Practice example: Specialist support - deafblind adult
Mr B is 58 and until four years ago enjoyed normal vision and hearing. As a consequence of a traumatic accident at home, which was judged not to have been anyone’s fault, he now has severe hearing and sight loss. His vision and hearing deteriorated rapidly following the incident, and now he sees only through a limited field in the centre of both eyes, and has no hearing in the left ear and very little in the right.
Mr B is extremely depressed and emotionally vulnerable. He feels his life has been ‘turned upside down’ in a way that feels sudden and final. He has had rehab and health support and is considered to be stable.
Mr B lives alone in a modern house close to the centre of a busy market town, which he previously shared with his wife, who is now deceased. Prior to his accident he had a small and active group of friends, worked as an accounts technician and took part in regular social activity, including playing golf. He has no immediate family close by; his son is very supportive but lives 200 miles away with his young family, which along with work commitments prevents him from offering any meaningful care to Mr B.
Mr B feels unable to cope in social settings he previously enjoyed because they are too noisy for his hearing aids. As a result he has withdrawn from contact with his circle of existing friends.
Following the closure of a local group for deafblind people two years ago, Mr B has no social contact and is feeling increasingly isolated. He has become a virtual recluse in his own home for personal safety reasons, as well as concerns over unexpected visitors. Mr B has been known to the local authority since the onset of his condition, when he was assessed and his needs deemed eligible, and he has had an annual review relatively recently. However, Mr B’s needs appear to have changed in the three months since the last review, due to increased isolation and depression. Following a recent stay with his father, Mr B’s son has requested another review.
The review is conducted and finds that Mr B’s needs have changed, so an assessment is arranged. The assessment is conducted in Mr B’s home, where he feels most comfortable. Mr B’s son arranges time off from work to be in attendance. As Mr B suffers from hearing and sight loss, the Care and Support (Assessment) Regulations 2014 and good practice require that a specialist assessor conduct the assessment. In this case a specialist assessor would be one who has received appropriate training in the deafblind condition. This is important because it will help to ensure that Mr B’s needs and desired outcomes are fully understood in the context of his situation as well as ensure the assessment process takes Mr B’s needs fully into account.
Mr B expresses the outcome he would like to achieve as: ‘I would love to be able to go out again and to have someone to have grown up conversations with, and to be useful to someone else.’
Preparing for an assessment
When preparing to make an assessment it is useful to ask yourself the following questions in relation to the legal duties for the Care Act 2014.
- What needs to be taken into account to ensure the assessment is appropriate and proportionate?
- How will you ensure a strengths-based approach has been considered?
- How do answers to the first two questions above affect the way this assessment is conducted?
- Who will be involved with the assessment?
- In preparing for the assessment, what additional issues or obstacles need to be considered (if any) – and how can they be dealt with?
- Have you considered the individual’s needs over an appropriate period of time to ensure that they have all been accounted for?
- What is the impact on the whole family? Should there be a carer’s assessment?
- What information and advice would be helpful?
- What preventative measures (to prevent, delay or reduce needs) will you consider?
- What else might you need to think about with regards to this example?
Ensuring the assessment is proportionate and appropriate
- Severity and extent of needs. Mr B’s physical needs (loss of vision and hearing) impact on most of the eligibility outcomes. However, his increased isolation also indicates mental health needs. In this case the assessor – who is trained in the deafblind condition – does not involve a mental health professional but does get the views of the occupational therapist already working with Mr B on his mental health.
- Person’s wishes, preferences and desired outcomes. Despite his current low mood, Mr B has a clear view of his wishes, preferences and desired outcomes. The assessment is undertaken by an assessor who has received training to QCF (or OCN) Level 3 in the deafblind condition to ensure Mr B is fully involved and understands the discussions taking place, to allow him to express his views.
- Potential fluctuation of person’s needs. Mr B’s needs do not appear to fluctuate. The current circumstances are as a result of a steady decline in his mood due to increased isolation brought on by his condition. The specialist assessor involves both Mr B and his son to properly establish Mr B’s circumstances, and, once established, sets an appropriate duration for the assessment which will not need to take into account any fluctuating need.
- Other information and assessments. Mr B is already known to social services and health services. The assessor gathers – with Mr B’s consent – all existing information: previous needs assessments; care/support plan; mental health assessment; care programme approach (CPA); GP/district nurse’s views, etc. This information is then examined to establish what is relevant in order to produce sufficient and appropriate background information which can be included with the information provided by Mr B and his son.
- Relevance of assessment questions for the case. Mr B has the appearance of needs across most – if not all – the eligibility outcome areas. The assessor has to identify which areas are or are not relevant to address in this assessment in relation to the needs that have changed. Most of Mr B’s needs continue to be those identified in previous assessments. The assessor will, therefore, present the existing information to Mr B and his son and further explore areas where the situation is different from that previously recorded/assessed. Only those areas where changes are identified will be explored in more detail.
- Proportionate. As above.
- Communication needs. Mr B’s condition requires a specialist assessor to ensure his needs are fully explored.
- Means. Due to Mr B’s deafblind condition a face–to-face assessment is the most suitable method. Mr B does not want a supported self-assessment at this time. Although he has used this assessment method in the past, due to his sight loss and low mood he is not confident in his independent understanding of the materials. Sending the assessment material in advance does enable him to reflect on it, think it over and discuss it with his son to enable him to regain confidence, with a view to completing a supported self-assessment in the future, which he would prefer. It is agreed that these discussions between Mr B and his son will help him become more familiar with the process and the areas to deal with, ensuring he is fully involved in the assessment.
- Location and timing. Mr B prefers the assessment to take place in his own home due to his concerns over safety and general anxiety about leaving the house. A firm date and time is agreed along with security passwords to reassure Mr B of the genuine nature of the visitor to his home (this is despite the agreed presence of his son and is indicative of the overall low mood and anxiety affecting Mr B).
- Capacity and level of understanding. Mr B does not need a mental capacity assessment or an independent advocate. The assessor agrees with Mr B and his son that the son will be present at each of the visits and will support Mr B in the process jointly with the specialist assessor. It is also agreed that Mr B’s care and support plan will be reviewed after one month to see if it is appropriate and that Mr B’s mental health is improving.
- Involvement. Mr B’s son cannot be heavily involved in his father’s care and support, but he has regular contact with his father and wishes to be involved. The assessor agrees with Mr B’s son that he will be present at each of the visits.
- Holistic. Due to the distance at which Mr B’s son lives from his father, and his family commitments, he is not a caregiver. However, the assessor will involve him in the assessment to help get a holistic view of Mr B’s needs. The assessor also agrees with Mr B that he will contact his GP and the local voluntary organisation Mr B has been in contact with.
- Process. Mr B and his son will be sent the assessment materials in advance, along with information about the assessment and support plan process. The materials sent to Mr B will be in large print to allow him to read them and provided in sufficient time to allow him to reflect on their content.
- Do the needs for care and support arise from a physical or mental impairment or illness?
- Do these needs mean the adult is unable to achieve two or more of the listed outcomes?
- As a consequence of being unable to achieve the outcomes, is there, or is there is likely to be, a significant impact on the adult’s wellbeing?
Determination. The assessment was conducted by a specialist assessor who as a minimum has training to QCF or OCN Level 3 in the deafblind condition. The outcome of the face-to-face assessment is that Mr B has eligible needs.
Condition 1. Mr B’s needs arise from physical impairment.
Condition 2. Mr B is unable to achieve two or more of the eligibility outcomes, including: developing and maintaining family or other personal relationships and making use of necessary facilities or services in the local community.
Condition 3. As a result, there is a significant impact on Mr B’s wellbeing, particularly in relation to his mental health, emotional wellbeing and domestic, family and personal relationships as well as his ability to make use of community services.
How the adult’s eligible needs might be met
The following are being considered for Mr B.
- Links with organisations that assist deafblind people, to increase his awareness of options for social interaction and communication and provide alternatives to his current isolation. This will be focused on providing specific support to Mr B in addressing his communication needs and enabling mechanisms to support social engagement with other people, be they deafblind or not.
- Arranging telecare to keep him safe and maintain independence with wellbeing, including a personal alarm linked to social services in the event of a fall. Installing speaking clocks and smoke and temperature alarms. Mr B is also introduced to the Type Talk service and assistive PC technology, including screen magnifiers to enable him to more readily keep in touch with his son and other friends through phone and email contact.
- Emotional support. This could be in various ways and a conversation with Mr B will ascertain which one is the most suitable/desired: peer support, meeting other deafblind people and/or counselling.
- Enablement to aid him to develop skills and strategies to cope with day-to-day life in a satisfactory way, aligned with his desired outcomes.
- Information on local groups and organisations related to his hobbies and interests.
- How do the outcomes concur with your assessment of the situation?
- What else did you think about?
- What else might apply/be relevant in your authority?
- What might you do differently?
- What have you learned?