Posted: April 11th, 2015

Factual summary

Factual summary

The case was allocated on the 18/02/15. I read the previous case notes on the frameworki and did a research on the effect of stroke on an individual and the care giver. Stroke: A Practical Approach by James D Geyer (2009).

I rang Mrs T B to inquiry her husband wellbeing and to inform her I am the social worker allocated to his case. We arranged a suitable time and date for the meeting.

I discussed Mr TB’s case with my practice educator, the types of questions I will be asking to gather information, theories and approaches relevant to the case.

Mr T B is a 78 years of India background. Prior to the stroke he lived with his in a sheltered accommodation. Mr T B is on as short stay in a nursing home. MR T B is constantly been monitored to ensure his stay in the nursing home is with DOLS, therefore he is been reassessed every three weekly to establish his wellbeing and his intention to return to the community.

Assessment report

Assessment visit to Rose Lodge to assess Mr T B.

I arrived at 13:00 at met Mr T B was finishing with his lunch and Mrs T B was present. I introduced myself and the reason for the visit. Mr T B stated that he wanted to use the toilet. The carers took him to his room and I went to the staff nurse to read the support plan in Mr T B records,

While Mr T B was being supported by the carers, I discussed with Mrs T B (who is the informal carer for Mr T B). She expressed her concerns for Mr T B returning home and she is still waiting for the structural adaptation for their home. Mrs T B stated that she is worried that Mr T B would never get better because she felt the medical team has given up on her husband.

While we talking the carers signalled that they were finished with the personal care with Mr T B. On entering the room I introduced myself to Mr T B and the reason for the visit. Mr T B stated that he knows the reason why I was there that Mrs T B had informed him of the visit. Mr T B remembered when he had his stroke (6/11/14) and that he fell out of bed and his wife rang the ambulance.

He mentioned that that it was inevitable that he would someday have a stroke because he was overweight and had heart disease. Mr T B stated he was discharged from Charing Cross hospital and placed at Rose lodge on 22/01/15.

During the assessment, I observed Mr T B had left sided weakness due to the effect stroke. During the assessment Mr T B stated he is not happy being in Rose lodge because the carers are telling him when to sleep and when to eat. He expressed dissatisfaction with the meals that there is too much spice and he had spoken to the manager of the service on Wednesday about the meals.

I asked Mr T B about his future intention regarding his residential needs. He stated he would love to return home. Mrs TB stated Mr T B cannot return home because she is unable to meet his needs and moreover the house is not adapted to meet his needs. She stated the doors are too narrow for his wheelchair assessed, the bathroom needed to converted to a shower room and Mr T B needs 24 hours care.

At this point Mr T B was distressed and stated that the thought of remaining in Rose lodge is making him depressed. He stated, he was an independent man and now he had to rely on carers to use the toilet, eat and sleep. I reiterated these measures are put in place to enable and assist with his day to day activities. Mr T B stated he will be happier at home and Mrs T B was upset that Mr T B is not considering the implication of returning home and his care needs at night.

Mrs T B requested for Physiotherapist and OT. I informed her that the referral would have to be made by Mr T B GP. She said that nothing was done for husband by the doctors at Rose lodge and this is upsetting because it seems that they have given up hope on her husband recovering.

I explained the financial contribution and eligibility criteria to Mr and Mrs TB. At this point Mr T B stated he wants to buy a house in the South. I asked South of where and he said Devon. He stated he has money over £100 000 and Mrs T B stated Mr T B is confused and they operate a joint account and they do not have any saving up to that amount. I informed her I would be sending her the financial contribution form (FCF) for her to complete. I also provided her the information to assist her to understand the criteria for financial contribution to Mr T B’s care.

I spoke to Staff nurse (L). She stated, a physiotherapist has being to see Mr T B however the physiotherapist has advised Mrs T B that the chances that Mr T B will walk again is not possible.

Cognition:

Mr T B presents as confused and unable to engage the present line of conservation we had. Mr T B was observed to stray away from our discussion and he was repeating previous conservation of how rude the carers are toward him. Mr T B has capacity to make decision to his wishes and choice.

Behaviour:

Mr T B behaviour was pleasant. Nurse L reported Mr T B has settling into his new environment. Nurse L mentioned Mr T B is not happy with the meals and the manager is addressing the issues

With personal care, Nurse L stated it is a challenges on some occasional in the morning to assist Mr T B with personal care. She stated his cognition impairment is prominent because he is not able to follow instruction, therefore requiring 3 staff to assist with personal care.

Psychological and emotional needs:

Mr T B presents distressed at the mention of next place of resident. Mrs T B and nurse L stated he has occasional episodes of sadness and mood changes.

Communication:

He is able to speak in full sentences, however reduced insight, engagement and motivation as well as memory affects content of communication.

Mobility:

Mr T B was diagnosed with Hemiplegia (complete paralysis of half of the body). He is unable to mobilise. Nurse L stated Mr T B requires assistance of 2 – 3 staff to transfer with the use of the hoist and XL sliding sheets and unable to weigh bear. Mr T B is unable to participate in any part of the transfer, this include rolling in bed and unable to pressure relieve independently in bed.

Nutrition:

On admission to Rose lodge, Mr T B weighed 105.8kg and the last weighing on the 02/02/15 was 101.4kg. The dietician from Charing Cross required Mr T B is placed on modified diet. Mr T B requires prompting from carers and supervisions due to the risk of choking.

Continence:

Mr T B has catheter for urine and bowel incontinent. Mr T B has a night catheter bag and he is able to call for assistance for bowel movement. .

Pressure sores:

Mr T B remains at very high risk of developing pressure sores due to obese status, incontinence, dry skin, neurological deficit and being immobile. Nurse L stated Mr T B has a second degree pressure sore on the sacrum and heel. Mr T B requires turns every 4 hour (including night) to manage pressure points.

Pain:

Mr T B complains of pain in his right leg and his knees and this is being managed by medication.

Three days after the assessment, I received an email from the daughter through a legal representative. Mr TB’s daughter was not present at the assessment however she has informed us that she had made an official complaint about the assessment. The email was forwarded to my practice educator and team manager, who ware addressing the matter as a case of urgency.

Email sent to the risk panel committee requesting for extension of the short stay at the nursing home from the 03/03/15 to 24/03/15 to enable Mr T B to make informed decision with regard to moving back to his home.

Call made to Mrs TB to inform her of the decision to take Mr TB case to risk panel to request for permanency. This type of permanency is not indefinite but subject to whenever Mr TB feels he is able to manage in the community with a package of care put in place.

Action of the assessment is being arranged for risk panel meeting on the 17/03/15

 

Brief Outline of Work Undertaken

I prepared for social work contact with Mrs P by reading through previous assessments completed by other professionals who have had involvement with the service user. These assessments had been completed by the social workers hospital assessment team (HAT), physiotherapist, occupational therapist, dietician, staff, psychiatrist, rehabilitation team and the care staff at the nursing home.

I conducted an assessment of Mr TB’s social care needs. I liaised with Mr TB, his wife, and the nursing home staff. I applied the bio-psychosocial theory and partnered with the Mr TB and his wife.……

I conducted mental capacity assessment (Mental Capacity Act 2005) in order to determine whether Mr TB has capacity to make an informed decision regarding his future plans to returning back home.

The community care assessment conducted determined that Mr TB had substantial care needs and that support was required to ensure his health, wellbeing and safety.

The decision to extend his short stay at the nursing home pending his care needs is able to be managed in the community.

The extension for short stay to be reviewed every 3weeks to establish when Mr TB can manage his wellbeing in the community.