I recently visited a client who had asked for a review via a charity. She lived alone, had a long standing joint condition and restricted mobility. She presented with shortened gait pattern with a tendency to foot shuffle. Her right wrist was swollen and she had high levels of joint pain for which she was regularly taking strong pain killers and was also attending a pain clinic for support. She lived in a council owned property and had no rental arrears. The property had evidently been looked after.
In the past she had been provided with a powered bath lift by Social Services. This had become impossible for her to access without help - a fact established after a near miss fall and then an actual fall. She subsequently requested support to adapt the property and perceived a level access shower would be the solution. There was an over-bath shower but she was unable to abduct her hips and lift each foot proud of the bath side to enable transfer into the bath using a board or the bath lift.
Social Services reviewed the situation. It is unclear if the assessing visitor was an Occupational Therapist or Care Manager. They concluded that the bath lift was indeed less than satisfactory as she could not lift her legs independently and suggested a care package. This was declined by the client who retained the bath lift to enable support by her family when they visit. During the periods where she is not visited, the client understood the advice was to strip wash with a bowl of water to her feet, sitting on the toilet. This generated issues with her ability to lower a washing up bowl of water to the floor – and collect it again, as well as her ability to reach forward to the water.
So, what were the issues in this case?
Fundamentally the client did not feel able to access the bath, reported herself as not strip washing effectively and was afraid of falling forward trying to negotiate bowls of water. She had started to withdraw from social activities as she felt she may be ‘smelly’ or less than her personal standards of acceptable cleanliness. She was resistant to the idea of carers – although received income related benefits so would not have had to pay the full cost of this.
She had received a Section 47 assessment from Social Services. This relates to the National Health Service and Community Care Act 1990 and this, in essence, states that if it appears to the local authority that the person for whom they may provide or arrange the provision of community care services might need such services they are to assess the needs of that person. Here, she had been assessed as needing access to bathing which had a proposed solution of a carer to facilitate access.
The assessment had identified the most obvious and easiest way of managing the situation by care provision, but had not considered the provision of equipment or property adaptation to allow her to manage independently.
The client had hoped to receive an assessment for a shower adaptation. This would have been reviewed under the Housing Act within the Disabled Facilities Grant, the purpose of which is to modify an environment that is currently forming a barrier and therefore disabling the individual. The aim is to restore or enable independent living, privacy, confidence and dignity for individuals and their families. It is therefore an assessment which needs individualised evaluation. Unfortunately this lady appears not to have received an assessment from an Occupational Therapist who is qualified to review the needs, current risks, environmental options and fully appreciates the benefits of enabling independence.
Instead this client had received a care assessment identifying an assisted bath would be necessary, 3x a week with a carer visit for 45 mins on each call. The average cost of care per hour is £13.68 per hour. Assuming that the care agency would permit a 45 minute call and there was no travel cost charged, this client would have a weekly care time requirement of 2hrs and 15 mins, at a cost of £30.70. Over the first year this would have totalled £1600.56
To remove the bath, fit a level access shower and slip resistant floor and also renew the wash hand basin and WC would have cost approximately £4500.00
Assuming this was completed by a Disabled Facilities Grant, this would have a grant condition period of 5 years, so the cost of the adaptation per year is £900. This is considerably less than the yearly care cost. The care would equal the cost of the adaption in 2.8 years.
This client did not want to receive care support, feeling that this was inconvenient and invasive. She was independently minded and keen to remain self-sufficient. Fortunately for this client, she made contact with a charity that sourced an independent Occupational Therapist to review the situation and an application for a Disabled Facilities Grant was made. So, for this lady, the barrier is being addressed.
The question is, was this an unusual case? Are other clients also receiving care they do not want in place of an adaption to facilitate their independence?
