EXERCISE 1 – PRINCIPLES – DEFINITIONS
Aileen (35)
Aileen is a 35-year-old woman who had head injuries 8 years ago in a motorbike accident, which left her very seriously physically disabled, and with brain injuries which resulted in significant communication difficulties. She has a medical degree, and was in a hospital post with very bright prospects. The insurance claim which followed eventually resulted in a substantial award, which means that Aileen has a large sum of money in a bank account and sufficient income to cover her support, care costs and living expenses. A friend, who she has known for many years, deals with all of her financial affairs. Members of her support team are very concerned about this arrangement and think the friend is transferring large sums of money from Aileen's account to his own account. Aileen has been able to communicate that she is happy with the friend looking after her finances, and does not want the friend challenged about this.
Alistair (57)
Mr Smith 57 years is severely disabled as a result of a stroke. To give his wife a break and fortnight away visiting relatives abroad with their son, he has been admitted to a care home for a 10 day respite. On admission he is bright and cheerful and looking forward to his stay. His son informs the staff that his father is fully continent and needs a lot of personal care but otherwise requires the minimum of supervision. He has a tendency to become slightly agitated in the evening but can be calmed down easily with conversation and a cup of tea. On his return from holiday the son arrives at the care home to find his father stupefied, uncommunicative and wearing an incontinence pad. He is informed that his father has been commenced on Diazepam due to a worsening of his nocturnal agitation. The following day his son and wife contact the social worker who has arranged the respite stay to express serious concerns about the way they believe she must have been looked after. They say that he has managed to communicate that he just wants to forget it and not pursue the matter. The social worker says she wants to make a visit and arrange for a medical examination.
Andrew (50)
Andrew has a learning disability and lives with his brother and sister in law. He sometimes upsets his sister in law, when she feels he is creating too much noise, and then she often insists he stay in his room without any meals for 24 hours. If she feels he is not keeping himself clean enough, she makes him have a thorough wash in cold water. Andrerw’s brother collects his benefits and keeps all of it for “his keep”, He has helped him complete an application for DLA and intends keeping all of that as well “for the trouble his brother causes”. He gets cereal and cold milk for his breakfast, a sandwich is left for his lunch and he has to eat the same food as the rest of the family in the evening. He does not always like the curries and things that his brother and sister in law eat, but they always demand he finishes his food.
EXERCISE 2 – INQUIRIES – VISITS – INTERVIEWS
AZEEM (83) ERMINA (84)
Mr. and Mrs. H. have been married for 50 years and have four grown children. They migrated to the UK in their 40’s from India. Despite Mr. H. being physically and verbally abusive to his wife their entire married life, she has stayed with him and has never told anyone of their problems. Over the last five years, Mrs. H. has become increasingly forgetful and confused which only infuriates her husband more. The doctor she now sees has diagnosed her as having dementia and says that her condition will only worsen in the next few years. When asked about the bruises on her arms and back, Mr. H. tells the doctor that she has frequent falls. He then promptly finds a new physician for his wife; she has had four doctors in five years.
DAVID (20)
David Jones is 20 years old and since birth has had significant cognitive deficits and visual and hearing impairments. He lives at home with his parents. David attended a specialist residential school but returned home full time on leaving at 18. A domiciliary care service also comes to the house three times a week to provide David with a bathing service. David's father, George, works long hours and his job involves a lot of travelling including being abroad one week in three. Since David has become older, his physical and behavioural needs have significantly increased and his mother, Margaret, has had to provide for most of his needs at home. Margaret and George have become involved with a local carers group. They have consulted with health and local authority providers about the need for better housing, medical and support services. They have also applied and been appointed as David's joint welfare and financial guardians under the Adults with Incapacity (Scotland) Act 2000. Two days ago Mrs. Jones told the bathing assistant that she could no longer cope with the situation, and that she was planning to ‘euthanize’ David and then end her own life. She informed the staff member that she was keeping back some medication that had been prescribed for David and some that had been prescribed for her, until she had enough to end it peacefully for them both. The staff member reported what Mrs. Jones had said to her supervisor who contacted the care manager who then visited Mrs. Jones. Mrs. Jones expressed some regret that the care assistant had passed on what she had said as she felt her confidence had been betrayed but confirmed what had been said previously. The care manager noted that she sounded stressed and depressed. She promised the care manager that she would not do anything until she had a carer’s and medical assessment. Also that she would discuss the matter with her husband when he returned in four days.
AGNES (73)
Agnes lives with her husband Ian in a ground floor flat. She has multiple sclerosis and now cannot read or write. A couple of years ago her health deteriorated and now she cannot walk very far. The only time Agnes goes out is when she attends a luncheon club twice a week. Both an OT and a home care worker have been involved for some time. There have been concerns in the past when Agnes has said he has not got any money left. She has never said where the money has gone. Service staff see very little of Ian, who seems to spend a lot of his time out of the house. There are often empty bottles of spirits in the house -- Agnes is known not to drink alcohol -- and old betting slips left lying around. During an assessment visit, Ian did say he did what he could for Agnes, but he had worked all his life and paid his taxes and it was up to services to provide what support she needed. Agnes has never been critical of him, and always seems highly anxious to keep things in order in case he gets angry with her. Agnes's doctor has been called out by a neighbour, who had heard Agnes shouting for help through the wall. When the neighbour went in she found Agnes crying and saying she was starving. She had not eaten for three days. She seemed to be extremely dehydrated and cried out when the neighbour touched her arm. Her neighbour helped her to the toilet, and Agnes said it was painful to pass urine. The neighbour phoned the health centre, but by the time the doctor visited Ian had returned home, said his wife was fine and they did not need any help. The doctor was only able to see Agnes very briefly, when she said she was fine and did not need any help.
Afternoon - Group exercise three
Definitions and context of abuse
• Definitions; what is abuse
•
• Examples; from professional experience
•
• Signs; what to look for
•
• Who abuses; ??
•
• Context; where, when, how
Discuss in groups and feedback
Afternoon – group exercise four
Case example; Tom and Lesley
Consider:
• What you do.
• Individual and joint agency responsibilities. Joint working
• Consent and sharing of information. A plan of care/action.
Tom and Lesley
• Tom Walker is a 60 year old man who lives with his girlfriend Lesley. Tom lived with his parents till they died and he inherited the property.
• Services were withdrawn from Tom after he sexually assaulted a care worker. Lesley was resettled after spending much of her life in a long stay learning disability hospital.
• Neither Tom nor Lesley wish to receive any support or services. Tom is aggressively dominant of Lesley.
• A fire (cause unknown) has caused damage to the kitchen of the flat and the fire prevention officer is concerned that the couple neither understands nor is coping with the seriousness of the situation.
• Lesley suffered burns.
• The fire officer reports that the flat is no longer weather tight (it being winter), the wiring is unsafe for use and the house is in a deplorable and filthy condition: there being little furniture, extremely cold; piles of papers lying around (which may constitute a fire risk); no evidence of food or provisions.
• On speaking to Lesley he found her extremely flat and depressed. Tom resented certain questions in respect of his concerns and told the fire officer to “get out and leave them alone, he is the master of this house and Lesley”. The fire officer made an emergency referral to S.W
• Lesley was taken to A&E, her burns were treated and although she is well enough to go home hospital staff are seriously concerned about her safety and welfare.
• Repeated calls from a social worker have been met with hostility from Tom.
• A GP has seen Tom and Lesley recently. He refused to divulge information on them and felt they were just naturally responding to a crisis which they would “get over” and should be allowed to get on with their lives and their right of confidentiality protected.