Dementia, Social Work and Awareness

Dementia awareness week starts tomorrow on 19th May. When I think about ‘dementia’, I don’t think about government initiatives and new exciting ways to ‘raise awareness’. Raising awareness is good but only if we are raising awareness with a reason. Awareness isn’t enough. I’m an avowed cynic of the government’s ‘Dementia Challenge’ for many reasons but not least, the name. Dementia is not and shouldn’t be a ‘challenge’ any more than we need a ‘broken leg’ challenge or, to put it perhaps more honestly, an ‘age’ challenge. Fundamentally the language of ‘fighting’ dementia is embedded in an ageism that doesn’t recognise that dementia is a process and a range of symptoms that can look very different from person to person, family to family and society to society.

When I think about ‘dementia’, I think about the people I’ve had the privilege to work alongside as they experienced challenges of the systems that we have created to make experiencing illness more of a challenge. The ‘challenge’ isn’t dementia. The ‘challenge’ isn’t age. The ‘challenge’ if we want to use that language, is one of a health and social care system that stigmatises and isolates. That creates language and rhetoric around ‘choice’ and ‘involvement’ but rarely delivers or delivers in inequitable manners which further increase the challenges to those who have to navigate systems.

I think about Rose and Maisie. George and Bill. I think of Dorothy and Lily. I think their families and those of them who didn’t have families. I think of the different types of dementias and memory impairments that have affected the people I  have met and their famillies. Alzheimer’s, most commonly, but also vascular, Lewy Bodies, Korsakoff’s, Picks and the many that have names I can’t remember. I also think about the calls for more dementia nurses, more Admiral nurses, which I am sure is a good thing. But I want to draw out a call for more dementia social workers because I think, if there’s a role that can be played, it has to move into the territory that social work  has, in the crux between medical and social systems.

I worked in an older adults mental health team before ‘memory clinics’ came into being. Memory clinics are good. They are good for diagnosis. I argued for a social worker or two in our memory clinic but there was no funding for it. It wasn’t seen to be ‘necessary’. No, we need nurses because nurses can follow up the clinics. Nurses can monitor the medication. We don’t want to pick up care management responsibility for the group of people who would come into memory services because that is the local authority’s job. These were the responses I had. And there’s the rub. There was and perhaps, still is, the opportunity for single care coordinators to link between health and social care and if any are best placed for straddling that divide, it is the mental health social worker who specialises in dementia.

While I worked in a mental health trust, I had good working relationships with the multidisciplinary team but my social work background gave me an additional role in terms of managing, developing and advocating for those who needed social care support as well. Amid all the calls for more support and research in dementia, we see little call for more social workers who specialise in dementia care, and I think we are missing a trick. Of course, I’m biased. It was an area I loved with a passion. I do think that if there’s one area in mental health services that we can, and should, push against the removal of social workers, it is in the older adults services and dementia particularly.

Working in dementia services, I worked a lot with families, sometimes at great distances because they did not live near their loved ones. We ensured that the information was there to guide people through the systems – when we had it anyway. We worked particularly with people who ‘didn’t engage’ with services (I hate that term) because they didn’t understand or acknowledge their diagnoses and often the work we did would be very slow at first. A knock on the door. A few words and a smile. We kept going, kept going, until our faces became familiar. We had the opportunity to work in different ways and to build up relationships. I was lucky with my managers. We had different criteria for admission into our services than the adult teams. When I visited some people, two/three times a week – or undertook visits to family members to offer an ear to listen – even if there was little practical support I could give, it felt like time well-spent but it might not have been exactly ‘working to the service model’.

If I could design a model for dementia care, it would have social workers at the heart of it. There would be multi-disciplinary teams of course,  but they would include district nurses as well as community psychiatric nurses. We’d have some specialist OTs, medical covers and social workers would be the care coordinators – straddling the balance between health and social care systems. The support would be there for families and friends as well as those with none. We would have time to put together support plans which were able to ensure that people’s wishes were captured as soon as possible and work on advance directives and lasting powers of attorney from the first point of contact. But if people didn’t want to discuss those things and just wanted to ‘be’ – we can do that too.

Social work could be a key to unlocking integrated dementia support systems and as a profession, we have to ensure that our voice is not lost. The desire to medicalise dementia is a result of a nonsensical funding system where health is funded through the NHS as free at the point of delivery whereas social care is means-tested. This means there are many interests regarding freezing social care and social work out of dementia services. People don’t want to pay for services when they could be delivered free. This shouldn’t though, drive policy in the future and without social care sitting alongside nursing, we risk losing the heart of support systems which need to reflect social situations as much as medical needs. It’s imperative that the voice of social care remains at the heart of dementia care and dementia services.

Maybe we need some ‘Admiral’ type Social Workers out there.  Meanwhile, for dementia awareness week, we should examine what we want dementia services to look like and ask people who have dementia to tell us what they want from services rather than making decisions around what we think is best. I think social work and social work values are particularly well-positioned to seek and respond to those voices.  As for awareness, it’s better than lack of awareness but as we move into an ‘awareness’ week, it’s worth thinking – why do we want to become aware and what are we going to do when we are aware. Awareness without action or change, well, it’s not much better than a lack of awareness.

Choice, Control and Obfuscation – How the Personalisation Dream is Dying

In the bold move towards a transformation in adult social care, it feels from where I sit, that control has completely overtaken any pretence of ‘choice’ in the so-called move towards more idealised ‘person-centred’ care and support planning.

I hope I’ve been clear over the years in which I’ve expressed a remarkably consistent view that I love the idea of people being able to choose the support plan they like from a wide menu of options with ‘professionals’ taking less of a role.  I am a massive fan of direct payments. I want people to have more personalised care and more creative care. Desperately. The options just aren’t there yet for people who lack capacity and that is a terrible disservice and inequity that is being served throughout the care system.

Removing care planning from my role doesn’t concern me – unlike those people on the training courses who bang the drums blindly about how wonderful and bright it looks when we allow people to choice whatever they like to put together packages of care, I don’t want ‘retain control’, I truly don’t believe that I, as a professional ‘know better’,  but likewise I know that with the user group I work with, it is rare that I can just hand someone a support planning tool and a list of potential providers and tell them to ‘get on with it’.

That is as far from reality now as it was 20 years ago in my work. While I can say that everyone I care co-ordinate who has a ‘package of care’ is now officially on a ‘personal budget’ and some even have direct payments, it hasn’t really increased choice or control for any but a couple of those people.

If anyone for a moment wants to ponder the duplicitious nature of those in policy making ivory towers who dribble down policies which they want to couch in ‘soft’ language so they are difficult to challenge, one only has to read a fantastic piece of research conducted and published on The Small Places site.

It is worth reading through the piece in detail. Lucy, the author, made a number of requests to local authorities to ask about how their Resource Allocation Systems (the link between the ‘assessment’ and the ‘cash’ – basically) was calculated.  She seemed to come up against a wall of obfuscation but it’s worth looking at her research in detail.

This reluctance for me, seems to relate to the lack and reduction in spending on care and support – the key ‘missing piece’ as to why a council can ‘reassess’ someone as needing less ‘cash’ than they did last year with a more traditional care package.

My personal experience is that the council I work in (and this is similar to things I’ve heard from people in other councils) probably doesn’t want to share it’s RAS because it’s ashamed of the utter dog’s dinner that it’s made of it. It doesn’t ‘work’. It doesn’t make sense. It is frequently changed. There is more emphasis on physical health needs as opposed to mental health needs and while there can be manual adjustments, some of the figures that are ‘spat out’ just seem nigh on ridiculous (and that works for sometimes calculating care ‘too high’ as much as a figure which is ‘too low’).  It comes down to everything needing to be qualified and fitted onto a spreadsheet when actually the needs of two people who might fill out a self-assessment with the same ‘tick boxes’ might have very different needs in reality – no RAS can account for that. One person might under-score because they are embarrassed by the process and don’t want to admit to being incontinent on an initial visit from a social worker because they haven’t been able to tell anyone other than their GP – another person might be anxious and think they can manage less well than they can. Sometimes and this is what local authorities and health services seem to find hard to account for, you just have to treat people and their needs as individuals rather than the subject of outcome measures, tick box performance indicators or resource allocation systems.

Shouldn’t personalisation be about putting the user at the heart of the system? Every user should have a copy of the RAS and how the figure was determined. Which questions are weighted and which aren’t. Without that, there flow of money and the control rests solely with the local authority.

I’m fully against ‘traditional’ care packages. Having someone anonymous and constantly changing pop in for a 30 min welfare check once a day isn’t about improving the quality, control and choice in someone’s life, it’s about a local authority doing the absolute bare minimum that they can get away with to fulfil their statutory duties of care.

The lack of openness about the ways that the RAS shows the true colours of the reasons for these pushes towards the Eden of ‘Personalisation’.

While I have no doubt that for some people, as I keep saying, those with advocates, family or who are able to voice their own needs clearly, have and will continue to benefit enormously from having direct payments – it’s worth remembering that direct payments have been available and accessible for many years now.

Forcing everyone onto personal budgets has only discriminated against those with carers by reducing the amounts of money they are entitled to through the RAS (that’s my own experience of how our local RAS works) and has discriminated against those who lack capacity by promising all sorts of ‘creative’ ways of exploring third party management of support plans but without providing any real ways of accessing it (this is my current bugbear as I have been requesting assistance with this for months for service users I work with but have been told it is not possible for older adults yet as only those with learning disabilities have budgets large enough to make it cost effective – thereby clearing discriminating on the basis of age and type of disability).

I have changed from a fervent advocate of a system which was supposed to be so much better for everyone to a bitter opponent of a system which favours some kinds of disabilities over others, some kinds of service users over others, some kinds of carers (those who are willing to put a lot more time in to manage and support plan where necessary) than others and all to provide fewer services under the guise of choice.

No wonder Burstow is pushing everyone towards direct payments. He is pushing everyone towards a system which masks the way that payments are determined and discriminates openly against people who lack capacity or who have the ‘wrong’ kind of disability or family support.

Now we know that the local authorities can hide the way they make financial calculations, it becomes much more obvious to see behind the facade of the ‘Wonderful Wizard of Oz’ who promotes choice as the final goal to achieve at all costs.

I feel tricked and betrayed by the implementation of the personalisation agenda and the lack of any of the services around it to tackle directly with the problems at it’s heart.

I was deeply disappointed, for example, that the Mental Health Foundation’s ‘research’ and work with people specifically with dementia only focussed on people who either had capacity or had family.  Their advice talks lovingly of setting up trust funds, appointing brokers – well, that is a fantasy rather than a reality and exists only on paper as a choice. They merely replicated a lot of work which was done when direct payments were rolled out around lack of take up for people with dementia and they hadn’t said anything new (I happened to write my dissertation about the lack of take up of direct payments for older adults so did actually do literature researches at the time..).

Anyway, I’m getting ahead of myself.

For now, I think it’s important that we who see through the cosy policy makers congratulating about a ‘job well done’ speak up and speak up loudly for those for whom the system is a further barrier for true individualised care because these self-same policy-makers see them as ‘too difficult’.

My title explains that the personalisation dream is dying but it isn’t dead yet. To be brought back to life, all those involved need to embrace the principles of honesty and openness and not blind themselves to their successes if they can’t see the continuing barriers.

Panels

Since I’ve been employed as a social worker one of the constants in my working week has been the presence and existence of ‘panels’ in many different forms. There was a brief stage when we were told not to refer to them as ‘panels’ but rather meetings but it’s all the same thing at least, in the setting in which I’ve been working. They are groups of managers and professionals of a variety of provenances making funding decisions on behalf of the local authority or health service.  Of course sometimes they say it is about joint decision making (which is why the word ‘panel’ is frowned upon now) but that’s really a facade. I make recommendations but I have little authority over funding decisions.

Different local authorities often have different mechanisms so my explanations of the panels that I might attend come with the proviso that things are arranged and organised in a variety of ways.

We have panels which primarily make decisions about packages of care that exceed a particular baseline cost. That baseline has changed a variety of times but generally managers in each team are given a certain ‘threshold’ to which they can approve funding requests but above that and any application for funding for residential or nursing respite or long term care have to navigate a ‘panel’.

We have separate panels for high cost personal budget packages which would be provided for care at home and those which approve residential and nursing care/respite and continuing health care (which authorise applications for long term payment for care by the NHS )

Going to panel generally involves the transfer of reams of paperwork. I’d probably say it’s the most obvious way though that I provide the function of advocating for a particular service user or family member when I ‘present’ the situation to those who make the ultimate funding decisions.

Contrary to what some people might think, I have absolutely no vested interest in the local authority or NHS ‘saving’ money by not agreeing to a particular package – indeed, I won’t tend to bring something to the panel if I don’t wholeheartedly agree with it myself. I am a great advocate of money being spent where it is needed.  I have a general wish to see public money well-spent of course and I understand the need to ration resources but if I bring something to the panel and authorise an assessment, it is because I believe that that is what is needed according to my professional  judgement and as far as that’s concerned, balancing the rest of the local authority’s budget is not an issue I consider (which is obviously why these panels exist!).

Similarly with the Continuing Health Care Panels  I cannot conceive of a situation where I would bring someone to that panel if I didn’t absolutely want and believe that they should get that funding.  If I attend and collate a report it is because I and the multi-disciplinary team behind the report, believe in it.  I absolutely want people to get what they are entitled to and have no ‘secret instructions’ to try and deny the funding. The rules though are not altogether clear but it suits the funding parties and the governments to keep the rules complicated and unclear. There’s a lot of money at stake.

The panels are open to service users and carers but for me, personally, it’s very rare that service users or carers attend with me.

I have more often  had family members attend Continuing Health Care Panels with me and found it is a much better way of working as it allows a lot more transparency and removes one of those bars between me trying to put the words of others in my mouth.

By now, I know the people who sit on the panels and they know me. That’s a massive advantage in being able to persuade and cajole. It makes me realise how useful it is to have built up links and a reputation among the more senior management. I like to think that a trust develops.

Panels used to scare me because I’d be questioned, often in detail about the proposals that would have a substantial monetary implication for the local authority. My paperwork and assessments are examined in great detail and a level of scrutiny applied. Now that I’m more confident, I tend to take pride in presenting my reports and welcome the questioning as I know what to prepare, what to highlight and what to expect.

I’ve had panels where paperwork alone is assessed and where we are not required to attend in person.  I prefer being there ‘in person’ especially when there are any question marks that I feel I can clarify.

One of my favourite tasks in my work is feeling that I am genuinely able to advocate and navigate a person or family through the muddy mired waters of local authority funding streams and decisions. I wouldn’t say I enjoy the panel process although there is a satisfaction in having something approved especially if it is something you feel might be hanging in the balance, but I don’t dread them as much as I used to.

As for now though, it’s just another part of the process of seeing a paper ‘plan’ through to fruition.  I know they work differently in different areas – indeed, I’ve seen them in different forms in the local authorities I’d work for – but that’s how they work – whether they are called meetings or panels, the effect is the same.

And that’s the explanation of what the panels are – the other side of each discussion I have and each decision that is made by the faceless ‘management’ that I sit in front are that they are desperately important decisions to each person who is reliant on the authorisation of that funding to allow them to life their lives more fully, to allow their family to have access to respite services. My job as I see it, is to bring the paperwork and paper assessments ‘to life’. I am not only writing about a person on a pro forma, but I’m able to flesh out the requested questions and documents with a person, with a family, with relationships.

That’s why I don’t mind attending  these panels as much as  I used to. I’m not frightened of them anymore. I see them as an opportunity to take a crucially important role in someone’s life and to speak for them and not  just about them.

Technology, Social Media and Social Services – Finding new ways to ‘help’

iPad con dock y teclado inalámbrico

Image via Wikipedia

I have some across lots of discussions and debates about ways of using social media and new technologies and interactions to ‘help’ social services become more effective. Most of it seems to revolve around building online directories and databases of micro providers and services that are available which build on so-called community capacity to improve the way that personal budgets can or might work.

At the risk of sounding overly cynical there is nothing ‘innovative’ in my mind about building a directory of services.  To me, this is not a particularly innovative way to use ‘technology’ in social services.  It taking a very obvious and well-trodden route to using new technologies. Providing directories while being useful to a certain group of people again exacerbates the isolation of those who are not party to or able to use them.  Being innovative isn’t always necessary to be helpful but it is very important that new ideas are focussed so we don’t just end up with increasingly specialised, localised directories that might have more ‘interactive’ features and feedback, look more ‘user led’ and compatible with the buzz words of social media but in the end they are brushing the surface of possibilities.

It feels more and more as if that there is a growing division between the ‘haves’ and ‘have nots’ as far as personal budgets have been extended and does absolutely nothing to address or use technologies to address those who reside continually in the ‘have not’ section.

While at work, we labour with database systems that have clearly been developed through conversations between commissioners and software companies without any recourse to frontline practitioners, nice new provider directories are being tinkered around with while the fundamental foundations of the systems we work with remain resolutely inaccessible.

I’ve had a few ideas myself and whilst I lack the technological expertise to see any of these ideas to fruition, this is a kind of ‘wish list’ of the sorts of things I’d like to see.  I’m under no illusion that these are ‘new’ ideas. I am sure similar things already exist in some form but they are things I’d like to see pan out in the longer run. Things I’d like to use at work.

I’d like to see more creativity in the use of technologies to assist with decision making for adults who have some kind of cognitive deficit. I’m a great fan of the ‘tablet’ and ‘touch screen’ model as I think it is intuitively an easier interface to understand.  When I see people instinctively reach out to touch the screen of my Kindle (which isn’t touchscreen!) I realise that we are becoming conditioned to seek the easiest input methods which are about touching a screen and speaking into a microphone and perhaps writing on a tablet. Now, voice recognition has improved, I’m yet to come across very successful handwriting recognition (possibly because I have scrawly almost illegible handwriting) but there is potential there. In the meantime, pictures and touchscreens seem like a good way to go.

Using pictures/sounds/music it can draw on multi-media ‘shows’ and explanations of different options – moving beyond the ‘written word’. Providing documentation in aural form or in pictorial/moving form rather than reams of leaflets. Having recordings of familiar voices or pictures of familiar faces might help to reassure. I’m a great fan of telecare in general with the proviso of always being mindful that the human contact is not replaced but in days where human contact is sparsely provisioned anyway, it may be something that can be experimented with.

Why not a YouTube type video to explain how services can be chosen instead of reams of ‘easy read’ leaflets which really aren’t remotely ‘easy read’. Instead of flooding people with lists of providers (which, while good for some ignores those who are restricted in terms of capacity and carers to choose ‘freely’ the types of services they garner) why not explain and expound in different ways the ways that services can work?

Why not explain providers in terms of what they can actually provide and what purpose they serve rather than creating directories that are meant for people with a good understanding of what they want and need?

I was in a day centre last week and there was a seemingly unused Wii. I wonder if he Kinect might be a better project to develop some type of interactive play, exercise and work as it doesn’t need a controller at all and uses the more innovative way of body movement.  Using participatory games with larger screens in company can provide different stimuli. I know why games developers  haven’t tackled directly the ‘older’ market with games that might otherwise reside in memories but why not repackage old school yard games and board games with Kinects and iPads? It may be a good way to introduce the use of these new technologies in a ‘friendly’ manner which may then see them used in other wider ways – such as directories or personalised information sources. Using YouTube video channels for personally designed ‘reminiscence’ therapies could personalise the delivery of memories and digitise memory boxes where items are not there to build up the frames of someone’s life and people aren’t there to fill in the gaps.

There are many ‘dating site’ type services that match people and organisations. Volunteers to voluntary groups etc. How about a type of match between schools and residential homes? I know it’s something that’s sometimes done locally where I work and having spoken to both providers and some of the kids who go in, they seem to enjoy it and it can change and break expectations – each of the other.  I

We talk of social media a lot and often it is used to provide ‘recommendations’ to particular services through these databases. Perhaps more user and carer led general recommendations can be collated. Crowd source an ‘introduction’ to social services provisions by those currently using the service.

Ask ‘what do you wish you’d known?’ ‘what do you wish someone had told you?’ and while taking out all the obviously libellous stuff, a local authority must be brave enough to leave in the criticisms. We learn through complains and criticisms and it can take a lot of guts (or anger) to make a complaint or to criticism and that MUST be respected by the service and the individuals at fault and used as a means of improvement.

I don’t want to see local authorities ‘whitewash’ problems in order to gain sparkling OFSTED or CQC inspections. It sullies the whole process and makes the inspections worthless. Regulation should be less authoritarian and more about actually making improvements and making things better for the end user – not about allowing local authorities to produce the ‘right’ results while poor practice is brushed away from the sight of the inspectors.

But back to my point about using social media to crowdsource – it is important that social media ALONE is not used as an ‘answer’. Crowd sourcing must be honest but it must also be broader than putting out an ‘internet consultation’ and having a Twitter account or blog. There must be pounding of the streets too to engage those who are not able to use digital means to put their points across. There should be knocking at doors and face to face discussions – not leaflets, not inaccessible (for some) groups.

Talking about crowdsourcing though, there’s a much better and perhaps more obvious way it can be used and certainly isn’t being used at the moment and that’s to engage other social workers and professionals into putting together more information and useful methods of practice for ourselves. Sure, it needs time but we remain reliant on organisations to provide ‘guidance’ such as SCIE (who do provide fantastic resources) and BASW and the College of Social Work but why none of these organisations who purport to exist to help social work and social care practice actually engage more directly and use social media and open access blogs/discussion groups/forums/micro blogging etc to engage with currently practicing social workers is completely beyond me.

I’ve become very interested in open access education and resources and feel there is great scope for professional engagement and information to build its own resources and information together with users and carers, together with other professionals but there has to be a push for social workers to see the benefit of sharing and finding appropriate ways to share the information that we learn every day.

I have other ideas which will come in different posts  but I’d be interested in hearing other peoples’ ideas for uses of ‘technology’ in the very broadest sense and how they can develop to help the broadest range of people we see in social services – particularly those who are less able to look information up in various fancy online directories.

Perspectives, Students and Ageing

I enjoy having students around. It helps keep me fresh and enthusiastic and to see my job through the eyes of someone coming into it rather than through the occasionally blurred eyes of someone who has been working for a while.

I had a student shadowing me for a period yesterday. It was a  fairly standard visit as far as my work goes. The person we went to see (who I’ll call Mrs J) was someone I’ve been working with for a few years. While I endeavour to do my best in every aspect of my work, I can’t deny that Mrs J  is someone I have a soft spot for.

I started working with her about three years ago and to say she is isolated is an understatement. For obvious reasons I can’t go into the details but suffice to say since my first encounter with her we have both come a long way. She has had a lengthy compulsory hospital admission during this period and has lived in three different flats (and two different hospitals) in that time. She is now living in a beautiful flat and has a secure tenancy. She is ‘settled’ for the first time in many many years.  She even has a fairly interesting personal budget to pay for a support worker.

I thought it was quite a good visit. We got through a lot of things that needed to be done and things that needed to be discussed.

As we left the student said to me how sad she felt after the visit. She asked me if all the visits I made were that ‘depressing’ and wondered if I worried about ‘getting old’.

It took me by surprise because I thought it had been quite a positive visit and wasn’t feeling remotely ‘depressed’. Then I remembered the perspective I had and the perspective she has. She doesn’t know, apart from the words that I filled her in with, where my ‘starting point’ with Mrs J was. I can explain and expand but it isn’t the same. My ‘starting point’ needs to change and as long as I consider where Mrs J was three years ago, I wonder if I am becoming complacent about the further routes to enrichment and recovery in her life.

It made me think about the way that new eyes can improve the work that I do and shatter some of that selfsame complacency. I shouldn’t look at where I am now necessarily in the context of where we’ve been but rather where we are going.

As for the sadness in my work, I don’t feel it. I feel it some days and in some situations, of course. It’s hard not to and a part of compassion is empathy but I remember a conversation I had a few years ago when I wasn’t long in the job with a colleague who reminded me, while I was expressing my own concerns about age in general, that we only see a small proportion of the population and to constantly remind myself that most people age well. I try to remember that. I wonder if that is one of the reason for prejudice against older people and a lack of respect in the care system.  We just don’t like being reminded of the fact that we will get old. It personalises the work in a way that working in other areas of social work might not. We all hope to grow old. We owe it to those we work with and for to provide the most assistance and to make what can be the unpleasant task of ‘dealing’ with public services as painless and as accessible as possible.

Food for thought.

Rankings and Musings

Quick post today as I have a few things on the go.

So, Wikio sent me their top 20 UK Health Blogs and again, I’ve made the list. Thanks to everyone for your support and do check out the other sites there – there are some real gems and it’s a pleasure to be among such fine company.


1 PsyBlog – Psychology Blog
2 Sarah Boseley’s global health blog
3 A boy with Asperger’s
4 Dr Grumble
5 Maternity Matters
6 Bad Medicine
7 Where Are My Knees?
8 Confessions of a Serial Insomniac
9 Fighting Monsters
10 Purple Noise
11 frontierpsychiatrist.co.uk
12 National Death Service
13 The Voyage
14 Aspergers, family life and me
15 Bah! to cancer
16 PlanetOutreach-ASD
17 the DeafBlog
18 Carers blog
19 Lake Cocytus
20 DPAC

Ranking made by Wikio

I also was interested in this post from Community Care about crafting in care homes.  I wish there were more personalised activities (or any activities beyond the ‘singalong’ and ‘bingo’ ). It does raise important issues about the sense of self and differing interests and pursuits that one has when one might need residential care and why we make assumptions that what is enjoyable for one person would be enjoyable for the next, just because they are the same age.

With the move towards self-directed support in care provided at home, I wonder when residential services will also pick up.

On a related issue, I caught this link yesterday on Twitter about a care home which has installed touch-screen computers. For me, it’s an obvious step to take but its’ a shame it had to be provided by a grant and not by the provider service themselves – seeing how much they charge for placements!

I wonder how much these private companies are subsidised by these types of grants…

Still, it is good to see some different ideas about ‘activities’ in care homes and a challenge to the assumption that older people just want to sit around and sing ‘Knees Up Mother Brown’.