Older People, Dementia and Policy in Scotland - Term Paper Example

Introduction It is becoming clear from both public debates and academic and policy maker discourse in the UK that many older people (i.e., those over the age of 65 years) much prefer to live their lives within their own homes. With aid from family and friends, an aggregate of the senior community seek to maintain their autonomy, independence and active well being (Audit Commission 5). However, a number of errors have been found in the reporting of expenditure of public care services, and these are attributed to the nature and parameter of service delivery across different areas of the UK. For example, evening and weekend home care in most areas, whilst others are consistently unable to receive night home care. Further, home-care workers trained in mental health were only available in 7 of 58 areas in a national study. Also, many older persons and their informal carers have not received additional support from community care agencies, as do older persons and trained carers within hospitals and nursing homes. In the future, older people with mental health problems are to receive an equally good response regardless of where they live. This is one of the ways by which government and volunteer agencies seek to develop home-centered care, and to support informal carers and service users (Audit Commission 32). This paper will present a review of Policies For Older People Throughout The UK, With A Final Focus On Policies Pertaining To Dementia. Firstly, a background of the focus on equality and diversity in UK discourse will be presented. Secondly, UK policies since 1990 shall be described. Thirdly, policies with regard to dementia particularly shall be highlighted. Next, recommendations for best practices shall be given. A final conclusion shall review the main arguments and support the implementation of integrated support services for home-based carers and service users. Equality and Diversity A feminist approach to the ethical care within social work for the older person is of recent intense focus in discourse. This school of thought encourages the professional social worker to actively reflect on concepts of social justice, autonomy and human rights, as well as extending investigation in to how aging is understood (Lolyd 1171). It has been suggested that a feminist perspective can highlight issues of practice with regard to older person demographics, economics, politics and organisational levels. Issues of social justice and equity are continuous Scottish Executive policy aims. Community care policy goals seek to extinguish inequalities in availability and access to services across Scotland, as well as between particular groups of people (e.g., travelers and other minority groups) (Scottish Executive a. 5). Anti-Ageism is a facet of Social Justice and community care has an active role in increasing the number of older people who have high well being, are independent and healthy. The Social Justice Annual Report (Scottish Executive a. 6) has concluded that quality services which are accessible and effective are those that are designed with people’s needs in mind. This requires a change in the quality of public services to support users and their carers, such as working more closely with these parties in the planning and delivery of services. It is obvious that all involved support the active role of older people in practicing their right to inclusiveness in decision-making processes and the development of policy. Participation, partnership working, consultation and information giving are all ways in which the older person can actively contribute to awareness and gathering of information on issues (Scottish Executive a. 6). Policy History In 1990 with the release of the National Health Service and Community Care Act, it was perceived generally amongst the health care agencies of the UK that a new approach to social work and older people had begun (Lymbery 864). Until this time studies had consistently reported on the absence of attention and the undervaluing of social work practices withholder people. The change in legislation enabled social workers to become ‘case managers’ which emphasized management and process. The Act urged local authorities to consult people in their communities and to involve individuals in decisions about their care. From the late 1990s discourse emphasised terms such as “efficiency and effectiveness” were replace with less managerial and more socially aware terminology within policy documents (Scottish Executive a. 9). Instead, it was beginning to be realized that community care delivery had to be “need-led” or “person-centred.” Changes to performance indicators were also introduced, as outcomes were no longer personal assessments and the number of completed care packages. However, at one point it was contended that many agencies at both the local and national level take for granted the participation of informal carers. By the year 2000 service users and their carers were actively participating in decision-making processes, and service user-led agencies significantly increased. In Scotland, the Community Care and Health Act, 2000, aimed to support older people who wanted to stay in their own homes. For example, Scottish Ministers can make regulations to specify that attorneys or guardians can receive direct payments on behalf of someone who may be unable to give consent, for example a person with dementia (Office of Public Sector Information.com [OPSI]). Resources were provided to enhance home care packages and to provide ‘intensive care management’ to target care management resources (OPSI.com; Scottish Executive 31). For those involved in the provision of health care services for the elderly experiencing mental illness the Audit Commission report has been greeted enthusiastically. Essentially the document served as a benchmark for England and Wales from during 2000 to 2001. This is the first time that this area of community welfare has been audited. Collaboration with the NHS trusts, health authorities, social services, the independent sector, carers and primary care has initiated the assessment of practices across agencies, with a clear goal of linking and joining up for an integrated service care provision (Anderson 193). The Audit Commission report sets forth comparative data regarding commissioning, resourcing and delivering services with significant input form carers. The Scottish Executive carried out a review of recent research into older people and community care across the nation. The National Care Standards Committee developed principles and standards for high quality care in collaboration with stakeholders who use the services. The legislation of the Regulation of Care (Scotland) Act, 2001 the Care Commission is responsible for the registration and evaluative systems to monitor standards (Scottish Executive a. 33). Cooperative planning and delivery of health services with a focus on health and social work services is the ultimate long-term goal of community care policy. The Joint Future Agenda (Scottish Executive b. 5) provides a programme to develop integrated community care services. A report, the Expert Group on Older People (Scottish Executive a. 13) found that it is critical that the joint agenda be broad to cover the diverse and multi-faceted care needs of older people. It is clear that a multidisciplinary, multi-stakeholder approach is the only way to go forwards with a solution that works. Systems are now being constructed to evaluate the Joint Future Agenda, showing the commitment to consider user needs and their viewpoint during development. The Joint Performance Information and Assessment Framework (JPIAF) have initiated the development of research based methods to determine the service user and carer satisfaction. The outcome of this is an anticipated “toolkit” to enable service users to provide their point of view and to express their needs by way of a variety of communication channels (Scottish executive). Dementia Policies Dementia specialist residential and nursing homes have been found to be limited in their availability with regard to location within the UK, as up to two-thirds of the nations do not have consistent high quality environments suited for people experiencing this illness (Audit Commission 61). Nowadays it is recognised that legislation and policies must focus on informal home based care services, whereas currently the majority of the budget is allocated to hospitals, nursing homes and residential care for older person mental health (Audit Commission 61). The Forget Me Not: Mental Health Services for Older People report has been hailed as a valuable read for those involved in commissioning, planning and providing these services (Heath 1534). Importantly, general practitioners (GPs) and primary care services are considered to be essential, although it is recognised that they are lacking in support and advice from specialists. Low-referring GPs are suggested to be contacted to gain additional training and support, and to gain their input on policy making. GPs are in the front line for contact with carers and users and so will be the ideal person to make contact with these parties, and to have knowledge and direct understanding of their needs (Scottish Executive a. 66). Hence referral protocols should be constructed to assist GPs to identify memory problems, depression or other signs of mental ill health in older people. Tests such as the Mini-Mental State Examination (Folstein et al, 1975), Geriatric Depression Scale (Yesavage, 1988) by GPs should be encouraged. GPs should refer users and carers to local support groups at an early stage. In the early stages of dementia GPs should be able to provide advice and support to users and carers. Information about services is to available locally, and presented in a way that is understandable to the lay person. When it is obvious that specialist care is required; the Community Mental Health Team (CMHT) makes an assessment within the home. Home-based services are encouraged. Community specialist staff seek to train home-based carers, who in turn should seek to cultivate and develop their care skills and competencies. Respite care needs to be available also, including within the home. However, those who can no longer support their own wellbeing need to be admitted to a hospital or nursing or residential care. It is critical that integrated management occur to link community care services, home-based carers, voluntary organisations, and users and their carers. It is has been suggested that the Audit Commission lacks clear focus on the early treatment of depression outside of specialist services, such as at the home level with informal care (Heath 1535). Health and social teams must be able to provide a range of specialist services (i.e., dementia care) at the local level. The Care Programme Approach provides a method of individual care planning that can foster effective communication among practioners, users and carers. To achieve these outcomes clear goals have been established, such as the clear balance of home-based, day and hospital services. Monitoring of service quality will provide a high level of information to be used for planning. A focus on innovation development and jointly commissioned services reflecting the national framework are anticipated. Best Practices A majority of the organisation and fulfillment of the role of social care and protection in the UK is currently undertaken by volunteer organisations. It is a recommendation of the Forget Me Not report that that these agencies be given the support to orient themselves more fully on community-based care services (Carers net.com). It is also required that the National Health System (NHS) in collaboration with local councils should shift their focus to support of home-care providers to provide a range of diverse services that meet the mental health needs of older people who experience dementia (Audit Commission a. 68). Also, that the mental health specialist in each area periodically assesses the advice support and training provided to homes. The recommendations of the Audit Commission align with the suggestions of a joint working party of the Royal College of Psychiatrists and Royal College of Physicians (1998) (Anderson 199). Again, the focus is on coordination across agencies with awareness and continuous training in good practices, part of this being increased transparency and inclusiveness of the general public. Together, these documents have contributed to the publication of the National Service Framework for Older People that provides a national reference framework. It is necessary that empirical investigation and statistical data be used to understand the consequences of age and aging policy, as well as in the planning and development of optimal responsive care services (Scottish Executive a. 69). To this end, the Scottish Executive has carried out numerous research studies into older people, their need for services and areas of policy concern. For example, the Care Development Group has introduced free nursing and personal care in Scotland had input from commissioned research. The most recent commission of a review of the research reveals that the attitudes of the provision of free personal care services and the affect of policy and available support such as through nursing services have been largely ignored. This could be amended by future research. Conclusion Many people in the UK over the age of 65 years prefer to remain at home during their twighlight years, drawing on friends and family to maintain their autonomy, independence and active well being. However, it is clear that in some regions across the UK informal home-based carers and service users do not have equal access to resources, specialists in mental health, or care provision teams focused on dementia care, to support and enable the former parties to be responsible for, and to contribute to, their own health. Issues of equality and diversity contribute to the issue of carers and service user rights to social justice, care and protection. The Scottish Executive policies in the last 5 years have served to support and encourage awareness of aging and the needs of the aged. This requires a change in the quality of public services to support users and their carers, such as working more closely with these parties in the planning and delivery of services. Policy changes since the 1990s have seen the increased contribution of users and carers to policy-making decisions; however, until recently, government and other health care agencies have been remiss in coordinating and collaborating at the community level to determine user needs. The Forget Me Not report highlighted policy and protocols within Scotland to integrate care services to older people experiencing dementia. Especially, the document may prove useful in the commissioning, planning and delivery of care services to all older persons who are in need. Overall, it appears that best practices require agencies to collaborate more closely with GPs who are in the front line of service delivery for informal carers and service users. Also, it is suggested that individual health care plans be developed to inform across all stakeholders involved in the health care of the older person. References Anderson, David. “Reviews: Forget Me Not. Mental Health Services for Older People, by the Audit Commission. Psychiatric Bulletin, Vol. 25. 2001. pp. 198-199. Audit Commission. “Forget Me Not 2002: Developing Mental Health Services for Older People in England”. 2002. 28 October, 2006 from Read More