When a person with a rapidly deteriorating condition is nearing the end of their life, they can be fast-tracked and receive free health-funded care as quickly as possible. The person will have a care package arranged and this is increased as required. If they live alone, or family members don’t feel confident being on their own with the dying person, then 24-hour care is provided.
This is what should happen according to Continuing Healthcare guidelines, but it’s not always applied consistently. I have seen some people receive the support and live a lot longer than expected, but others die without ever being fast-tracked.
Unlike health professionals, social workers can’t complete a fast-track form. We have to complete an assessment – that can take up to three hours if it’s a complex case. We have to work out the annual and weekly cost of the plan and we then have to get authorisation, which can take up to three days. After this, we have to complete a support plan and get that authorised. Then brokerage has to find providers and increase the support plan for us – that can sometimes take days.
‘The first question is cost’
About 12 months ago, a ‘panel’ was set up. All cases have to go to that panel now. Some are rejected; others have to be reviewed weekly. We also have to answer a standard list of questions in the client’s case notes. The first question is ‘cost’. The provision of fast-tracked 24-hour home care has subsequently become extremely rare in adult services. The panel also often refuse nursing home placements for fast-tracked people, in favour of residential placements. I’ll give an example – but there are more.
One of my clients was near the end of his life and wanted to die at home. I requested home care support for him during the day and overnight. I sent in my assessment for authorisation but a manager questioned me about why this man needed carers overnight. I explained he needed assistance to go to the toilet, to be turned to prevent pressure sores and for reassurance as he lived alone and was aware he was dying.
He had been pressing his pendant alarm at night for help and reassurance.
When I continued to say this care was necessary, the manager asked another social worker to do a reassessment. This social worker upped the daily home care calls, but didn’t arrange overnight care. The man kept pressing her alarm and continued to get distressed at night. His daughter went away for a few days and, because there was no overnight care in place, my client went into the hospice for respite and died.
I am appalled by these cuts and delays, which have closely followed the introduction of the panel. These money-saving, paperwork heavy practices are failing to consider that social workers are working with people who are very sick, deteriorating quickly, and who are often very frightened. People are going through a lot of unnecessary distress and they are increasingly unable to die in their preferred place of care – their own home.
We are responsible for these terminally ill people – and adult social services should be responding in a timely and appropriate manner.