What help? From where?

Mr Peters, a man in his early nineties, profoundly deaf, is living alone, following the death of his wife eight years previously. He has a hearing dog. He is fit and walks daily with the dog, though with increasing difficulty.

Contact 1

His son, living 300 miles away, is concerned about the steepness of the stairs in his father’s house and the lack of an adequate stair rail. He phones the local social services department to ask advice. Details are taken and he is advised that there will be a long delay before a visit can be made and that his father should sleep

downstairs. Three weeks later, a home visit is made and a new rail is fitted the same day with no charge being made. Mr Peters is astonished, and pleased.

Contact 2 – three years later

Mr Peters’ main social contact (and occasional support for sorting out matters like a broken vacuum cleaner) is his son-in-law, who is planning to move away. (His daughter had died some years earlier.) The son-in-law is concerned that his father- in-law is becoming frailer and wonders whether he should consider a move to a residential home. Mr Peters does not want this. The GP suggests he should think about home care. First attempts to pursue that fall flat for reasons that are not clear, but seemingly because his needs are not seen to be urgent. His son tries to review with him and local services what should happen.

There are several strands to what happens.

The social services department wants to assess over the phone in terms of whether or not it has to take action. (Is he at risk in daily living? Is there an emergency? Will the current arrangements break down in the near future if nothing happens?)

A list of home care agencies is supplied with no recommendations.

Age Concern staff, one of the agencies, when approached say that they are not taking on new work because they cannot get the staff.

Eventually, contact with a neighbour leads to a recommendation for a particular home care agency.

The agency is approached; the organiser undertakes a visit (an assessment) and agreement is reached for two visits per week of one hour, primarily for cleaning and ironing; the cost is £11.40 per hour.

Immediately, this scenario illustrates the complexity of the problem.

Should the solutions be sought privately or through the health and social care system? (It had not proved possible to find local domestic help and there were concerns about how to be sure of the quality.)

Is there anyone available to help an individual think about their current lifestyle, future problems and the options?

Does anyone locally know the range of different services that are available?

Should the State have any responsibility for helping people think through their problems (whether called an ‘assessment’ or not)?

Who is to pay?

Should there be a link between primary care and access to other services? (In this scenario should a worker in one service have taken on the GP’s suggestion that the person should have home care?)

How are social services departments and primary care teams to manage demand for services, required as they are to deal urgently with anyone where there is a high risk but also to help in the development of what are termed ‘low-level’ services?

The account above was written in September 2004. In January 2005 there were changes.

Scenario 2b: What next?

Mr Peters had a stroke and was admitted to hospital. His son travelled down to the hospital the next day, arriving early afternoon to be greeted with a question from the nursing staff: ‘Have you brought his clothes? The doctor says he can go home.’ When the son asked whether they knew about his home circumstances and had assessed his capacity to cope at home, there was an immediate retraction. Social services staff at the hospital were unavailable but Mr Peters could stay in hospital until he was assessed. Later that week a social worker assessed him as being eligible for a place in an intermediate care scheme, where he went for two weeks. The social worker was very helpful, efficient and responsive, calling at short notice, liaising with both Mr Peters and his son. Mr Peters enjoyed his stay at the

intermediate care centre, recovered well and seemed to enjoy being looked after. He surprised everyone at the case conference to plan the arrangements for his return home by saying that he wanted to stay on, had only been there for two weeks and the brochure said that people stayed for four weeks. It was pointed out to him that the brochure statement was ‘up to four weeks’ and that people thought he had recovered well and was ready to go home, though he should not drive again in the near future until he was reassessed as being fit. He returned home with a package of services: meals-on-wheels daily with the possibility of increased home care hours; he was to attend the intermediate care centre once a week; a taxi was arranged to take him shopping each week; Age Concern was to be asked to help him with managing his finances – though, to the surprise of the social worker, Age Concern staff said that they did not do this sort of regular assistance though would help in claims for benefits. Within days the arrangements for services at home broke down, because Mr Peters did not want the meals, the taxi service or to go to the

intermediate care centre. He became ill and did not eat. The situation collapsed, perhaps because he no longer wanted the responsibility of looking after himself and his house. Mr Peters has moved to a care home and enjoys living there.

Two points are worth noting. The first is that Mr Peters had been leading a highly independent life before his stroke, including daily walks with his dog, driving and doing his own shopping. He had made it clear that he did not want to move from his house. Second, the social worker, when the link had been made after the son had challenged Mr Peters leaving hospital after 24 hours, was extremely helpful, taking on the responsibility of finding out things, passing on information and being willing to adjust her schedule to help sort things out. It was surprising that she was not aware

of the services of the voluntary sector but she proved to be a very important resource for father and son. This type of help seemed only to be available because he was taking up a hospital bed or was on the threshold of residential care.