Empowering with Older Adults in the Community - Research Paper Example

Working in Partnership and Power/Empowering and working in Professionalism with Adults in the Community Partnership: Working with Adults in preparation of care plans Social work involves the process of working with individuals who may sometimes be discriminated against. Among older adults, this is an issue because of the practice of ageism where age and prejudice is highlighted and considered as determinants in the access of services. Partnership working manifests in work with service user and in work with professionals within the multidisciplinary setting. In general, good partnership is apparent when a service works with clients and social workers as well as other professionals (Warren, 2007). Differences on how partnerships are being utilized in social care have been seen, especially with various agencies working well with their clients, and yet, not working well with other professionals. On the other hand, other agencies may work well with other professionals and agencies within their multidisciplinary network, and yet they may not work well with their clients (Thompson, 2000). The goal within this social work practice is therefore to establish a balance between work with other professionals and working with clients. Partnership working with the different service users simply refers to working with clients in a coordinated and interactive way (Thompson, 2000). In this type of partnership, the service user is considered the expert on all things which relate to themselves and as such their contribution to the entire process and partnership is highly essential. Effective partnerships with other professionals are crucial in the delivery of services. Relations among agencies can often be strained, especially when these agencies may not share the same goals, obligations, and concerns. The importance of sharing goals with each other from the very beginning has therefore become an essential part of effective partnerships. This sharing is expected to support the resolution of issues in a strong and positive manner (Thompson, 2000). Open channels of communication are an important element in partnerships and they can be established by coordinating with the service user client and other professionals in making crucial decisions in various phases of the social work interaction. Partnerships support the sharing of responsibilities in resolving issues, guaranteeing that all parties involved consider their contributions as crucial to the entire working process (Thompson, 2000). Plans must therefore be founded on the result of negotiated interactions among the parties, not influenced by any biases or preconceived notions on client behaviours (Braye, et.al., 1998). Within the partnerships, service user clients have the right to express their preferences on decisions and options which would affect their lives, and also to know what the professionals’ opinion is (Trevithik, 2002). This is important to ensure therapeutic working conditions and mutual respect among the service users and the professionals involved in the client’s care. Partnerships do not necessarily imply equal power among the parties or partners; however, it implies that all members or partners have the right to express their preferences, opinions, and to participate in the different processes (Braye, et.al., 1998). In instances where the allocation of power is uneven, the client must still be clearly informed about the decisions and discussion which relate to her care (Tunnard, 1991). For some clients, partnerships can present a difficulty, especially if they have had a negative history in relation to partnership working. In these instances, partnerships may not work well until the client has shifted his thought processes about the partnership process (Braye, et.al., 1998). In order to restore the client’s faith in the partnership working, sessions which stimulate their self-confidence can be carried out (Trevithik, 2002). Moreover, professionals can also apologize to the client for the mistakes which were committed in the past. This can help build trust and rapport with the clients, thereby laying out a new foundation for a trusting relationship. The previous experience which I will refer to is the case of Mrs. Patel who recently suffered a stroke was discharged and was now recommended to a day care centre to provide her family temporary respite in her care. Her care later involved a multidisciplinary assessment of her general condition, mostly of her ability to live alone, including her ability to carry out her activities of daily living independently. The Centre for Policy on Ageing through the Care Quality Commission specifies that its concerns relate to older adult care, specifically: the shape of care provision; access to care and services; choice and control; and quality and safety (2011). These policies serve as basis for the provision of adult care and for protecting their safety. After specialist evaluations identified some needs which called for special assessment, client consent was gained in order to refer her for appropriate services. In this process, the care manager facilitated and coordinated the process of multidisciplinary evaluation (Coulshed and Orme, 2006). Based on the National Service Framework for Older People (DOH, 2001), various systems must be established in order to ensure the efficient coordinated working of professionals in the evaluation of the needs of older people. In Standard 2 of the National Service Framework, the single assessment process is recommended for older clients. It is a standard which calls for the cooperation of agencies and professionals on all levels as a means of securing effective assessment of client needs. It is therefore crucial for social workers to identify the significance of our efforts within the multidisciplinary process, and also the importance of the various skills and information which other professionals can bring to the process (Crawford and Walker, 2007). In considering other disciplines, the goal has always been to establish a cooperative grouping of professionals working with each other to evaluate client needs beyond professional and organizational limits. As a social worker coordinating care, I made a referral to the occupational therapist who was working with the same agency. The Katz Index of Independence in Activities of Daily Living was utilized by the therapist in order to review the client’s safety in potentially living alone. Assessing need is an aspect where multidisciplinary working can benefit the service user client (Leathard, 2005). As a member of the team, I was able to coordinate with the client’s physician and rehabilitation officer on the overall assessment of the client, and on their opinions about the client’s condition and possible care. I coordinated with the occupational therapist in the agency in order to review the client’s progress in gaining the appropriate skills for independent living. I was able to coordinate and liaise well with the other workers, mostly in assessing the client and generally working in a coordinated fashion with these workers. When organizational boundaries were crossed, barriers were often encountered. There is an inherent concern on the relations of service users and professionals, as well as their relations with other professionals and with the organizations and agencies (Weinstein, et.al., 2004). The need to work beyond these barriers was the challenge I had to deal with while working the client’s case. An evaluation and coordination between the different professionals was eventually established and the goals in relation to the client were eventually agreed on by the professionals and the client. This process established the role of effective communication and the importance of coordinating with the relevant professionals before any pertinent decisions can be made (Thompson, 2005). The role of effective working and cooperation when working with other professionals was also established in the review of this case (Crawford and Walker, 2007). After an evaluation was carried out, barriers to the process were seen in relation to the contrasting professional opinions between the attending physician and the occupational therapist. In this instance, the importance of professionals sharing data and clarifying such with each other emerged (Weinstein, et.al., 2004). In this client evaluation, I was also called on to review the practice of the occupational therapist in refusing to immediately grant the client’s need for assessment in his ability to carry out his daily activities. Power/Empowerment: Analysis of power issues in working with adults Power issues may become apparent in working with older adults. These power issues mostly stem from the fact that it is easier for social administrators to manage empowered clients (Thompson, 2007). Empowerment was made possible on the part of the client by allowing her to control her daily activities, based on her preferences and her capabilities. In order to establish an effective strategy for establishing opportunities for major change and development, connections with other people, and networks for reciprocity and mutuality may have to be forged (Tew, 2006). For some people, the coordinated application of power may have a better impact than isolated displays of power (Adams, 2008). Discovering power together may be strongly applicable to women, to the working class, and to the various members of ethnic minorities where their daily activities are highly based on limited resources (Crow, 2002). Concerns on the issue of power relationships within social work in relation to service user participation has recently emerged (Tew, 2006). Empowerment has been defined as the process of improving a person’s capacity for decision-making, controlling one’s life, fulfilling personal goals and consequently improving the quality of one’s life (Braye and Preston-Shoot, 1995). The description highlights the importance of individuals controlling their lives; this process of establishing control can be carried out through structural and fundamental changes, as well as supporting the need for improved communication within an organization (Adams, et.al., 2002). Empowerment is a term often used in relation to service users. It is defined in different ways and its application is often put at issue (Gomm, 1993). Nevertheless, it is a term which relates to the act of having more control over one’s life and overall status. However, since older adults can sometimes go through issues which relate to oppression and discrimination, its application in social work is often limited. In effect, within the social work setting, empowerment covers the psychological, as well as the social and political processes; it also involves the process of supporting service users in handling various social issues (Thompson, 2000). In order to secure such empowerment, attempts at increasing the power which service users have over their lives and decisions have been implemented. This is also a way of reducing the client’s dependency. Empowerment is often supported through various resources, including educational and counselling resources (Thompson, 2001). Empowerment can be considered as a means of securing authenticity within social care, helping them identify the means by which barriers to independence can be removed. Empowerment is often described as the right to choose and to consider risks (Kemshall and Pritchard, 1996). It can sometimes contrast with social work processes of risk assessment since this is a process which evaluates hazards and dangers; it often does not consider empowerment (Ryan, 1996). Even as a professional may have a good working relationship with a client, being a strong support system for the latter, the professional must also review the rights in relation to other clients and professionals. It may not be ethical to support client’s actions if such actions would negatively impact others (Banks, 1995). Empowerment as an adjunct of social care planning implies that the service user must be incorporated into all aspects of the planning process and made to think that their opinion and preference is going to be considered. In effect, allowing his participation in the planning process would ensure that he is being respected as a service user and that the overall plan would actually be followed. Empowerment carried out through discussions may not always be possible or easy to implement. Factors like: social worker’s relationship with the service user and his family members and the user’s willingness to admit an issue, may cause difficulties in broaching the subject of seeking help (Mulender and Ward, 1991). It is crucial for professionals to be mindful of the fact that elderly adults may have gone through various issues in their lives, and that they may be at a point in their lives where they are proud and would not want to be dependent on other people or to admit any weakness. This may also be the issue with ethnic minorities who might not be welcome to the idea of relegating their older adults to nursing homes; and yet, they may also be incapable of providing sufficient care for their elderly (Banks, 1995). Effective negotiating skills may be crucial to get through unwilling service users, and asking the assistance of friends to broach the subject with the service user can help ease the topic into the user’s thought processes. In this case, the users and their carers are crucial participants in the overall decision-making process. Social workers have established different models of care and some of these have been more effective in empowering users. In instances where direct payments have been allowed, more financial autonomy for service users have been made possible and has given them a choice on the type of care to be administered and a greater control over their lives (Ryan, 1996). Being a support worker to Mrs. Patel, an elderly lady who recently suffered a stroke, it is determined that she has limited mobility and is unable to carry out her activities of daily living independently. She has been referred to day care in order to give temporary respite to her family caring for her. She would likely live with her family after her release, but she does not have constant care with them. A care plan has been established in order to assist her in gaining autonomy. There is a significant issue in her case in relation to her ability to carry out her tasks independently. Empowerment has a favourable view of service users, viewing them to be competent enough to make their choices when given access to the appropriate resources (Mulender and Ward, 1991). As social workers have legally granted powers, as well as the power to refuse the issuance of services, this power is also acknowledged by service users (Koprowska, 2006). This may cause issues and distrust among the service users; the social workers therefore have to infiltrate this veil of distrust and establish strong relationships with users, one which is actually based on respect and mutual trust. Policies have also been written on the practice for Social Care Workers, and these policies relate to confidentiality, equal opportunities, safety, and risk assessment (The Social Work Processes, 2008). Without these policies in the practice, the social workers may sometimes practice in less than ethical means and I made sure that the different social workers and other professionals involved in the client’s care were fully aware of their ethical obligations. In order to support the legal changes in the Equality Act emphasized the need for managers in adults’ social care to acknowledge the occurrence of age discrimination; to identify the main features of age-equalities approach to social care; to acknowledge the barriers in achieving age equality and minimizing age discrimination; and sharing data and implementing changes which overcome the barriers (SCIE, 2008). Professionalism: Analysis of research with adults on their experience of social work intervention In assessing the research with adults on their experience of social work intervention, it can be deduced that studies in the UK establishes that older adults or those who may be terminally ill have a stronger desire to live independently for as long as they possibly can (Lloyd-Williams, et.al., 2007). Several factors impact on their desire to remain home, the first being the broad physical environment, the second being own material environment, and the third refers to the individual’s social environment and their access to formal care (Rolls, et.al., 2010). Research suggests that it is crucial for individuals’ living arrangements to not cause assumptions on quality of life and social support (Rolls, et.al., 2010). Those who live alone may sometimes feel lonely and depressed, as well as lacking in community support. The social network which these older people exist is also impact on their levels of loneliness and the perceptions which other people have about their loneliness (Scharf, et.al., 2005). Studies seem to support the idea that older adults living in deprived inner city or rural areas have a higher risk of isolation and of loneliness. Interacting with other people is therefore an important aspect of Mrs. Patel’s care. Her plan of care therefore included socialization activities which were meant to improve her overall feeling of wellness. The social environment for older adults living alone includes the formal and informal networks. This network includes wider kinship and social networks as well as access to social servcies (Rolls, et.al., 2010). Individuals approaching the end of their lives require assistance in various aspects and activities of their life, including transport, homemaking, grocery store runs, nursing care, personal care, and grooming. All these services are provided by informal and formal carers and social workers are often there to coordinate these types of care. Diverse environments, such as rural and urban areas may have varying effects on the kind and level of family or any other support available, including the time provided for the needs. Three elements have been considered as strongly associated with deaths in homes: provision of home care and its intensity, living with relatives, and extent of family support (Gomes and Higginson, 2006). However, higher numbers of older adults living alone in rural or inner urban areas often do not have access to informal support. Moreover, the number of carers to older people living alone may be affected by social and economic changes, including employment changes. These factors may cause them to feel pressured to provide the care themselves or to relocate to other places in order to earn income for their family. They may also feel that pressure to extend their work hours in order to earn higher income for their family (Rolls, et.al., 2010). The present UK policies highlight the importance of independence or of home care, not care settings. In order to give Mrs. Patel’s family some form of respite, Mrs. Patel was entered into the care setting. This is a favourable intervention in this case as it has given the family a chance to rest and to distance themselves from their responsibilities. It is a temporary respite, but a useful and energizing one as well, allowing both the client and her family to place distance between them and to consider time apart from each other, carrying out other activities. There may sometimes be a shift or change in power relations from professionals to individual persons while the National Service Framework for Older People seeks to guarantee that services are appropriate for the needs of the service user (McCarthy and Thomas, 2004). The concept of individual responsibility which is established through decision-making and personal choices is supported by the principles of autonomy. Older individuals also need to be involved in their care and that their carers must recognize their client’s motivations in needing more or fewer services or more (or less) attention (Genevay, 1992). Moreover, while there has been lesser emphasis on the UK policies on client choices, the capacity for choices at the end of life may eventually be based on age, incapacity, and other resources. At the end, dignity and autonomy may sometimes be ignored or lost (Rolls, et.al., 2010). Social interactions and options may also be reduced. While solitary living may soon become a common feature among service users, evidence suggests that formal services are often sought in an inverse proportion to needs (Rolls, et.al., 2010). In the UK, a study established that those with informal carers were more likely to die at home, and to have a need for palliative care. In an Australian study, the authors revealed that older adults living with carers, seek services more often than not that those who do not have carers. Carers therefore serve as initiators to improved access to social services and related services. Some studies also claim that having younger carers for older adults may be the more effective option, especially for those who live alone (Grande, et.al., 2006). Social services are also in the dilemma which relate to limited finances in meeting the needs of older adults due to their growing population. In Western countries, changes in demographic qualities cause the increase in the number of households progressing to old age and a varying balance between the older and younger generations. In relating these research studies and these concepts to the case of Mrs. Patel, it is crucial to note that she may indeed prefer to live alone, but before she can do this, all the tools which would help her live an independent life must be taught, discussed, and planned with her. After considerations made above, professionalism, partnership, as well as empowerment are considered complementary elements in social work practice; empowerment is the more crucial element in relation to the two other elements (Trevithik, 2002). These concepts are all based on the viewpoint of power and the service user client gaining more power over his life and his situation. Social workers have a significant amount of power in general, as far as their practice is concerned and because of their general access to essential resources. On the other hand, service users are often made to suffer issues which relate to economic, gender, social, and age discrimination. In some cases, such discriminatory practices are often manifested by the social workers themselves via their preconceived notions and unfavourable assumptions about service users. Based on these considerations, it is crucial for professionals to review discriminatory practices and to aggressively reduce its application within the social work practice (Thompson, 2000). In order to empower clients, the ability of professionals to compromise and negotiate is necessary (Trevithik, 2002). Moreover, in order to ensure favourable results in the delivery of social care, service users must be viewed as necessary contributors to their care. As a result, the social worker must recognize the favourable qualities which service users have (Trevithik, 2002). Reflection In reflecting on the social servcies administered to the client, the Gibbs Reflective Cycle provides an orderly reflective process. First of all, Mrs. Patel who recently suffered a stroke was discharged and was now recommended to a day care centre to provide her family temporary respite in her care. I felt that she was not ready yet to live alone again and a day care centre would help reduce the stress on the family members and therefore ensure that they would also feel refreshed and reinvigorated in administering to her needs. Allowing respite for family members would also work well for Mrs. Patel who would feel less of a burden to her family even if only for a short period of time. She would also benefit from time away from her family and interacting with other members of the community and the care centre. In evaluating what has happened, I would assess that what was good about the experience was that I was able to understand the needs of Mrs. Patel and what she was going through emotionally. I was able to deduce that older adults may sometimes feel inutile once they experience difficulties in carrying out their activities. However, doing these tasks for them would not be doing them any favours. They would benefit more from being assisted in managing their own activities, and they would benefit more from doing these activities on their own. I was able to understand that teaching these older adults how to manage things on their own and how to carry out their activities of daily living independently would be the more helpful option for these older adults. It gives them dignity and to a significant extent, it strengthens their self-esteem and their self-respect. Age discrimination is often a major issue in the delivery of social services to older adults (Levitas, et.al., 2007). Due to financial difficulties, concerned authorities have considered the application of budget cuts for the allocation of services for the elderly and those who require palliative care. One of the services which would likely suffer in these budget cuts would be the services allocated for elderly adults living alone (Department of Health, 2001). These cuts would reduce financial allocations for home services, transport, as well as home care services. This is a dangerous possibility because the social services for these elderly adults would be compromised. Older adults preferring to stay in their homes, living independent lives, the reduction of their access to services would severely endanger their lives and would reduce their rates of mobility and recovery (Wanless, 2006). Moreover, allocations for assistance to these older adults living alone may be compromised and they may not have enough resources and training to live independent lives. Reduced financial assistance would reduce allocations for occupational therapists who can be hired to work with these clients, teaching them independent living (Wanless, 2006). Such reduced allocations would also compromise the availability of social assistance from the social services – services which can potentially provide community support for these clients. Independent living is an important consideration for older adults because it implies that they would be much less of a burden to society. It also implies that the service users are being empowered in their care and in everything going on in their lives (Seymour, 2007). In effect, there is a partnership established with the service user, partnership in the planning of care, and in the delivery of services. This process would also help speed up the client’s recovery from her stroke, allowing her to regain her mobility and her eventual independence. Placing the client in assisted living would assist her temporarily, would teach her the skills she needs to learn in order to eventually gain independence. However, she has to apply these skills without assistance. And allowing her to live independently would ensure that she would safely carry out these tasks and that she would have the necessary muscle and bone strength to carry all her activities (Seymour, 2007). Older adults often have to stave off despair due to their limited functionality in society and due to their various social and health issues. Allowing them some control and independence reduces their despair and depression. Based on the reflection, I was able to gain the essential insight into the client’s condition and preferences (Urdang, 2010). In the process, I was able to deduce that if I were to encounter a similar event in the future, that I would immediately refer the client to the proper rehabilitation facilities. I would coordinate services to make this happen and I would ensure that these older adults would have independent capability before being relegated to independent living. I would also assist them in learning the skills for independent living, also ensuring that these older adults would have regular monitoring in their social services needs. This monitoring would also secure the monitoring of their needs and their overall functionality. 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