Role of a Social Worker for Older Adults with Dementia in the Community

The
role of a Social Worker relating to Older Adults with dementia in the community

This assignment will explore the role of a social worker considering older adults with dementia in the community. It will identify the intervention and services available and the impact of social work within this service user group, taking into consideration social, political and economic factors.

Social
work is thought to have been influenced by the middle ages, when there was a
breakdown in this feudal system due to famine and war; therefore, resulting in
an increase of those in need. To resolve this problem, England passed several
Poor Law’s between the mid-1300’s and mid-1800’s. The most significant was the
Elizabethan Poor Law 1601 (Zastrow, 2009, pp.11-14), which was designed to
maintain order and contribute to the general kingdom. This law gave the local
government the power to raise taxes and use the funds to build/maintain
Almhouse’s (Hansen, 2011), to provide sheltered relief for the less fortunate
and vulnerable. This law set the pattern of public relief under government
responsibility in Great Britain for the next 300 years, shaping the social work
of today.

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Social
work is aimed to bring about positive change in people’s lives for individuals,
families and the community (Adams, 2010, pp. 4-6). It is a profession that
promotes social change and problem solving, to empower and enhance the
well-being of service users (SU). Social work is an extremely diverse
profession that works with a diverse range of service users; therefore,
requires many to work in key specialisms such as children and families, young
offender’s, learning disabilities and older people (Beckett and Horner, 2016,
p.36), they must therefore ensure they have the adequate knowledge relating to
their specific area, such as dementia. Dementia is a progressive cognitive
condition resulting in it becoming increasingly difficult for an individual to
maintain their level of independence (Lymbery, 2008, p.28).

Many
social workers do not perform one single role but in fact participate in a
combination of roles and may work in a variety of settings within a framework
of relevant legislation and procedures to support individuals, families and
groups within the community. The Professional Capabilities Framework applies to all social workers in all settings (BASW,
2018). It provides a shared understanding of what is expected of social workers
across the profession and at different levels. The framework consists of nine
domains which sets out how a professional social worker should practice.

To be able to practice effectively, the social worker must use essential knowledge, skills and values to respond effectively to people’s needs and aspirations (Marshall, 1990). Social work assistance may be required when an individual becomes physically or mentally unable to cope with everyday independence (Adams, 2010, p.156). Their aim is to provide practical and emotional support and to identify services that the SU and their family may require, maximising their quality of life and identifying possible safeguarding issues. It is a social workers duty to protect vulnerable individuals from risk, abuse and neglect.

In
2014, the Care Act was introduced, which condensed many existing laws regarding
safeguarding adults. This gives professionals a statutory responsibility to protect
adults to have the right to live in safety, free from abuse and neglect
(Skillsforcare, 2014).

Communication
plays a vital role in effective social work practice both with the SU, family
and other social workers/professionals. It is important that social workers
have the capacity to adapt their communication skills to different contexts, as
it is central when assessing, planning and coordinating a case (Adams, 2010,
pp. 141-146). Communication skills include verbal, non-verbal and written
aspects. When working with individuals with dementia, it is important to
recognise non-verbal communication, as the SU may be unable to express
themselves verbally. Such situations should be approached in a sensitive manor
as the SU may be aware of their increasing vulnerability; therefore, a level of
respect and empathy should be used, this may also help aid the forming of trust
between services and the individual.

Effective
communication skills will also be useful when applying basic aspects of
counselling. Although a social worker is not a qualified counsellor, it will be
inevitable when providing emotional support for individuals, as they are likely
to be experiencing high levels of stress at the point that they require social
work assistance (Adams, 2010, p. 156). Although, it is important to recognise
the limits of one’s knowledge and professional role within such aspects.

As
a social worker, it may be required that they need to act as an advocate for
the SU to represent them by ensuring their voice is heard to share their views,
perceptions or wishes.

Empowerment
has become a significant concept in social work practice. It involves giving
the SU choice and control in their lives (Maclean and Harrison, 2015, p.33). Its
origins lie in seeking to connect the personal problems in peoples lives,
including personal issues, to wider social and political issues whilst
addressing inequalities. Empowering individuals can be carried out by promoting
independence where possible, this will promote self-esteem and general
wellbeing of the SU using a holistic person-centred approach (Maclean and
Harrison, 2015, pp. 33-36).

Social
work theories are general explanations that are supported by evidence obtained
through the scientific method. Having the knowledge of a range of theories may
help to understand why a person may be behaving in a particular way. Using theories
can help to explain practice to the SU/families and can specifically relate to
their current situation (Maclean and Harrison, 2015, pp. 9-11). For example,
Eric Erikson’s (1950, cited in Maclean and Harrison, 2015, p. 97) developmental
theory argued that there are eight stages in human development. Stage eight
(integrity vs despair) specifically focused on older adults, stating that at
this stage they may reflect on past life and feel a sense of satisfaction or
disappointment, which may affect the emotional/psychological being in later
life. This is particularly useful to consider when working with older adults at
a specific stage in their life to understand how they may being feeling.

The
way in which these roles are carried out can involve direct work, in which a
social worker uses their interactions with the SU as a means of facilitating positive
change by acting as an advisor, mediator, educator and catalyst. Another way in
which it can be carried out is by taking an executive role, which draws on
external resources therefore acting as a gatekeeper, care manager,
responsibility holder, control agent, co-ordinator and service developer
(Beckett and Horner, 2016, p.20).

The
root of the profession is underpinned by core professional values which relate
to human, legal and civil rights of the SU, the equality, dignity and worth of
the individual to protect from discrimination and prejudice whilst maintaining
person autonomy, independence and freedom of choice (CommunityCare, 2010). They
therefore must be sensitive to cultural and ethnic diversity and strive to end
discrimination, oppression and other forms of social injustice such as Ageism.

The
PCS Model, defined by Professor Neil
Thompson (2005) refers to the need to recognise discrimination and the
focus of anti-discriminatory practice. It is presented at three separate, but
interrelated levels known as personal, structural and cultural which links
personal experience, beliefs and attitudes with the wider social group. It
recognises that discrimination is not just an individual issue, but is also
present within cultural and social structures and networks. This attempts to
explain how and why discrimination occurs and therefore leads to internalised
oppression (Coventry, No date).

Social
workers that specialise in working with dementia, must first acknowledge how
devastating it can be for both the SU and their family. Usually when a referral
is received, it will be at a point when the SU and their family are near to
their limits of coping (Dobrof, 1986, p. 56). It is therefore important to
consider both SU and their family/carers when assessing, to ensure all needs
and circumstances are identified, evaluated and responded to adequately
(Davies, 2012, p.278). Assessment under the Mental Capacity Act (2005, cited in
Walker and Crawford, 2014, p. 160) is essential for the SU, as it is important
not to deny them their right to make unsupported decisions, even when the
liberty of the individual is at stake. The SU should be at the heart of
decision making (McDonald, 2010, p.137).

Social
work with older people takes place in various settings; such as, sheltered
housing, residential homes, nursing homes, day services and domiciliary care
(Adams, 2010, p.154). The SU and their carers should receive person-centred
care and services which respect them as individuals and which are arranged
around their needs (DoH, 2001).

Although
the SU is at the centre of the social work intervention, it is legal policy to
consider the carers needs within the process. The Care Act (2014) sets out
these obligations to consider a ‘carers assessment’ to highlight caring
capabilities and any support they may need including emotional, practical and
financial.

The
process of intervention should identify the most appropriate ways of achieving
the objectives set out in the assessment of need, for both SU and carers
(McDonald, 2010, p. 72). It is likely that as a result of an assessment, a care
plan will be considered to identify service providers, relevant resources and
positive outcomes.

There
is a vast amount of interventions available for both SU and Carer/family, they may include a variety of group activities or day services
run by charitable organizations such as Outreach UK (OutreachUK, 2017) or
Alzheimer’s Society (AlzheimersSocietyUK, 2017). Day centres provide
quality time for the person with dementia and invaluable respite breaks for their
carers (SkillsForCare, 2012). There are
many support services available to enable the SU and their carer to keep
socially included by attending events such as a Dementia Café, this gives the
opportunity to meet new people and speak freely to others in a similar
situation (BPS, 2014). All the above examples enable the SU to maintain a sense
of independence, improve physical functioning, increase confidence and continue
to participate in society (Kerr, et al. (2005). Sometimes changes to the social
or physical environment can be effective at improving well-being and reducing
unwanted behaviors.

The main focus for the SU is to allow them to stay at
home for as long as possible, but when the needs of the SU and family/carer
becomes too great, the social worker will assist to get the SU home help in the
form of domiciliary care, to help aid their independence (Berkham, 2006,
p.123). As a person’s dementia progresses, they will need more support and
care, and there may come a time where full-time residential or nursing care is
needed. Care homes give people with dementia the chance to live in a home
environment with trained staff on hand to look after them day and night. A
care home can offer similar kinds of care to what family members/carers provide
at home, such as help with washing, dressing and providing meals (NHS, 2015).

Working in collaboration is essential practice in social
work to allow individuals to be offered the range of support they require
(SCIE, 2010). The Health Act (1999) introduced new partnership
flexibilities to enable health authorities and councils to improve services of
health and social care. Its aim was to bring together the public, private,
voluntary and community sectors, service users and their families in effective
partnership. Multi-disciplinary/agency
teams play a vital role in ensuring that all aspects of the SU’s needs are
considered, so that effective advice, skills and interventions can be given. It
aims to bring together professional agencies, SU, Carers and service providers
to work together to promote better quality of care to achieve the same outcome.

The demographic shift as older people live longer means
there is an increasing demand for services; therefore, collaboration can help
address financial strains; as social work has moved beyond the lone social
services departments and has now incorporated a range of charitable/voluntary
organizations to aid support for SU and their families/carer (CommunityCare,
2009).

There
can be major implications for individuals who require interventions, as
services arranged by a Local Authority is not always free. People with dementia
are currently spending hundreds of thousands of pounds on their care, as local
authorities are increasingly unable to provide people with the support they
need because of the lack of money in the system (AlzheimersSociety,2017).

The
Care and Support Commission, led by Andrew Dilnot, published its report (GovUK,
2013) in July 2011, its recommendations included the introduction of a cap on
social care costs and a more generous means-test “to protect people from
extreme care costs”. On 17 July 2015, the Government announced a four-year
delay on the introduction of the cap, as the proposals to cap care costs were
estimated to cost the public sector £6 billion over the next 5 years;
therefore, the government decided it was not the right time to impose these
costs (Jarrett, 2015). Therefore, there remains an uncertainty towards the
finance of social care in the future.

To
conclude, social work aims to empower, safeguard and provide services to help promote
someone’s wellbeing. Social work is continually evolving with changes to
society, laws and policies. Social work requires an individual to be
well-informed, confident and competent in practice whilst having a strong
ethical and value base.

Word Count: 2197

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