Social work recording: Discussion about discharge
Characters:
- Shola – Hospital Social Worker
- Elsie – Service User, 87, frail after a fall and broken arm
Location:
Hospital (Private Room)
Elsie needs to be discharged from hospital. She is going to return home with a six-week reablement package and, Shola suggests, support with meals twice a day. Elsie thinks she’ll be fine managing her own meals.
[SCENE: PRIVATE ROOM IN HOSPITAL]
[THE SOUND OF A HOSPITAL IN THE BACKGROUND.]
Shola: Here we are, Elsie – we’ll have a bit of privacy in here. Let me help you sit down.
Elsie: A bit of privacy, ha! A bit of privacy so you can stick your nose into my business.
Shola: I’m here to discuss your return home from hospital, Elsie. We need to discuss a reablement plan for you – we want to help you be comfortable and safe at home. I’m here to talk through how we can put together a package that will work for you.
Elsie: Reablement? Is that English?
Shola: (laughs) It’s the word we use. It just means we’ll put a plan in place to help you adapt … become able again after your hospital visit… we want you to be confident looking after yourself. So we can help you adjust to preparing meals, for example, make sure you can wash yourself safely…
Elsie: (interrupting) I’ve looked after myself for the best part of 87 years, left home at 16, brought up 2 children, nursed my husband through 3 years of cancer care. I don’t need some stranger coming into my house telling me how to boil an egg, thank you very much. I had a fall, that’s all. I still have all my mental faculties. I don’t like being talked down to.
Shola: You’ve had a very full life, Elsie, and – believe me – I know you have all your faculties. I hope you don’t think I’m talking down to you.
Elsie: (muttered; bad-tempered) Just because I’m old, people treat me like a fool.
Shola: All anyone wants is for you to return home, to be safe and able to look after yourself. You’ll need to adapt, and that’s what the reablement package is for. I’m particularly concerned that you’re able to cook for yourself – so I’d like to suggest you have support at mealtimes. How does that sound?
Elsie: I can’t afford to have someone coming in three times a day just to cook for me! I’m not Lady Muck!
Shola: You won’t need to pay for the first 6 weeks of the reablement programme. And we can re-assess towards the end of the reablement period to see what other support you might need longer term. The aim of reablement is for you to regain independence, so it may be you need very little support afterwards. Whatever plan we put in place, we’ll make sure it’s affordable for you. We’ll do a financial assessment and we have leaflets that clearly lay out the cost of care. For now, though, let’s see if we can work out what support you might need and we can talk about costs when I come back later in the week.
Elsie: I don’t mean to cause you offence, Shola, but I don’t want to have any foreigners looking after me. Some of the nurses here don’t speak proper English and I’m supposed to trust that they give me the right medicine! I can only imagine these ‘support workers’ – or whatever you call them – will be migrants.
Shola: I can assure you that anyone who has access to your home will be fully qualified, supervised and subject to all the proper checks.
Elsie: So they will be migrants! Listen, I’m not a racist, Shola, I have no problem with people like you who bother to learn the language and fit in with our customs. There was a time when we needed cheap labour in this country, and we welcomed people from all over the world, but enough is enough. Some of these Polish and Russians – they come here and take jobs away from young British people. Sooner we’re out of Europe the better, as far as I’m concerned. My brother died fighting for this country, it’s about time we took it back.
Shola: We’ll make sure whoever supports if qualified to meet your needs. They’ll be able to help you with your diet and communicate with you professionally in English. Their nationality shouldn’t matter. Maybe you’ve had a bad experience with someone from Eastern Europe in the past – but be careful not to stereotype people.
Elsie: I don’t need a lecture from you! I told you I’m not a racist… I just think people who choose to live and work in England can at least learn proper English.
Shola: I feel it’s important we look at your needs and put the appropriate support in place. The offer is for fully qualified workers to help you get used to living back at home. I can’t force you to accept the reablement package, but if you don’t agree to having a support worker help with mealtimes I want to discuss other ways we can make sure you’re safe and able to look after yourself. You mentioned you have children – do they live nearby?
Elsie: I’m not asking my daughters to help. They’ve got their own lives to live.
Shola: Is there anyone else who can look in on you?
Elsie: I really don’t like having people in my home. I have my routine. People come in the house and want me to do everything according to their timetable. Everyone’s always so busy these days. I like to have a cup of tea and listen to The Archers. I like to nap. That’s all I want – to go back home and settle back into my day to day life. I don’t need for much, the house is safe and warm. Marion insisted on the double-glazing and central heating. Everyone in the street knows me. I can hobble down to the corner shop if I need milk. I have my newspaper delivered. I really don’t need any help.
Shola: Might a neighbor be willing to help you get settled back at home?
Elsie: I don’t know how many different ways to say this to you, Shola. I am not a charity case and don’t want to be treated like one.
Shola: The idea behind the reablement package is that it will help you to be as independent as you can be. It’s short term and we can try to arrange it to fit in with your routine. And if you do need ongoing support there are various ways we could arrange it.
Elsie: You clearly have a plan in mind for me. You might as well tell me what it is.
Shola: Having talked to people here at the hospital who’ve been looking after you, I would like to suggest we arrange some support for you at mealtimes, so you can become confident cooking for yourself again.
Elsie: I’m not having a stranger in my house three times a day.
Shola: What I would suggest is you have help with breakfast, and the support worker discusses with you how to manage lunch and your evening meal.
Elsie: You certainly are full of suggestions! Look, I can tolerate a visit from a stranger once a day. If it’s really necessary. But it will be too disruptive to have people call in day and night.
Shola: We can assess your needs on an ongoing basis. But, I agree, I think it would be good to put support in place from the point that you’re discharged from hospital. We can arrange for a support worker to visit you for breakfast and leave you with lunch. Is there anyone who could look in on you in the evening?
Elsie: I don’t want to ask my daughters for help, if that’s where you’re heading.
Shola: You don’t want your daughters to help?
Elsie: I’m sure Marion will look in on me anyway. She’s visited me while I’ve been in hospital. She doesn’t need to be asked.
Shola: Well, maybe I could talk to your daughters on your behalf? I understand you don’t want to ask for their help – but if I explained the situation it might help them to…
Elsie: (interrupting) Fine. Talk to Marion if you must. You have my permission. I don’t mind Marion coming round at dinner time – if she can spare the time. I don’t want to be a nuisance that’s all. Maybe if you explained what support you think I need, I suppose she can make up her own mind.
Shola: That sounds like a plan, then. I’m sure Marion would like to understand what she may need to do, just in the short term, to help you settle back home. What about your other daughter?
Elsie: I will not be left alone with her. You can talk to Marion but I don’t want Sarah knowing I need help. She is not to be trusted. I don’t want her coming round uninvited. Marion has a key, but there’s no need for Sarah to be involved in my care. I don’t want to be left alone with her.
Shola: You said Sarah has problems of her own.
Elsie: I don’t want to get involved. If she and her boyfriend want to spend their money on drink, it’s none of my business – as long as they don’t keep coming round to borrow things I never get back.
Shola: Okay, well I’d like to talk some more about making sure you feel safe and secure when you return home. I’ll be back on Tuesday and we can talk about this again. I will also give you the proposal for the reablement package and a leaflet explaining all the costs and how they might be paid for. I’ll bring a financial assessment form, as the local authority may be able to cover some or all of the cost. And, when we meet again, we can talk about any other concerns you have about returning home. In the meantime, I’ll also talk to Marion – with your permission.
Elsie: Yes, yes, – you can talk to Marion.
[END OF SCENARIO.]
How would you record the events?
07.07.2017 11:15 – Purpose of visit – to plan for Mrs Elsie Cook’s discharge from hospital
I met with Mrs Elsie Cook in the lounge of Windsor wing at St. George’s hospital. I began by explaining that the hospital team have assessed Elsie as being well enough to return home and that the meeting was to plan her return home. (No Jargon – plain English)
I explained to Elsie that we would start with a reablement package and then review after 6 weeks to see what if any needs she would have after this. I explained that the purpose of reablement was to enable Elsie to be discharged home with as little risk as possible and to help her regain her independence after her fall.
Elsie was initially resistant to the idea of a support package saying that she could look after herself and that she was worried about the cost. I explained that there would be no charge for the first 6 weeks and that she would be financially assessed for any help required after that. She was, in my opinion, generally a little resistant to the idea of social care support, based on her expressed reluctance. (Evidence-based)
Elsie then expressed concerns about having “foreigners” supporting her as she felt they may not “speak proper English” and she did not trust them to give the “correct medication”. (Real)
I explained that all support workers would be fully qualified, supervised and subject to all relevant checks. This appeared to reassure her. I will notify the care agency chosen to support Elsie so that they are aware of her views.
We then discussed other options for support which may be more in tune with her daily routine. These included neighbours and her daughters. Elsie did not want to ask her neighbours for support. She agreed to me talking to one of her daughters, Marion, who she said already had a key, but became anxious about talking to her other daughter Sarah saying “I don’t want Sarah knowing I need help. She’s not to be trusted I don’t want to be left alone with her”. She disclosed that Sarah and her boyfriend “spend their money on drink” and “‘borrow things I never get back”. (Accurate)
I told Elsie that I would speak to Marion but not to Sarah. She agreed to this. I also said that I would visit Elsie again on Tuesday to confirm the arrangements regarding the discharge and the support package. I will also undertake some discreet enquiries with Marion about her sister and review the case file to see if there is any further information about Sarah Smith before coming back to Elsie on Tuesday. (Read the record)
I summarised the agreed actions with Elsie:
- I will discuss Elsie’s discharge with her daughter Marion and ascertain what support she is willing and able to provide
- I will set up an initial reablement package to provide an overview of the immediate post discharge period and to provide specific support with breakfast and lunch. This package will taper and give an indication after 4 weeks as to whether there will be any long term needs
- I will visit next Tuesday at 11a.m. to discuss the proposal for the support package, supply an explanatory leaflet and a financial assessment form
- We can also discuss if there are any other concerns she may have about her discharge including her relationship with her daughter Sarah, whether this is a safeguarding issue, and whether we need to put anything in place to address this.