medication is a health 'need' - we 'help out' with administration if there happens to be a carer going but we wouldn't provide a visit only for medication administration and we certainly would provide a service if someone had no other needs (there are FACS issues too potentially). So yes, the DN teams do take responsibility for this in my area.
I am very disheartened at some of the comments on this subject. Clearly, social workers are not aware of the difference between social care and health care. A meds prompt is a health care responsibility and should be provided by the NHS free at the point of delivery. Just because the NHS will not do it does not make it an LA responsibility with a charge being made for the client. Just because the NHS says no does not mean that the LA should say yes. Instead of meekly stepping in to the fill the gap, social workers should get clients to complain to their PCT or advocate for their client.
Our LA run a "Limits of LA lawful provision" course to ensure that social workers know what is their responsibility and what is the NHS's responsibility.
A1ext: We refer to DN's if its support with medication only - it is argued that this is a health need and as there are no other social care needs then we woudn't fund support - we also argue about the cost involved - i.e. our cheapest commissioned visits is £6.73 per visit for something that potentially takes 1 minute to do - does it cost a DN £6,73 to do it? The answer is No! They do take it on usually after considerable arguement, they do have resources - they employ healthcare assistants who meet lower level healthcare needs. SS do not say some one needs medication so why would we pay to administer it?
It's disgraceful frankly..... firstly, providing adequate personal care and support is not altogether an investment cost .. it is also an investment to prevent further and higher costs resulting from deteriorating health and injury/accidents - all likely putcomes of incorrect medication consumption - reablement costs, hospitaliastion and more indirect costs of care mangement, assessments, etc., etc., all for the sake of a few pounds.
The problem is that Social Care management are looking in every nook and cranny to cut costs, reduce funding and generally absolve themselves of personal social responsibilty (PB's...??) hence let's argue about the old chestnut (Coughlan case...?) over who is responsible for what. Ridiculous. We as a society have a need and responsibility to ensure that people are safe, cared for and looked after ... it doesn't matter if it is social care cost or health care cost...it has the same impact on us all financially. In fact, I'll refine that. It matters agreat deal that we keep costs at social care levels and NOT health care levels a great deal.
At least this nonsense will come to an end if the Health Bill goes through an gets implemented so that the service users doctor will fund the care need in the most appropriate way.....almost certainly via social care overseeing visits.
In the meantime, let's hope someone goes for a judicial review over the way LA's are refusing these social needs and they get woken up about their responsibility. Instead of playing games.
PJ
Playing devil's advocate: it is the service user and the local authority who fund the cost of medication-only visits and that is the crux. If the person is self funding their care then they pay the lion's share. Whereas if health services meet that need it is free at the point of access. So arguing over responsibility does take on significance, am afraid, particularly when local authorities budgets for adult social care are taking a hammering.
Why should health services, taking on admirable prevention service type tasks such as the 5 a day initiative, giving out contraception, funding gastric bands & stop smoking aids etc (to help reduce the overall buden on the NHS) , not charge for such services, yet somebody with a primary health need, who for physical or cognitive reasons needs help to take meds to maintain their health and reduce overall burden on NHS, have to pay a care worker to assist?
Until health and social care funding and payment for services are on some kind of level playing field, this argument will run and run. Integration is oft-talked about in adult services but the funding hurdle is the biggy. Will we ever have a government brave enough to stop playing divide and rule with health and social care? Unlikely due to the cost implications. Just saying.
You are correct 'Pops' and 'PJ' is incorrect. Medication is not a social need in its true sense although there are social benefits but it is primarily a medical / Health need.
Pooled budgets would however, go a long way towards addressing this and other such issues. Also Direct Payments could be used plus any other 'care' benefits received.
Yes PJ, I fully understand that the money comes out the public purse one way or another, the fact it services are not funded in that way, if someone needed medication prompts 4 times a day it would cost social services £9, 798.88 per annum, the person themselves may have to contribute or even self fund that service.
Health have the resources to provide that service, they have health care assistants and district nurses who work in the community and it would effectively cost them less to provide the same service. HC assistants probably cost about £10 an hour they could potentially visit 4 people in a given area per hour, that would cost £2.50 per person per medication visit as opposed to £6.73. There is method in the madness, medication prompts are fundamentally not a social need when the one and only support need someone has is to be given their medication. And I wouldn't go as far as to say the LA is refusing to support, I guess we are merely exploring other options before we commission services to meet that need.
On the flip side, I have Personal Assistants who have been on special training courses to administer special medication when the district nurses have said they could not meet that need in the community as they don't have the appropriate training, difference is that the service user in this case had lots of other social care needs. So we do meet these needs and even provide the training for staff so that they can do it - when the NHS won't.
cb:we would insist it is a health rather than social care matter and they do go in and do this..
Oh don't get me wrong I completely agree!
We are relatively rural however and the district nursing teams are stretched and can have many miles to cover - very quickly popping in to complete a task that takes less than a minute 7 times a day becomes unfeasible for them also unless absolutely necessary.
Rupert M: You are correct 'Pops' and 'PJ' is incorrect. Medication is not a social need in its true sense although there are social benefits but it is primarily a medical / Health need. Pooled budgets would however, go a long way towards addressing this and other such issues. Also Direct Payments could be used plus any other 'care' benefits received.
Aagghh...
There we go again........ it's this very idea that we HAVE to make these distinctions that cause so much time, trouble, worry and effort. Whatever "true sense" of social care actually is anyway.....
This is straight forward, or it should be. The only reason this issue is being dealt with in the way it is, is because of perceived financial savings from social care budgets driven by central government cuts and underfunding. It's not an intellectual consideration of whether medication is a social need or a medical need. It's about saving money!
If medication isn't taken in the correct way and at the correct time - within reason and in some cases - then there will be consequences which will impact financially and resourcefully on social services. This is a fact, generally. What social services should consider therefore, before starting out on this path, is if prevention is better than cure...?
Interestingly, and ironically, if the failure to take medication does NOT result in complications, hospitalisation, etc., then I think we can clearly state that not taking the medication in the first place cannot be a medical need...!!
As I said, if and when the new Health Bill comes into being, these issues won't even be discussed (thankfully..) as doctors have the overall care budget for each individual to allocate as needed - and not as defined!
Finally, I'm not sure how you think DP's address this issue...? Under assessments together with underfunded financial awards (medication visits disregarded by assessing LA who believe it's a 'medical' need) are making care provision impossible to purchase, for the need, for the money allocated.
pops: Playing devil's advocate: it is the service user and the local authority who fund the cost of medication-only visits and that is the crux. If the person is self funding their care then they pay the lion's share. Whereas if health services meet that need it is free at the point of access. So arguing over responsibility does take on significance, am afraid, particularly when local authorities budgets for adult social care are taking a hammering. Why should health services, taking on admirable prevention service type tasks such as the 5 a day initiative, giving out contraception, funding gastric bands & stop smoking aids etc (to help reduce the overall buden on the NHS) , not charge for such services, yet somebody with a primary health need, who for physical or cognitive reasons needs help to take meds to maintain their health and reduce overall burden on NHS, have to pay a care worker to assist? Until health and social care funding and payment for services are on some kind of level playing field, this argument will run and run. Integration is oft-talked about in adult services but the funding hurdle is the biggy. Will we ever have a government brave enough to stop playing divide and rule with health and social care? Unlikely due to the cost implications. Just saying.
Not advocating it but........ the new Health Bill does just that....!
(put the two together under the auspices of ones' doctor..... in general terms)
A1ext: Yes PJ, I fully understand that the money comes out the public purse one way or another, the fact it services are not funded in that way, if someone needed medication prompts 4 times a day it would cost social services £9, 798.88 per annum, the person themselves may have to contribute or even self fund that service. PJ: If it worked that way. In reality, for the most part, medication visits are also tied in with *other* care provision. Get up, put to bed - often the prescribed times for medication. With meals - often prescribed medication times. And, this activity doesn't affect the majority of service users who do not suffer from short term memory loss or dementia. A1ext: Health have the resources to provide that service, they have health care assistants and district nurses who work in the community and it would effectively cost them less to provide the same service. HC assistants probably cost about £10 an hour they could potentially visit 4 people in a given area per hour, that would cost £2.50 per person per medication visit as opposed to £6.73. There is method in the madness, medication prompts are fundamentally not a social need when the one and only support need someone has is to be given their medication. And I wouldn't go as far as to say the LA is refusing to support, I guess we are merely exploring other options before we commission services to meet that need. PJ: They are a social need if not taking the medication leads to social repercussions such as pre/post hospitalisation (falls/accident etc) reablement, added social care visits, added care management time and so on. In addition, this is ironically amusing. If we argue that not taking medication does not lead to problems developing...then I think we can also argue that the process is not a *medical* one. (on the basis that no effects transpire from it). If we agree that problems will/can/do arise out of not taking medication then the costs to social care in the longer run must be considered and taken into account. If increased care and social care management is needed following hospitalisation for not taking medication then we have not only failed, we have mistakenly taken away care costs in the interim to pay more later. That is a misappropriation of funds, in my view. Of course, one can follow this through ad infinitum. Each non funded medication visit (or thereabouts...) resulting hospitalisation, then increased socail care costs, then hospitalisation, then increased costs....and on and on..! A1ext: On the flip side, I have Personal Assistants who have been on special training courses to administer special medication when the district nurses have said they could not meet that need in the community as they don't have the appropriate training, difference is that the service user in this case had lots of other social care needs. So we do meet these needs and even provide the training for staff so that they can do it - when the NHS won't. PJ: Interesting... Are you saying that these PA's are *allowed* to administer drugs? In principle, at the moment, non medical staff cannot administer drugs....only prompt the service user to take them. Injections or putting drugs into the mouth of a service user is the reserve of medically trained staff only. Are you seeing a change in that? It is also one of the reasons that this 'activity' might be considered non medical..... there is no medical intervention on the part of the social care provider/worker....? prompting cannot be considered medical delivery ...but a good argument could be forwarded for it being a social activity...? PJ
PJ:
If it worked that way. In reality, for the most part, medication visits are also tied in with *other* care provision. Get up, put to bed - often the prescribed times for medication. With meals - often prescribed medication times. And, this activity doesn't affect the majority of service users who do not suffer from short term memory loss or dementia.
A1ext:
They are a social need if not taking the medication leads to social repercussions such as pre/post hospitalisation (falls/accident etc) reablement, added social care visits, added care management time and so on. In addition, this is ironically amusing.
If we argue that not taking medication does not lead to problems developing...then I think we can also argue that the process is not a *medical* one. (on the basis that no effects transpire from it). If we agree that problems will/can/do arise out of not taking medication then the costs to social care in the longer run must be considered and taken into account. If increased care and social care management is needed following hospitalisation for not taking medication then we have not only failed, we have mistakenly taken away care costs in the interim to pay more later. That is a misappropriation of funds, in my view. Of course, one can follow this through ad infinitum. Each non funded medication visit (or thereabouts...) resulting hospitalisation, then increased socail care costs, then hospitalisation, then increased costs....and on and on..!
Interesting... Are you saying that these PA's are *allowed* to administer drugs? In principle, at the moment, non medical staff cannot administer drugs....only prompt the service user to take them. Injections or putting drugs into the mouth of a service user is the reserve of medically trained staff only. Are you seeing a change in that? It is also one of the reasons that this 'activity' might be considered non medical..... there is no medical intervention on the part of the social care provider/worker....? prompting cannot be considered medical delivery ...but a good argument could be forwarded for it being a social activity...?
Not having a replacement hip can lead to social consequences so Social Services should fund that as well according to PJ's logic - we have to draw a line somewhere as to where financial responsibility lies. The less severe / acute the medical need the more it is possible to make a case to blur the boundaries of responsibility BUT health, is health, is health and medication is Health-prescribed and subject to Health oversight..
Rupert M: Not having a replacement hip can lead to social consequences so Social Services should fund that as well according to PJ's logic - we have to draw a line somewhere as to where financial responsibility lies. The less severe / acute the medical need the more it is possible to make a case to blur the boundaries of responsibility BUT health, is health, is health and medication is Health-prescribed and subject to Health oversight..
Oh come on...... medical intervention is not ambiguous. Medical operations are not social care.....be serious.
Where you fail to see the real issue is that the service user is a cost to our society, our taxes and our funding. It still costs even after you have made some purile decision about who should pay. We ALL pay for it, for heavens sake. There is a system in place for Care workers, the length and the breadth of the country to visit service users in their homes on a daily basis. It makes blindingly obvious sense to utilise that resource.
Look, if failure to take medication results in hospitalisation then you may well argue, therefore, that this is a medical process. What transpires however, is (foreseen) social care costs resulting DIRECTLY from those actions. It will and does demand more reablement costs, more care management costs and almost certainly continued and increased social care provision costs. It is my contention therefore that funds are not being appropriated (in the first place) in the correct way as preventative costs for future deterioration of a service user.
If one wants to assert that failure to take medication does not necessarily lead to problems and hospitalisation then clearly, and by definition, the process cannot be described as a medical.
Finally, as I said..... let's not get carried away by *medication visits* as though they are the main type of social care provision calls, they're not, and when they are the sole reason for the visit there is NO MEDICAL intervention being carried out. Social Care providers CANNOT administer medicines. They merely 'oversee' it. Clearly that is a task that does not require specialist medical training.
Hi PJ, exactly that, I had a service user whose medication was administered via a syringe driver and needed to be changed every 8 hours (give or take a few minutes), when the SU had a care agency they said that they could not administer the meds due to organisational policy, the district nurses said they could not committ to administering the medication (esp as some of the nurses were not trained to administer this drug), the final suggestion was to employ unregulated personal assistants to attend a training course organised by the Parkinsons Disease Society to then administer the drug, the other option would have been residential care with nursing for this particular service user - alternatively he could have not been prescribed the drug and compromised every aspect of his quality of life. Is there a law or specific policy that says if it is more than 'prompting' of medication then you need a medically qualified staff? Would make CHC meetings more interesting, as they seem to say carers can give this medication with training (even when the route of the medication is more than prompting).
I think we'll just have to agree to disagree with regards to the issue of if the one and only need is to have medication prompted then health should provide the service.
Regards,
Alex
Hi alex,
First off, I'm not a medical expert whatsoever.......
My experience of syringe drivers is for 'end of life' care & support only where, normally, a whole plethora of support services are involved (..at home) but the medication - usually morphine - is carefully controlled, sometimes electronically and overseen by DN (district nurse), a Palliative care team (if that exists in your area) and maybe Mcmillan and/or Marie Curie staff. Because this drug is a 'controlled drug' it requires medical supervision and care workers would not touch any of the equipment involved in the driver (usually a box with phials close to the service user tubed into an under the skin piece of equipment). I'm told by colleagues that *normally* syringe drivers are used short term, for end of life situations but I cannot say for sure if that is 100% correct and they are not used for prolongued medication situations. I do not know.
I suppose the first thing then is to ask if your service user was in an 'end of life' situation?
It is becoming less clear about the overlap in these cases between medical intervention and social care but, from the small amount I've researched (I'm also interested from a care provision aspect as LA's refuse service users these calls and I want to know, also, to what extent care provision CAN intervene without faling foul of medical regulations...) it seems there may be ways around *some* of these issues by obtaining consents from the service user, their doctor, the district nurse - probably all three - with regard to certain types of medication administration.
For example, we have a quadraplegic SU and for whom we have the agreement of SU (via guardian) and the doctor, together with a risk assessment ...to physically put the medication into the mouth of the SU. These are 'rare' cases it seems to me but it does show the precedence that might allow the administering of oral medication without the need for medically qualified staff to be present.
I suspect, and doubt, that any doctor would consent to any invasive proceedure (injections, for example) by anyone other than medically qualified staff at any time. I think, in the case of a syringe driver, for numbers of reasons (even though the medicine is 'outside' the body), type of drug, complications, untrained staff etc. it is probably safe to assume it will never be anything but a task for a medically qualified person to undertake. (That's my assessment only, though...)
With extra training, care workers (subject to agreement from doctor/SU again) can, and do, undertake PEG changes of the bag outside the body. They do not touch the intervention end.
I would think that for your SU, the first discussion should be with the doctor of the SU to see IF there is any possibility he/she would agree to allowing a suitably trained care worker (not medically qualified...) to replace the medication phials outside of the body. If it is a no then that is that. If it's a maybe then there might be avenues to pursue with the SU consent, of course, to find a suitable solution.
How about Mcmillan nurses....?
Clearly nursing home admission for this is a ridiculous outcome for the SU, for the costs and for the community but it is a complexity of medical regualtions bearing down on the issues. (I cannot, as yet, find any legislation that deals specifically with this - as per usual, it's probably enshrined in a multitude of regulations overseen by a multitude of organisations and a complexity that requires a rocket scientist to make sense of it.
I would say that these were not the types of cases I was referring to for medication visits however, where the main thrust of the activity is to ensure SU's (mostly those with memery loss issues) take medicenes that 'control' certain aspects of their lives - rather than immediate critical medical administration.
Sadly, as cuts bite, I think we might be seeing more of this type of problem where the growth in PB's makes 'private' demands that cannot be met by existing services in general and health care staff in particular. If there are not enough DN's to meet the need then waht is to be done. Residentail Nursing home is not the answer for cases such as you explain and it should not be considered the default option because of lack of anything. No doubt the SU does not wany this outcome and it may be that within the 'human rights' and personal choices area that gently pushing might get a preferred result.
I'm glad you brought this up as it has given me inspiration to find out how these situations can be handled suitably for the SU firstly, then the service provision after.
Hi PJ,
No this was not palliative care it was a special drug that was prescribed by a Neuro- Consultant for symptom relief in Parkinsons disease, its quite an expensive and rare drug - I'm not sure if it is classed as a 'controlled' drug, but certainly the route was via syringe driver and includes a mechanical device. The DN's refused to meet the need, care agency refused to meet the need, basically, Personal Assistants recieved special training through the Parkinsons Disease Society, they have the number of the Specialist Parkinsons Disease nurse who they can call if there are any problems and also the consultant at the hospital, but they are based about 50 miles away, having said that they have been very supportive in improving the quality of life for this service user and worked really well with me to make sure the service users wishes are respected.
Hi A!ext,
I'm fascinated and intrigued that you have found a solution...
This may have wider reaching 'consequences' than it seems. I'd be interested to know more...
Would you be willing to write privately to tell me some detail...your LA, for example, and the background and people involved in *allowing* this essentially medical activity to be carried out by non medical trained staff - I assume it involves only replacement of phials (?) outside of body but, nonetheless, a step forward, I'd say. Finding this kind of training to provide care workers with enough expertise to carry out the task would not be difficult to arrange but the possibility of undertaking the process, potentially, quite great.
Not interested in identifying you ar the service user or any sensitive information...... just the process involved who agreed (doctor?), SU, that sort of thing and which LA this has happened in...?
Understand if you're not confident or happy with that and thank you for sharing the information anyway...
Hi PJ, I've 'started a conversation' with you, never done that before so not sure how it works, look out on your profile. Thanks Alex
What is a Health or Social Care need would have been agreed between the PCT and the LA. If the LA has been providing the medication prompt visits they should not withdraw the service until something else is put in place, doing so would put the elderly person’s health at risk, this could be unlawful.
The social worker assess the health, housing, social care need (NHSCC) once assessed it has to be met (FACS). The question is who should meet it the PCT or the LA, if the elderly person “Needs to be prompted” someone has to.
The only person who could rule on this is the LA social services legal officer the social worker can refer it to them (Law for Social Workers Brayne & Carr).
The PCT could fund a care provider to provide the service to the elderly person.
Or solicitors in community care law - Community Care Law usually involves challenging the decision of a public body such as a Local Authority or Health Trust.
The line between health and social care is not always clear. Every government since 1948 has not had the courage to sort it out. We need a single body, under a single statutory framework that deals with the charging issue and is not based upon a medical model. Until that day comes we are stuck with what we have got. So social workers should be clear about what they are responsible for and what the NHS is responsible for. I suggest a quick purchase of Luke Clements & Pauline Thompson's Ciommunity Care and The Law would do the trick.
Meds prompts, applying creams, surgical stockings, changing catheters - all NHS responsibilities. IF LAs are to do such tasks (not that we would in our LA) they should be properly delegated to the LA by way of a s75 agreement with the full cost being reimbursed to the LA and the client not being charged. Ongoing oversight of the tasks remains the responsibility of NHS via District Nurses/GPs
Sadly, we have a hotch potch of local arrangements which vary wildly according to where you live. When Lansley's bill is passed this postcode lottery will turn into a free for all -across every aspect of health care.
Hello
Whatever happened to 'duty of care' ? The client has been assessed and found that without medication prompt the medication will not be taken and the client's condition will deteriorate, possibly resulting in hospital admission. Does the client require somebody to be physically present to take medication ? Could an electronic pill dispenser, that has the times pre-programmed be the answer ? It is risable that person-centered care is so widely promoted, but the gap between rhetoric and experienced reality is getting wider and wider. 'Doing more for less' are the latest buzz words from the NHS and Local Authorities. I just wish they were in a situation were they can not get the help they need .
Mollycat
Thanks for the helpful responses.
He had a review of his Parkinsons medications recently as was mismanaging them, overdosing and his health and wellbeing declining. He now only takes tablets.
I have been looking in to electronic pill dispensers but they don't seem appropriate for him. The reason he needs support with medication is due to memory and mobility. A reminder is not sufficient. He would need one he can keep in his pocket as by the time he needs the medication, his mobility has reduced to such a degreer that he would not be able to get to a larger electronic pill dispenser. Then the problem is that there is no one to fill up the dispenser in the morning as the staff at the Very Sheltered Housing Scheme say that their staff are not able to secondary dispense so would not be able to transfer the medication in to the dispenser. Could that be questioned.
Some of the visits I can combine with other personal care support, but that still leaves two visits for just medication prompts.
"They are a social need if not taking the medication leads to social repercussions such as pre/post hospitalisation (falls/accident etc) reablement, added social care visits, added care management time and so on. In addition, this is ironically amusing. If we argue that not taking medication does not lead to problems developing...then I think we can also argue that the process is not a *medical* one. (on the basis that no effects transpire from it). If we agree that problems will/can/do arise out of not taking medication then the costs to social care in the longer run must be considered and taken into account. If increased care and social care management is needed following hospitalisation for not taking medication then we have not only failed, we have mistakenly taken away care costs in the interim to pay more later. That is a misappropriation of funds, in my view. Of course, one can follow this through ad infinitum. Each non funded medication visit (or thereabouts...) resulting hospitalisation, then increased socail care costs, then hospitalisation, then increased costs....and on and on..!"
If we argue that not taking medication does not lead to problems developing...then I think we can also argue that the process is not a *medical* one. (on the basis that no effects transpire from it). If we agree that problems will/can/do arise out of not taking medication then the costs to social care in the longer run must be considered and taken into account. If increased care and social care management is needed following hospitalisation for not taking medication then we have not only failed, we have mistakenly taken away care costs in the interim to pay more later. That is a misappropriation of funds, in my view. Of course, one can follow this through ad infinitum. Each non funded medication visit (or thereabouts...) resulting hospitalisation, then increased socail care costs, then hospitalisation, then increased costs....and on and on..!"
Thanks PJ for making this argument . I will try and argue that without these medication prompts, based on previous experience, the future costs will be higher. As an assistant social worker, i don't feel hugely confident at taking on this, but as others like Mollycat pointed out in the thread, I have a duty of care and do not want to leave this person to get worse.
cli_snapple:Then the problem is that there is no one to fill up the dispenser in the morning
most (but not all) pharmacies will do this for you. Sometimes its just about finding the right one.
products such as this will keep beeping until the pills are taken. If done via telecare then the idea is that if a person doesn't take the medication after a certain amount of prompts then an operator will call through to check everything is alright.
Backed up with a product such as this
For some people, in some situations technology can really work. As the older generations become increasingly tech savvy then I can see these type of items becoming more and more acceptable.