K217 Ena

K217 EMA Report Gary Table of Contents Page 1. Table of Contents Page 2. Introduction Page 3. Context Page 4. Discussion Page 8. Conclusions and Recommendations Page 9. References Introduction This is a report on Gary a 52 year old male service user who lives within the county of Conway. Due to a serious car accident some time ago he has lost the use of both his legs and he does not work and relies on disability benefits for his income, Gary lives alone and has some care provided by his daughter and the rest by a support worker.This report has been commissioned by Gary with the help of his support worker as he is interested in taking up some retraining so he can move towards getting back into the job market and becoming more independent. His daughter and son in law are apposed to the idea as they think Gary is getting on in years and she would not be able to attend the address to get Gary ready for work before 9. 30 am as she needs to get her children to school.His daughter also has reservations about the Gary's ex-work colleague as he has a reputation of being quite demanding of his employees and pays only a basic wage. In this report we are going to look into all the options that are open to Gary as in regard to him getting extra care so that he is able to push towards his goal of retraining for work. The key issues that we need to address as regard to Gary are can we get him the extra care that would make him more independent and give him the mobility to let him attend further education and training to put him back in the work place.This report is being compiled for Social Workers that are based within the Adult Social Services within Conwy County Council. Context With Gary's situation a number of significant events have happened which have led to his current situation, he lost the use of his legs sometime ago and lives alone after getting divorced some 15 years ago. Gary is suffering from depression and is taking medication for this, his daughter and son-in -law are relied on for most of his care and a support worker attends each day to give him a bath.Since the onset of his depression Gary has withdrawn from doing the activities that he used to enjoy and he is very much cutting himself off from the world. He enjoyed used to enjoy using his personal computer to research local and family history. The root of Gary's problem I believe is that he has become depressed due to his isolation from the real world and with his current lack of care and mobility he is almost ‘stuck in a rut' and needs to be removed from this situation and given more self worth.Gary needs a more active place in society and the more help that he can be given the more he will feel like he has a purpose in society, his family have reservations about the course of action that Gary wishes to pursue due to their limitations as regard to the time of day that his daughter can attend to get him ready and also the reputation of the old work friend that is offering him f uture employment.Adult Social Services have a number of goals for people who are disabled they include Maintaining independence, opportunities to contribute to the community, feeling valued, access to social contact and community, keeping active and alert (http://www. york. ac. uk/inst/spru/pubs/pdf/newvision. pdf) all these apply to Gary and Adult Social services need to move forward with Gary to give him a greater quality of life and move him towards the goals hat he wish to obtain there are a number of options that are available to them. There are a number of perspectives that could be considered when looking at the situation of Gary, we can look at through the eyes of the Social Model of Disability (K217 Book2), Sigma (Goffman 1968) , empowerment (K217 Book 3). When looking at Gary's situation I am applying the Social Model of disability which was created by disabled people themselves.This was primarily created as a result of the response that society has given to disabled peopl e and also a reflection of the experience that disabled people have come across in the health and welfare system which as given them a feeling of being socially isolated and oppressed. The second perspective that I am going to apply to this report is empowerment, this gives the service user greater control of the services that they receive, being involved in the planning of services and developing good practice. (Barnes and Bowl, 2001) DiscussionIn the case study that this report is based upon Gary has been in a serious car accident that has deprived him of the use of his legs and this now means that he can only get around with the use of a wheelchair. This situation has had a knock on effect of him have a low sense of self-worth and a lack of pride in his situation, he suffers from depression and is taking medication for this. Radar (the disability network) and Depression Alliance commissioned a report (http://www. depressionalliance. org/PDF/depression-disability-and-employment-re port. df) that looked into depression as a disability and how we can improve the way we look at depression and the changes we can make to help reduce job, long term economic inactivity and isolation. Of the 566 people who answered 95% were living with depression and a quarter (148) people had a long term physical health condition. 77% of the people reported that they had not received any support with employment. Gary is living with a type of disability which is difficult, most disabled people are not depressed and do not stay depressed.The prevalence of depression among disabled adults is twice that of healthy older adults (Beekman AT, 2002), the relationship between depression and disability is a two way street with depression there being a link between physical disabilities and depressive symptoms in older adults (Gill TM,Kurland B 2003). There is clear evidence that Gary has on the onset of depression that can be linked to the impact of the loss of his legs in his car accident an d with him now socially isolated and without employment these have now added to the problems over a period of time.In a report by Tania Burchardt called †Enduring economic exclusion' Disabled people,income and work' the study found out that disabled people now make up a large and growing proportion of people who are of working age, it now stands between 12 and 16% (Enduring economic exclusion Page. 4) One telling statistic is the problems that disabled people have getting work, and that one third of those disabled people who find employment are out of work once again the following year.In the report by Tania Burchardt the income statistics show that half of all disabled people have incomes below the general population indicator of poverty after it was factored in about the additional cost that disabled people incur due to their health. Gary wants to gain access to retraining so he can move towards gaining employment once again after he becomes qualified in the sector that he w ishes, to do this he is going to need some extra help from the local Conway Council to get to his goals.Conway Adult Social Services have a number of options that they promote that may be of assistance to Gary, they already give him care to help him get bathed and his daughter and son-in-law take up the care duties in the morning. Conwy can provide Homecare that can help with a range of things such as help getting up, getting dressed, preparing meals, doing laundry and shopping where appropriate (http://www. conwy. gov. uk/upload/public/attachments/466/Microsoft_Word__CCO_Leaflet_eng. df) . Gary would need to be assessed as to the level of care that he would be entitled to also considered as to the possibility of equipment or adaptions that could be made to the home to help him live more independently and safely in his home. Though Gary is set on this course of action his daughter and son-in-law have reservations about his age and the amount of care that she could give her father du e to her own family commitments.His daughters view point about his age and the fact that any new employer might demand to much from him is really being based on his disability and not solely based on is age (K217, Book 2). There should be no denial of opportunities or restriction of choice based on assumptions that are made due to his disability. Through the social model disability is understood as an unequal relationship within society and there can be no barriers preventing people from gaining equal access to information, education and employment.There are options that perhaps he has not considered and with him feeling socially isolated due to living alone and his lack of contact with the outside world. Conwy Council Adult Social Services promotes day care or opportunities to meet other people and take part in outings and other activities so Gary would be able to haver a much more active life that would could help with the depression he is suffering. (http://www. conwy. gov. uk/up load/public/attachments/466/Microsoft_Word__CCO_Leaflet_eng. pdf) The principles of good practice (http://www. nderstandingindividualneeds. com/page. php? identity=principles) state that you have to give Gary a choice about the way in which he wishes to move forward and also take into consideration his emotional needs. Social development is about gaining relationships with a variety of people and taking part in an ordinary life and currently Gary is unable to obtain these basic rights. Gregory Beattie talks about how a depressed individual has a lack of socialization and social support groups (Beattie, Gregory,S. 2005) Social Causes of Depression) and Gary has a lacking in both these things as he is unable to access them. If Gary was to obtain the extra help that he is going to need to obtain the goals that he has set himself a consultation with both himself and his family is going to be needed as to ascertain as to realistic goals that can be set. There would be a negative impact o n Gary should he set himself unobtainable goals that he then fails to obtain, this would be damaging to the situation.Statistics show that disabled people have a lower overall level of qualifications when compared to that of able bodied people (Employment of disabled people DoEE) 38% of disabled people have no qualifications compared to only 16% of non-disabled people. The report also concluded that of the 2,015 disabled people that were spoken to (26,000 households in total) 64% strongly agreed and 29% agreed that getting a job was important to them so the statistics show that it is important for disabled people to be in employment. 47% of the economically inactive disabled people who see themselves as being able to work would like a paid job.When speaking about Gary's visions of eventually going back into work his daughter has reservations incase he is taken advantage of by his employer and in the report one in six people (16%) who are economically active stated that they have exp erienced unfair treatment or discrimination in the work place. When looking at the overall statistics you can see that 42% report that that they have been discriminated by a potential employer and 41% by an employer, these figures speak volumes and during any assessment they will need to be presented to Gary so that he can see the real picture in the job market for disabled people.The option of Direct Payments is one that should be explored with Gary and when he is assessed for the amount of care that he needs the options should be discussed at length, direct payments have both good and bad points and do not fit everyone. As direct payments will mean Gary being responsible for a number of things it also might be advantageous to also consult with his daughter and son-in-law to see if they would be interested in perhaps helping Gary should he need it.Radar the disability network have produced a fact sheet that the family may find useful (http://www. radar. org. uk/wp-content/uploads/2 011/06/6_directpayments. pdf) , the fact sheet points out how Gary would become and employer and all the responsibility that comes as well as all the paper work he will be required to keep. He will need to consider if he wishes to have the work load of sorting out all the pay, dismissal, redundancy just to name a few of the obligations that he would have to meet as an employer to a personal assistant.The other option open to Gary is to place the care that he requires in the hands of an agency or self employed to take the burden of work away from himself and organise his care around his specific needs. Bringing Gary into the centre of this assessment into his care will empower him to participate (K217 Book 3) Jones and Meleis describe the concept of empowerment as ‘a social process of recognizing, promoting, and enhancing people's abilities to meet their own needs,solve their own problems, and mobilize necessary resources to take control of their own lives (Jones PS, Meleis 199 3).The empowering of Gary will start a process of helping him assert greater control over the factors that affect his health, in the past it was assumed that service users were supposed to be compliant with the directives that were in place from the health care professional's-the biomedical model. In the empowerment model there is a contact between Gary and the provider who take a joint responsibility in terms of agreed upon outcomes, people within the health care profession are obliged to respect Gary and assist him in making decisions.Multiple studies have shown that people that are more involved with the decisions about the care that they receive and also the management of the conditions that they live have better outcomes than those who are not involved in the process (Wagner EH,Glasgow RE,Davis C, 2001) (Greenfield S, Kaplan SH,Ware JE Jr, 1988). Conclusions and Recommendations In this report we have been looking at the situation that Gary is currently experiencing, he is a dis abled person who lost the use of his legs in a car accident some years ago and lives alone now after a divorce.He is looking at the possibility of getting some higher education and hopes to move into employment in the information technology sector, it has already been stated that daughter and son-in-law have reservations about this course of action due doubts about the ex-work colleague of Gary's that is offering him employment and the problems that this will present to her care giving situation.The report has looked at the links between depression, disability and joblessness and we have shown that there are links between these elements that are making Gary's life move difficult but also you must take into consideration that fact that Gary is very socially isolated. The report then looked at the option of direct payments and how Gary's care could be changed so he will have more control and power over his care and become the central focal point so he can move towards a more independe nt life and obtaining the goals that he is setting for himself.The report looked at all the pro's and con's on the direct payment system and all the extra paperwork and responsibility that comes with employing someone and how records must be kept and these funds are public money have to be accounted for. My recommendations are the following, Gary should have his care plan reassessed by Conwy County council Adult social services with the remit of looking at the possibility of changing the level of care that Gary currently is getting and exploring the possibility of Direct Payments as an option.There should also be consultation with his daughter and son-in-law (with the relevant permissions) and have them present to discuss any and all options. Please present all options to Gary as regard to becoming a greater part of the community and providing information on the day care that you and provide and any opportunities to meet other people and take part in outings and other activities tha t your local authority provides to people within the county.A list of approved providers in the local area should be presented to Gary and also discuss the various support networks that you have for carers and also the options of homecare that you provide including help with getting up,getting dressed, preparing meals and shopping etc. Gary may need the help from the benefits advice centre as regard to making sure he is getting all that he is entitled to and though outside your remit perhaps access to DLA to help with transportation needs. 2789 References http://www. ork. ac. uk/inst/spru/pubs/pdf/newvision. pdf accessed 31/05/2012 The Open University (2010) K217 Adult health,social care and wellbeing, Book 2, Milton Keynes, The Open University Goffman, E. (1968) Stigma: Notes on the Management of Spoiled Identity, Harmondsworth, Penguin The Open University (2010) K217 Adult health,social care and wellbeing, Book 2, Milton Keynes, The Open University Barnes, M. and Bowl, R. (2001) T aking over the Asylum: Empowerment and Mental Health, Basingstoke, Palgrave.Meager N,Bates P,Dench S,Honey S,Williams M,(1998) Employment of Disabled People:Assessing the Extent of Participation, Research report RR69, Department of Education and Employment. http://www. depressionalliance. org/PDF/depression-disability-and-employment-report. pdf accessed 31/05/2012 Beekman AT, Penninx DJ,Deeg DJ, de Beurs E, Geerling SW, van Tilburg W (2002) The Impact of depression on the well-being,disability and use of service in older adult: a longitudinal perspective, 105:20-27 Department of Psychiatry, Vrije University Amsterdam.Gill TM,Kurland B (2003) The burden of patterns of disability in activities of daily living among the community-living older persons, 58:70-75, Yale University School of Medicine, Department of Internal Medicine,New Haven, Connecticut. http://www. jrf. org. uk/sites/files/jrf/1859353274. pdf (Enduring economic exclusion) accessed 01/06/2012 http://www. conwy. gov. uk/up load/public/attachments/466/Microsoft_Word__CCO_Leaflet_eng. pdf accessed 01/06/2012 http://www. understandingindividualneeds. com/page. php? identity=principles accessed 02/06/2012