Social work recording: Joint assessment
- Tony – Social Worker
- Randeep – Service user, 19 with physical and learning disabilities
- Navinder – Randeep’s mother and main carer, 54, with health concerns of her own
- Deborah – Care Act advocate for Randeep
Navinder and Randeep’s home
A visit to jointly assess Randeep and Navinder, as user and carer respectively. Randeep’s needs are becoming more complex, with a consequential increase in the pressures on Navinder. Randeep has an advocate, Deborah.
[SCENE: NAVINDER AND RANDEEP’S HOME]
Tony: Okay then, everyone, first off I just want to make sure you all understand why I’m here and what the purpose of the meeting today is all about.
Navinder: You’re here for Randeep’s assessment.
Tony: Well, actually, I’m here to assess the situation – for both you, Navinder, and Randeep. My aim is to see if you need more support by looking at each of your needs in context. I’ll be asking some questions, and making notes. Are you both okay with that?
Deborah: I’m here to act as an independent advocate for Randeep. I’ve already explained my role to Randeep and Navinder.
Tony: Thanks, Deborah. I’ll will make a note that you are here for the record.
Randeep: Can we watch Doctor Who?
Navinder: Always Doctor Who! We can watch it later, Randeep. Later. Right now, we have to talk to the man from the social services.
Randeep: What about?
Tony: I’m here to learn a bit more about you, Randeep. Is it okay if I ask you and your mum some questions?
Deborah: Is that all right, Randeep? Do you understand why Tony’s here?
Randeep: Yeah – it’s about the house and getting undressed.
Deborah: It’s about those things, yes, and other things to do with how you live day to day. Is it okay for Tony to ask some questions?
Randeep: He’s okay. He’s okay.
[TRANSITION / LATER IN THE CONVERSATION]
Tony: Yes, thanks for that Navinder. So, in terms of morning routine, are you able to help Randeep get washed and dressed in the morning?
Navinder: My back is not so good. He’s a big boy now. Should be able to look after himself a bit more.
Tony: At the moment, though, you’re Randeep’s primary carer -is that right? And Raandeep’s needs are getting more complex.
Randeep: Tom Baker’s my favourite. He has a long scarf and curly hair like my teacher, Mr Collins.
Navinder: We will watch Doctor Who later Randeep. Tony is asking about how you get dressed and washed in the morning.
Randeep: You put me on the toilet.
Navinder: Tony does not want to hear about this.
Deborah: Actually, Navinder, I know it’s uncomfortable – but Tony does need to hear about all aspects of Randeep’s personal care.
Navinder: It is not right for a mother of a grown boy. Not right for me to help him.
Tony: You’re uncomfortable helping Randeep on and off the toilet?
Navinder: It is not right. He is grown man now.
Tony: Would you consider having some outside help at key points during the day. morning routine, for example?
Navinder: You mean have strangers in the house?
Randeep: (interrupting, anxious) Not strangers, no. Don’t want strangers touching my bits.
Navinder: Randeep wears incontinence pads?
Tony: I’m like a Dalek I can’t go upstairs.
Deborah: Randeep, we’re talking about how you go to the toilet. We need to discuss this so that Tony can assess what support to put in place for you.
Randeep: No, no strangers in house. No strangers touching my bits.
Deborah: Randeep is very clear that he is unhappy at the idea of strangers helping him with personal care.
Tony: I’m trying to build a picture of what the current situation is. My understanding is that you, Navinder, look after all Randeep’s needs on your own right now?
Navinder: I do. But my health is not so good. He is such big boy now, my back hurts. It is not right for a mother. We don’t get out at all. Not much. Very depressing for me, for us both.
Randeep: We have Doctor Who on DVD. He is really good.
Navinder: Please, Randeep, I am trying to tell the Social Worker about our problems. You see, I cannot move like I used to. I have health problems of my own. I do what I can, but it is wrong. No mother should have to wipe up after their adult son.
Tony: And Randeep uses incontinence pads?
Navinder: It is the best I can do. I cannot get him to the toilet in time.
Randeep: Smelly, dirty, dirty.
Tony: Can you use the toilet on your own at all, Randeep?
Randeep: Peter Davison, Colin Baker, Sylvester McCoy
Deborah: Are you able to answer Tony’s question, Randeep? He wants to understand how you use the toilet?
Randeep: I can’t get on the toilet. I poo my pants. Mum cleans up. Don’t want strangers looking at my private bits. Laughing at me.
Navinder: You see the problem, he doesn’t want strangers in the house. But it is too much for me now. He is too big a boy to need all this help.
Tony: And you also help him to get dressed in the morning.
Navinder: I have to help him, he’s not able to himself, you know? we need some help here.
Tony: Do you want to talk me through how you get Randeep dressed – to help me understand what help he needs?
Navinder: He does not know how to dress himself. He is like a child.
Tony: What is it that prevents Randeep from dressing himself?
Navinder: Randeep had never dressed himself. He is not able to. Always I have dressed him, since he was a child.
Randeep: I don’t want strangers looking at me. Don’t want them touching my parts.
Deborah: Randeep is very clear that he does not want external help, particularly when it comes to personal care.
Navinder: He does not listen to me. And he does not understand that I will not be here forever. He needs to learn to accept help.
Randeep: Rough with me in hospital, the nasty nurses. Nasty nurses.
Navinder: He is still going on about this! When he was ten he went to the hospital and he did not like the bed bath they gave him. Very upset about it. But he’s adult now. He needs to understand I cannot keep helping him. It is not right.
Deborah: I do want to make sure that you make a note of Randeep’s discomfort at the thought of having help with Personal Care.
Tony: Okay, I’m going to summarise my observations, if that’s all right?
Randeep: The Master, Silurians, Davros, Zygons…
Navinder: Will you please shut up about the Doctor Who? This is important.
Tony: From what you’ve told me, Randeep has been needing more and more support from you to attend to his personal care.
Navinder: It is right. He is less able now even than when he was a little boy.
Tony: You are not comfortable helping him with his personal care, and find it difficult to provide all the support he needs due to your own health issues… including a bad back.
Navinder: Yes. This is right.
Deborah: But Randeep has made it very clear he doesn’t want anyone from outside the family helping with his personal care.
Navinder: Well, it cannot be up to him can it?
Deborah: It’s very important we take Randeep’s own wishes into account.
Navinder: But this is not right. Not right at all! You must understand how difficult it is for me. How very difficult. It is not up to Randeep.
Tony: Right now, I am just making an assessment and need to take everyone’s views into account, including Randeep’s wishes. It would be helpful to have your input Deborah to ensure that we have captured Randeep’s point of view. My primary concern is for the health and well-being of both of you in this difficult situation. I can see that you both do need extra support. I think that we should ask for an Occupational Therapist to visit. They will be able to make an assessment to see if there are ways we can make you even more independent. That way we can be sure of the support you need. We can work together to find a solution that works for everyone.
Randeep: Christopher Eccleston, David Tennant, Matt Smith. Don’t like the new one. My favourite is Tom Baker.
Tony: Okay, well look, I think that’s as far as we can go today. Thank you all for your time. I’ll refer to the OT, share a copy of my assessment next time we meet, and we’ll look into what support might be appropriate.
[END OF SCENARIO.]
How would you record the events?
08.07.17 – Reassessment of Randeep and his mother Navinder who is his main carer
Also present Deborah Jennings, Care Act Advocate for Randeep
I began by introducng everyone and checking that they knew why we were there today which was to reassess Randeep’s needs and to look at Navinder’s needs and to make any adjustments to the care package as necessary.
Navinder was quite clear that she was finding it increasingly difficult to look after her son saying “my back is not good” and “he is a big boy now”. She also said that she did not feel it was right for her to be providing personal care to her son now that he was an adult. (Accurate)
She said that she found it depressing as she was not able to get out. She also wanted to make arrangements for Randeep’s care as “I will not be here forever”. (Accurate) (Real)
Randeep kept referring to ‘Doctor Who’ throughout the assessment. Deborah helped him to answer some of my questions and I was able to ascertain that:
Navinder currently provides all personal care for her son including helping him on and off the toilet and changing incontinence pads. She wants some help with this.
Randeep was very clear that he did not want “strangers” helping him with personal care. He did not acknowledge his mother’s needs. He referred to “nasty nurses” and people laughing at his “private bits” which his mother said related to an incident when he was in hospital being given a bed bath aged 10. (Accurate) (Real)
I summarised by saying:
Both Randeep and Navinder have a need for support
Randeep did not demonstrate that he fully understood the process of making decisions about his care at this assessment and so will need some input from Deborah to ensure the support offered is acceptable to him. (Person centred)
We are not clear at this stage whether Randeep is able to be more independent with equipment or rehabilitation.
Navinder has her own health needs and also said that she gets depressed.
I propose the following action:
- I will refer to the community Occupational Therapy team for an urgent full activities of daily living assessment
- I will ask a colleague to undertake a carers assessment of Navinder’s needs, as I wasn’t able to do a full carer’s assessment with Randeep present
- I will offer Navinder information about back care and carers’ groups locally
- I will ask Deborah to continue to be involved to:
- support Randeep through the assessment
- help him understand what support package is being offered
- help the care provider to tailor any support to ensure it is acceptable to Randeep
I will also discuss with my line manager Randeep’s and Navinder’s disclosure relating to what happened to him in Hospital when he was 10 to see whether any follow up action is needed.
I will provide a copy of today’s assessment to Randeep and Deborah and Navinder.