Rutland County Council commissioned the Admiral Nurse service in November 2017 to which I was appointed to the role of Clinical Lead, supporting people and families affected by dementia.
Rutland is the smallest county in England and has a population of around 39,900 ; 25% of this population are 65 and over which is higher than the England average of 19.2%. These statistics may suggest that there is a greater need for development and access to health and social care services which are delivered closer to home. Working within the council allows me to have an overview of the different types of support across the county and how health and social care services can work together to support some of the most vulnerable in society.
It is firstly worth considering the definition of social care and how an explanation of this may improve engagement with the system.
Social care is support provided to a person in the community or in day or residential settings. It is designed to enable the person to live, adapt and cope with elements of their lives that they cannot easily address themselves, such as going to the toilet as well as dressing and feeding. Much of the focus of social care is to ensure that people can live as independent and fulfilling lives as possible.
Social care can be provided by local authorities, charities, independent care organisations and others, with a range of professionals involved. It is funded and commissioned differently to NHS services.
Who pays for social care?
One of the challenges is the public’s understanding of who pays for what amongst families and local authorities. A local council will do a needs assessment; followed by a financial assessment to identify if they will pay towards a person’s social care. If the person has savings and assets under £23,250, they will then make a decision on the financial contribution that needs to be made by the person (if any), and how much social care they will provide.
New rules for England have just been announced and will take effect from October 2023 – there will be a £86,000 cap on costs and anyone with assets less than £20,000 will have their costs covered by the state.
Scotland meanwhile adopts a system of free care to help with daily activities like washing and dressing, whilst Wales caps care costs and Northern Ireland provides care from home for free.
What could happen if families don’t have social care?
Many families feel they are trying to get support in a fragmented system, with carers sometimes asking why they have to tell multiple people the same thing over again.
There are experiences of families and people with dementia facing unnecessary hospital admissions; often they have attributed this to the lack of social care and community support in place.
How can families access social care?
Access to appropriate social care to meet a family’s needs hinges upon the completion of assessments. This may be a needs assessment by social care which may incur charges or, if nursing needs are indicated, this may be shared between social care and healthcare, or funded fully by health care. However this system is often confusing not only for families but also other professionals; carers become frustrated when health and social care do not seem to join up assessments. This can lead to distress and breakdown in relationships, causing an impact on the ability of the person to continue caring for their loved one with dementia.
With the specialism of Admiral Nurses in uncovering individual experiences and needs, in addition to their close working relationships with health and social care professionals, families can be supported in getting the outcome they need in these assessments. As an Admiral Nurse working within social care, I can ensure that the key details of the family’s life is shared with appropriate people and that families have effective support from diagnosis through to end of life care. Examples of what could be made available to families following these assessments include increased care at home or transition into a cared-for environment.
A family story
One carer I supported recently was facing significant distress as the person they were caring for had cognitive impairment but no diagnosis of dementia. I carried out a home visit assessment where I established a potential diagnosis of dementia, which then led to referrals to the GP and memory services.
This kickstarted an immediate referral to social care for a needs assessment for the person with dementia and the caregiver. Referrals for assistive technology and benefits advice followed so that the family could have that early support to reduce a crisis occurring. Working across the council, I was able to ensure that things could be escalated if they needed to be.
This to me is a good example of how health and social care can work together for the benefit of families to allow them to live confidently with the condition.