IMCA involvement in accommodation decisions and care reviews
The IMCA role and personalisation
Once the IMCA has checked that they have been instructed by an authorised person, it is for them to decide the best way to support and represent the person in relation to the accommodation decision or care review. The IMCA should make sure that the person's views, needs and wishes are central to the decisions being made.
Health and social care services are being transformed by personalisation. Put simply, this means giving people as much choice as possible about and control over the support they receive. One aspect of this involves extending opportunities for personal budgets and direct payments. But it is equally about services arranged by local authorities and NHS trusts.
Direct payments are available to people lacking capacity to manage them (DH 2009). However, few people receiving the IMCA service would have someone available to be appointed as a 'suitable person' to manage them on their behalf. This means that generally IMCAs should be looking to ensure that people have as much choice and control over the services which are arranged for them as possible, so that these services are personalised to their wishes and views.
For accommodation decisions, IMCAs need to look beyond the choice of accommodation to how well the support which will be provided will be personalised. In this respect there is a huge overlap with the IMCA's role in care reviews.
The opportunity for personalised support in any setting will depend on the service being able to access information about the person's:
- religion and culture
- preferences, including diet, clothes and personal care
- financial situation.
Many people who access the IMCA service will be in a poor position to provide this vital information themselves. Where it is available from the person it might be vulnerable to memory loss. It is also unlikely that there will be family or friends who can be relied upon to provide this.
IMCAs are in a unique position to draw together this information though their contact with the person, contact with others – including staff in previous services – and access to records. Gathering this information could make a measurable positive difference to the person's life. One approach is to attach this as an appendix to the IMCA report and to provide the appendix to the service provider. An example is provided in Appendix E.
June, an IMCA, was instructed for an accommodation decision for Betty, a woman with dementia, where there were plans for her move to a care home which could provide a higher level of support. Although Betty had a property and affairs deputy to look after her financial affairs, the deputy legally could not make any decisions about her care arrangements.
June looked at the CQC reports about the proposed care home. She then spent time collecting information about Betty by speaking to staff in the home where Betty had been living for eight years. June learned that Betty disliked wearing trousers, would chose not to drink coffee and enjoyed going out. June subsequently provided this information in a summary report that she gave to the new care home and which is now kept with Betty's new care plan.
Betty's property and affairs deputy paid the fees for the home on Betty's behalf. June spoke to the deputy who agreed it was in Betty's best interests to pay the new home an additional fee which would provide for one-to-one support for Betty to go out at least twice a week. June also learned that a friend sent Betty a card on her birthday and occasionally visited Betty. Although June got the name they could not find any contact details. June made sure that contact details for Betty's new home were easily available for when the friend made contact again. They also suggested the old home take her details and pass them on to the new service.
A social worker instructed an IMCA to represent a Raj, a 45-year-old man with mental health needs who was living at home alone, with some support. The social worker was proposing that he move into a care home after a number of serious incidents related to his alcoholism. These had resulted in several hospital admissions.
The IMCA visited Raj and discovered he was very clear about wanting to stay in his own home. He did however say he was lonely and bored. He also said that he didn't like the pre-packaged food that he was receiving. Raj wanted to have curries which he used to make himself until the gas supply was cut off because of unsafe use.
The IMCA met with the social worker and they discussed different ways to support Raj to remain in his own home. A revised package of care was put together. This included a regular visitor to go out with Raj, and arranging for a local Indian restaurant to deliver lunches. The visitor supported Raj to return to playing bowls which he had always enjoyed.
(Example provided by Advocacy in Somerset)