I’ve worked in the same local authority for a while. Other authorities I’ve worked in have similar but not equivalent procedures so I’m not sure how much this experience is reflected.
When we recommend a care plan or a placement – either permanent or temporary (such as respite) – we have to make our case to a panel of seemingly ethereal ‘higher’ managers and fund-holders – who will ponder and explore the paperwork and reports we provide to basically see if there is any way that the outcomes we wish to achieve can be successfully identified through cheaper means.
Of course, there is discussion about the purpose being about ‘advice and guidance’ but really it is about budgets. And that’s fair enough – we are using tax-payer’s money and I have no problem with being held accountable for the ways that we are making these decisions. Fortunately I’m able to happily argue my case.
I went to the panel earlier this week for two proposed care plans. There were similarities between them. Both are people who have what is termed as ‘moderate’ dementia although even that term in itself it very blurred. I probably wouldn’t describe the dementia as moderate to the family and friends who care for them as it presents in very significant ways.
One of the situations is that a woman who has been receiving informal support from a friend requires increased care because the friend is moving to a different city. Fairly straightforward to argue the point – her needs have not changed but rather her need for formal care has.
The panel clearly agreed (there weren’t any grounds for them not to really) – in some ways I expected them to argue more as I had been generous although not unrealistic with the times allocated for the tasks specified – but that was not questioned. We discussed the longer term which is highly likely to involve residential care – but for as long as possible, we want to see how far we can stretch care at home as historically, it is without doubt where she wants to be.
The other decision was a request for residential care. The person involved had been well-supported at home for a number of years while she had been deteriorating slowly. It had come to a point where the care provided at home would no longer be substantial enough to support her safely.
It was a slow and sad realisation, along with her family, that we had reached the stage where 24 hour care really was necessary.
I used to resent these panels or at least resent the time I would spend attending them. I think that was probably when I was less aware of the ways they argue and make those decisions. Sometimes they can drag you over the coals a bit but usually if you can forsee where the questions are coming from it becomes less forboding.
Ultimately, it is just another part of the process to take on board in a sea of processing and paper shufflings.